TY - JOUR
KW - Databases, Factual
KW - Humans
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/pathology/therapy
KW - Patient Dropouts
KW - Retention in Care/statistics & numerical data
KW - Risk Factors
AU - A. M. O'Connor
AU - G. Cousins
AU - L. Durand
AU - J. Barry
AU - F. Boland
A1 - 
AB - BACKGROUND: Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. METHODS: A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. RESULTS: 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. CONCLUSIONS: Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.
AD - School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.; Population Health Medicine, Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland.; Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
BT - PloS one
C5 - Opioids & Substance Use
CP - 5
DO - 10.1371/journal.pone.0232086
IS - 5
JF - PloS one
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. METHODS: A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. RESULTS: 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. CONCLUSIONS: Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.
PY - 2020
SN - 1932-6203; 1932-6203
T1 - Retention of patients in opioid substitution treatment: A systematic review
T2 - PloS one
TI - Retention of patients in opioid substitution treatment: A systematic review
U1 - Opioids & Substance Use
U2 - 32407321
U3 - 10.1371/journal.pone.0232086
VL - 15
VO - 1932-6203; 1932-6203
Y1 - 2020
Y2 - May 14
ER -