The Effects of Compliance in Medication Assisted Treatments
Given the litany of challenges faced by individuals in recovery from substance use disorders (SUD), the necessity to offer several tools to help individuals reduce or abstain from alcohol and other drugs has become increasingly clear.
In many treatment settings, both inpatient and outpatient, medication assisted treatments (e.g., buprenorphine/naloxone (“Suboxone”) and naltrexone/depot naltrexone (“Vivitrol”)) are increasingly being offered as a piece of what is considered best clinical practice.
We know very little, however, about how “compliance” (i.e., adherence) to medication prescription (i.e., specific dose and frequency specified by physician or other prescriber) impacts recovery. Furthermore, with our health care system’s modern emphasis on cost-efficiencies, we need to demonstrate that the clinically-accepted practice of toxicology screens can provide a boost to patient’s treatment outcomes.
In the current study, Blum and his co-authors from research departments and clinical settings across the country, tackled these important issues.
The study used urine toxicology screens to determine the presence of prescribed and illicit substances among 2,919 individuals in SUD treatment during 2010 and 2011. Although inpatient settings were also included, outpatient treatment was the primary modality (96%), with standard outpatient (53%) and opiate treatment (31%) representing the substantial majority of settings in which patients received treatment. Only the first and last screens were used in analyses, which varied considerably in the time-lag among the patients analyzed, but on average were about 6 months apart. Patients were deemed to have been “compliant” if their prescribed anti-addiction medications were detected at both first and last screen, and “abstinent” if their screens were negative for all tested drugs, apart from those with documented prescription.
Overall, they found that about two-thirds of patients were medication compliant, and about 40% of patients were abstinent at both first and last screens.
The odds of being abstinent at both screens were about 1.3 times greater for medication compliant patients.
Interestingly, for those who were not abstinent, medication compliant patients were less likely to test positive for marijuana, but more likely to test positive for benzodiazepines (i.e., non-prescribed anti-anxiety medications like Xanax). Authors also found that, when considering all available screens (not just first and last) for a randomly selected group of 511 patients, there were trends of increasing medication compliance, and increasing abstinence over time.
According to the National Institute on Drug Abuse, “medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.”
The increasing acceptance of medications, particularly for opioid addiction, in the field has seen leading addiction treatment organizations traditionally opposed to medication-assisted treatment, like the Hazelden Betty Ford Foundation, alter their philosophies based on this emerging science.
Blum et al.’s study makes two important contributions.
- First, their study suggests that urine toxicology screens should remain an integral aspect of SUD treatment. Upwards of 60% of patients tested positive for an illicit substance during treatment. Addressing positive toxicology screens, as a clinical strategy to discuss treatment progress, and any need for changes in the treatment plan, not only seems to be good clinical practice, but may reduce addiction’s overall financial burden, though cost-benefit analyses remain to be tested.
- Second, their work shows that adhering to anti-addiction medication regimens can increase the likelihood of successful treatment. This finding suggests not only that medications can be an integral aspect of a successful addiction treatment plan, but also that psychosocial strategies to increase medication compliance (e.g., cognitive therapy to address maladaptive beliefs about medication side effects) could boost rates of recovery and remission, and deserve further study.
Blum, K., Han, D., Femino, J., Smith, D. E., Saunders, S., Simpatico, T., … & Gold, M. S. (2014). Systematic evaluation of “compliance” to prescribed treatment medications and “abstinence” from psychoactive drug abuse in chemical dependence programs: data from the comprehensive analysis of reported drugs. PloS one, 9(9), e104275.