Retention in medication-assisted treatment for opiate dependence: A systematic review

ABSTRACT

Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010–2014) found wide variability in retention rates (i.e., 19%–94% at 3-month, 46%–92% at 4-month, 3%–88% at 6-month, and 37%–91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.

KEYWORDS:

• Opiate dependence
• systematic review
• treatment retention
• behavioral therapies
• medication-assisted treatment

Funding

This research was supported by a Senior Research Career Scientist Award (RCS 00-001) to Dr. Timko by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service, and an Advanced Fellowship to Dr. Garrison-Diehn by the VA Office of Academic Affairs.