Background: The average length of buprenorphine treatment for opioid use disorder is less than 6 months.
Objective: We conducted a systematic review to determine what factors were associated with longer retention in buprenorphine treatment.
Design: We searched Medline, Embase, and Cochrane Database of Systematic Reviews in February 2018. Articles were restricted to randomized controlled trials on human subjects, written in English, which contained ≥ 24 weeks of objective data on retention in buprenorphine treatment.
Main measures: We assessed whether dose of buprenorphine, treatment setting, or co-administration of behavioral therapy was associated with retention rates.
Key results: Over 14,000 articles were identified. Thirteen articles (describing 9 studies) met inclusion criteria. Measures of retention varied widely. Three studies compared doses of buprenorphine between 1 and 8 mg and showed significantly higher rates of retention with higher doses (p values < 0.01). All other studies utilized buprenorphine doses between 8 and 24 mg daily, without comparison. No study found a significant difference in retention between buprenorphine alone and buprenorphine plus behavioral therapy (p values > 0.05). Initiating buprenorphine while hospitalized or within criminal justice settings prior to outpatient treatment programs was significantly associated with retention in buprenorphine treatment (p values < 0.01 respectively).
Conclusions: Setting of treatment initiation and a higher buprenorphine dose are associated with improved long-term treatment retention. More objective data on buprenorphine treatment programs are needed, including a standardized approach to defining retention in buprenorphine treatment programs.
Registration: This review was registered with PROSPERO (#CRD42019120336) in March 2019.
Keywords: buprenorphine; long-term; opioid use disorder; retention; systematic review.
© 2021. Society of General Internal Medicine.