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Retention of patients in opioid substitution treatment: A systematic review

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  • Aisling Máire O’Connor
  • Gráinne Cousins
  • Louise Durand
  • Joe Barry
  • Fiona Boland

Abstract

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.

Suggested Citation

  • Aisling Máire O’Connor & Gráinne Cousins & Louise Durand & Joe Barry & Fiona Boland, 2020. "Retention of patients in opioid substitution treatment: A systematic review," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-23, May.
    • Handle: RePEc:plo:pone00:0232086
    DOI: 10.1371/journal.pone.0232086
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    References listed on IDEAS

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    1. Chao-Kuang Lin & Chia-Chun Hung & Ching-Yi Peng & En Chao & Tony Szu-Hsien Lee, 2015. "Factors Associated with Methadone Treatment Duration: A Cox Regression Analysis," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-7, April.
    2. Kaina Zhou & Duolao Wang & Hengxin Li & Xiaoli Wei & Juan Yin & Peifeng Liang & Lingling Kou & Mengmeng Hao & Lijuan You & Xiaomei Li & Guihua Zhuang, 2017. "Bidirectional relationships between retention and health-related quality of life in Chinese mainland patients receiving methadone maintenance treatment," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-12, June.
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