Retention and Outcome Predictors Post Emergency Department Initiated MAT for Opioid Use

Introduction: Introduction. Emergency Department (ED) initiated medication assisted treatment with buprenorphine/naloxone (bup/nal) and referral to outpatient care is provided by the Start Treatment and Recover (STAR) program for patients presenting at the University of Vermont Medical Center (UVMMC) ED with problematic opioid use. Participants in the program immediately receive a 3-day bup/nal starter pack and are guaranteed assessment at an addiction bridge clinic (UVMMC Addiction Treatment Program) within 24 hours (or 72 hours if enrolled during the weekend).
Objective: Here, we report on treatment retention rates and whether patient characteristics at baseline predict individual success.

Methods: Assessments at baseline and 3 & 6 months included urinalysis as well GPRA Client Outcome Measures, MINI International Psychiatric Interview, Treatment Effectiveness Assessment and PhenX Substance Use questionnaires. In the prediction analysis, half of the data was initially set aside. Serial univariate logistic regression was performed in the remaining half of the data to determine predictiveness of individual items from questionnaires collected at baseline in relation to three retention outcomes: presentation for initial assessment at the bridge clinic and past 30 day treatment retention at 3 & 6 months. The top five features (i.e. age, number of days using illegal drugs, using opioids, using marijuana, or income/wages in past 30 days) as defined by pseudo R-squared (Nagelkerke) were then tested as a single model on the set aside data.

Results: From September 1, 2019 to March 13, 2020 (date state of emergency declared in Vermont in response to COVID-19) 46 participants were enrolled. Three participants were withdrawn and five were incarcerated after enrollment. The follow-up rate in remaining participants was 73.68% (28/38) at 3 months and 81.58% (31/38) at 6 months. Participants not available to follow-up contact were designated as negative for retention. Treatment retention was 54% at 3 months and 59% at 6 months. The top five predictive features determined by logistic regression did not significantly predict retention rates above a null model at initial bridge clinic presentation, and 3 or 6 months when tested as single model on the set aside data.

Conclusions: Treatment retention rates, while lower than literature benchmarks, ^2,3 support continuation of the STAR program. Although we were unable to predict individual success, the current sample size is small. Further data collection is warranted.

References: 1. Brooklyn, J. R. & Sigmon, S. C. (2017) Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact. J Addict Med 11, 286-292.

2. D'Onofrio, G. et al. (2015) Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 313, 1636-1644, doi:10.1001/jama.2015.3474.

3. D'Onofrio, G. et al. (2017) Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. J Gen Intern Med 32, 660-666, doi:10.1007/s11606-017-3993-2.

Learning Objective: Learners will appraise the benefits of a Emergency Department initiated Medication Assisted Treatment program.