BACKGROUND: Guidelines recommend long-term treatment for opioid use disorder including the use of buprenorphine; however, little is known about patients in long-term treatment. OBJECTIVE: Examine the prevalence and patient characteristics associated with long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Study Design: This is a 12-year retrospective cohort study of adults on buprenorphine in OBOT in a large urban safety-net primary care practice. METHODS: The primary outcome was retention in OBOT for ≥1 continuous year. Patients who re-enrolled multiple times in the program contributed repeated observations. Potential predictors of ≥1 year retention assessed were: age, race/ethnicity, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. The different reasons for clinic disengagement by retention status (i.e. ≥1 year vs. <1 year) were also described. RESULTS: OBOT treatment periods (n=1605) among 1237 patients were assessed. Almost half, 44.7% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥ 1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]), compared to white, were associated with lower odds of ≥1 year retention. Relapse to substance use appeared to be a less common reason for disengagement for the ≥1 year (23.3%) compared to the <1 year (40.1%) treatment periods. CONCLUSIONS: Over half of patients were successfully retained in Office Based Opioid Treatment with buprenorphine for ≥1 year. However, significant disparities in one-year treatment retention were seen, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C. / 2018-11-09T00:00:00Z

In 2023, medication for opioid use disorder (MOUD), including methadone and buprenorphine, remains the most effective intervention for preventing overdose death among people who consume opioids. Yet, among those seeking treatment for opioid use disorder (OUD), there are disparities in access, quality of care, and treatment outcomes. Those disparities are related to attributes of people who use opioids, the circumstances of use, the nature of opioid use as a disease, and the design of services to treat the disease. The complex relationships between these attributes are not well articulated or understood. Health services research recognizes the biopsychosocial nature of the health conditions but research to improve treatment for OUD calls for a comprehensive, integrative, transdisciplinary approach. This dissertation presents such an approach by focusing on the biological and psychosocial implications of trauma and traumatic stress disorders in the etiology, presentation, and treatment of OUD. Aim 1 was to leverage a preclinical animal model in neuroscience to investigate how a fear memory cue may trigger recurrence of drug-seeking. Aim 2 was to examine how primary care clinicians incorporate principles of Trauma-Informed Care into OUD treatment based on qualitative interview accounts of their practices. Aim 3 was to leverage a longitudinal retrospective analysis of linked medical records and claims data to estimate the effect of post-traumatic stress disorder (PTSD) diagnosis on health services utilization and explores effect moderation by race and gender. The findings from the three studies inform each other, and the dissertation helps to clarify the significance of trauma in effectively and equitably serving people with OUD. Theoretically, the dissertation incorporates the tenets of Nancy Krieger’s Ecosocial Theory in its explication of OUD treatment. Ecosocial theory builds on the biopsychosocial approach in its inclusion of societal arrangements of power and structural oppression as shaping the pathways of embodiment. Many people with OUD incorporate lived experience of trauma. Utilization of formal OUD treatment settings can shape pathways of embodiment and may be yet another adverse exposure. The socially produced determinants of traumatic stress disorders and associated OUD should encourage health scientists to think critically and systematically about the connections between our biological, social, and psychological existence to be able to effectively respond to OUD as a complex biopsychosocial phenomenon. / 2025-08-23T00:00:00Z