'Too little dose - too early discontinuation?'-Effect of buprenorphine dose on short term treatment adherence in opioid dependence.

Abstract

Opioid substitution therapy is an evidence-based treatment for opioid dependence syndrome. Retention in treatment is a crucial mediator of treatment success. Our study aims to examine factors associated with early treatment non-compliance among patients who are initiated on office-based Buprenorphine Maintenance Treatment (BMT). This is a prospective observational study conducted among 89 subjects who were initiated on BMT and were followed up to 6 weeks. At baseline, we evaluated subjects using: Mini International Neuropsychiatric Interview Plus, Addiction Severity Index-Lite, Multi-Dimensional Scale of Perceived Social Support, Heroin Craving Questionnaire, and urine toxicological analysis. Treatment adherence for six weeks was noted. Among Eighty-nine subjects, 57 per cent of the sample reported addiction to pharmaceutical opioids. The mean dose of Buprenorphine was 6.7 mg (SD = 4.1). During follow up 67 per cent (n = 62) patients were adherent to treatment while 33 per cent (n = 27) non-adherent to treatment. The mean dose of buprenorphine in the non-adherent group was significantly lower than the adherent group (4.3 mg and 7.7 mg, respectively, t [87] = 3.8, p < 0.001). A comparison of groups based on the dose of Buprenorphine (6 mg or higher vs lower than 6 mg) revealed that odds of treatment non-adherence were three times higher in patients receiving 6 mg or lesser dose (Odds Ratio = 3.15 [95% CI = 2.0-8.6],χ2 [1] = 4.75, p = 0.035). Dose of Buprenorphine prescribed by the treating clinician influences early treatment compliance significantly.