Current thinking on the premarketing evaluation of abuse-deterrent opioid formulations

Abstract

Aims: Numerous prediction studies have identified variables (e.g., substance use and psychiatric severity) associated with attrition from outpatient substance abuse treatment (SAT). Very few studies have examined factors associated with dropout from the client’s perspective. Those that have indicate that dissatisfaction with aspects of treatment as well as individual status factors are reported reasons for dropout. The present study rates clients’ selfreported reasons for early attrition from outpatient SAT. Methods: Clients (N=106) recently admitted to two outpatient SAT programs, who irregularly attended treatment during the first 2–3weeks,were contacted for a brief telephonemotivational intervention. During this call they were queried about reasons for lack of attendance, which were then abstracted and coded. Results: Clients reported various and multiple reasons for poor early engagement in treatment that roughly paralleled those reported for dropping out of treatment by clients in previous studies. These reasons can be categorized as: Client Factors—particularly medical and psychological problems, and acute life stressors; Treatment Factors including issueswith clients and staff, as well as the schedule and nature of the treatment itself; and Environmental or Logistical Factors such as transportation, finances, and competing employment demands. Conclusions: Client attributions for outpatient treatment attrition are not fully parallel with variables identified in prediction studies obtained via patient assessments. Further, clients identify many issues that appear to be actionable in some way, and that if prepared for or dealt with by the clinics at both the programmatic and individual client levels, could improve retention. Financial support: NIAAA 1-P01-AA016821-01A1 and NIDA 2P60-DA005186-21.