Factors associated with early and later dropout from methadone maintenance treatment in specialist addiction clinics: a six-year cohort study using proportional hazards frailty models for recurrent treatment episodes
Autor: | Tom Fahey, Joseph Barry, Fiona Boland, Denis O'Driscoll, Gráinne Cousins, Eamon Keenan, Louise Durand, Kathleen Bennett |
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Rok vydání: | 2020 |
Předmět: |
Adult
Male Methadone maintenance Pediatrics medicine.medical_specialty Patient Dropouts Substance-Related Disorders media_common.quotation_subject Treatment dropout Toxicology Cohort Studies 03 medical and health sciences 0302 clinical medicine mental disorders medicine Opiate Substitution Treatment Humans Pharmacology (medical) 030212 general & internal medicine Dropout (neural networks) media_common Proportional Hazards Models Pharmacology Frailty Primary Health Care Proportional hazards model business.industry Addiction Middle Aged Time of death Behavior Addictive Psychiatry and Mental health Female business Ireland 030217 neurology & neurosurgery Methadone medicine.drug Cohort study |
Zdroj: | Drug and alcohol dependence. 219 |
ISSN: | 1879-0046 |
Popis: | Retention in methadone maintenance treatment (MMT) is associated with reduced illicit drug use, criminal activity, and mortality; however, many clients move in and out of MMT. This study aims to identify determinants of time to dropout of MMT across multiple treatment episodes in specialist addiction services in Ireland.Cohort study of persons attending specialist addiction clinics between 2010 and 2015. MMT episodes were periods of continuous treatment if there were no interruptions to treatment lasting7days. Proportional hazards frailty models were used to assess factors associated with time to dropout from recurrent MMT episodes at 3 (90 days) and 12 months (91-365 days). MMT episodes were right- censored at time of death, transfer to prison or primary care, and study end.A total of 2,035 individuals experienced 4,969 MMT episodes, with 2,724 dropout events during the six-year follow-up. Factors associated with dropout at 3 months included low dose methadone (60 mg/day) (HR = 1.49, 95% CI 1.29-1.73) and previous dropout (HR = 1.65, 95% CI 1.41-1.92). Adherence was protective (HR = 0.91, 95% CI 0.90-0.92). Dropout at 12 months was associated with low dose methadone (HR = 1.44, 95% CI 1.23-1.68), previous dropout (HR = 1.37, 95% CI 1.16-1.61), males (HR 1.26, 95% CI 1.06-1.50), benzodiazepines (HR = 1.22, 95% CI 1.03-1.45) and number of comorbidities (HR = 1.12, 95% CI 1.05-1.20); adherence was protective (HR = 0.86, 95% CI 0.84-0.87).Clients with a previous history of treatment dropout and those on low dose methadone should be identified as high risk for both early and later dropout. Inversely, adherence to treatment, not missing methadone doses, is protective. |
Databáze: | OpenAIRE |
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