Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India

BACKGROUND: Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM: To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS: A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention – 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital – baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS: Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.