TY - JOUR
T1 - Predictors of retention in heroin-assisted treatment in Denmark 2010-2018
T2 - A record-linkage study
AU - Brummer, Julie
AU - Thylstrup, Birgitte
AU - Melis, Francesca
AU - Hesse, Morten
PY - 2024/10
Y1 - 2024/10
N2 - INTRODUCTION: While randomized-controlled trials have shown that heroin-assisted treatment (HAT) is superior to methadone maintenance alone in treatment of refractory clients, little is known about client factors associated with retention in HAT in routine care.METHODS: This retrospective cohort study assessed predictors of retention in first treatment episode among a consecutive cohort of clients admitted to HAT in Denmark from 2010 to 2018, who could be matched to the Danish population register and for whom a Short Form Health Survey (SF-36) was available at admission (N = 432). The study derived predictors from client self-reports at intake and administrative data available in national registers. Cox proportional hazards regression modelled retention in treatment.RESULTS: The one-year retention rate was 69.63 % (95 % CI 65.06 %-73.74 %), and the median time in treatment was 2.45 years (95 % CI, 1.83-3.12). Bivariate analyses showed that retention was lower for clients who had recent cocaine or benzodiazepine use and among those who had experienced an overdose in the year prior to enrollment in HAT. Age below 40, recent illegal activity, poorer emotional wellbeing, previous residential treatment experience, and previous intensive outpatient treatment were also predictors of dropout from HAT.CONCLUSIONS: This observational study found that retention in HAT in routine care was similar to rates observed in randomized-controlled trials conducted in other countries. The results suggest that addressing polysubstance use as part of the HAT program may promote long-term retention, as may directing resources to certain subgroups identified at intake, including clients under 40 years and those who report recent criminal activity, emotional problems, or overdoses. The findings that previous residential treatment and intensive outpatient treatment were associated with dropout were unexpected.
AB - INTRODUCTION: While randomized-controlled trials have shown that heroin-assisted treatment (HAT) is superior to methadone maintenance alone in treatment of refractory clients, little is known about client factors associated with retention in HAT in routine care.METHODS: This retrospective cohort study assessed predictors of retention in first treatment episode among a consecutive cohort of clients admitted to HAT in Denmark from 2010 to 2018, who could be matched to the Danish population register and for whom a Short Form Health Survey (SF-36) was available at admission (N = 432). The study derived predictors from client self-reports at intake and administrative data available in national registers. Cox proportional hazards regression modelled retention in treatment.RESULTS: The one-year retention rate was 69.63 % (95 % CI 65.06 %-73.74 %), and the median time in treatment was 2.45 years (95 % CI, 1.83-3.12). Bivariate analyses showed that retention was lower for clients who had recent cocaine or benzodiazepine use and among those who had experienced an overdose in the year prior to enrollment in HAT. Age below 40, recent illegal activity, poorer emotional wellbeing, previous residential treatment experience, and previous intensive outpatient treatment were also predictors of dropout from HAT.CONCLUSIONS: This observational study found that retention in HAT in routine care was similar to rates observed in randomized-controlled trials conducted in other countries. The results suggest that addressing polysubstance use as part of the HAT program may promote long-term retention, as may directing resources to certain subgroups identified at intake, including clients under 40 years and those who report recent criminal activity, emotional problems, or overdoses. The findings that previous residential treatment and intensive outpatient treatment were associated with dropout were unexpected.
KW - Adult
KW - Denmark/epidemiology
KW - Drug Overdose/epidemiology
KW - Female
KW - Heroin Dependence/drug therapy
KW - Heroin/therapeutic use
KW - Humans
KW - Male
KW - Middle Aged
KW - Opiate Substitution Treatment/statistics & numerical data
KW - Patient Dropouts/statistics & numerical data
KW - Retention in Care/statistics & numerical data
KW - Retrospective Studies
KW - Young Adult
KW - Heroin assisted treatment
KW - Opioid use disorder
KW - Retention
KW - Opioid maintenance treatment
UR - http://www.scopus.com/inward/record.url?scp=85204454560&partnerID=8YFLogxK
U2 - 10.1016/j.josat.2024.209449
DO - 10.1016/j.josat.2024.209449
M3 - Journal article
C2 - 38960145
SN - 2949-8767
VL - 165
JO - Journal of Substance Use and Addiction Treatment
JF - Journal of Substance Use and Addiction Treatment
M1 - 209449
ER -