Assignment 3: Literature Review: Five Articles Abstracted onto the Evaluation TableIn Weeks 2–7, you will submit an evaluation table document with five research articles abstracted for your literatu
4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 1/13
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G o to :
J S ubst A buse T re at . A uth or m anuscrip t; a va ila ble in P M C 2 017 J u l 1 .
P ublis h ed in fin al e dit e d fo rm a s:
J S ubst A buse T re at. 2 016 J u l; 6 6: 4 8–53.
P ublis h ed o nlin e 2 016 M ar 9 . d oi: 1 0.1 016/j. js a t.2 016.0 2.0 09
P M CID : P M C4892369
N IH M SID : N IH M S786788
P M ID : 2 7211 996
P atie nts ’ b elie fs a bout m edic a tio n s a re a sso cia te d w it h s ta te d p re fe re nce
fo r m eth adone, b upre norp hin e, n alt r e xo ne, o r n o m ed ic a tio n -a ssis te d
th era py fo llo w in g in patie nt o pio id d eto xif ic a tio n
Lis a A . U ebela cke r , G enie B aile y , D ebra H erm an , B ra dle y A nders o n , a nd M ic h ael S te in
B utle r H osp it a l, 3 45 B la cksto ne B oule va rd , P ro vid ence R I, 0 2906
B ro w n U niv e rs it y , D epartm ent o f P sych ia tr y a nd H um an B eh avio r, B ox G -B H , P ro vid e nce , R I, 0 2912
S ta nle y S tr e et T re atm ent a nd R eso urc e s, 3 86 S ta nle y S tr e et, F all R iv e r, M A, 0 2720
C orre sp ondin g a uth or: L is a A . U ebela cke r, B utle r H osp it a l, 3 45 B la cksto ne B ou le va rd , P ro vid e nce , R I, 0 2906, L uebela cke r@ butle r.o rg ;
T e l: 4 01-4 55-6 381
C opyrig ht n otic e
P ublis h er's D is cla im er
T he p ublis h er's fin al e dit e d v e rs io n o f th is a rtic le is a va ila ble a t J S ubst A buse T re at
S ee o th er a rtic le s in P M C th at c it e th e p ublis h ed a rtic le .
A bstr a ct
Subse q uen t t o i n itia l o pio id d eto xif ic atio n, p eo ple w ith o pio id u se d is o rd er a re t y pic ally a d vis e d t o
e n gag e i n f o llo w -u p t r e atm en t t o p re v en t r e la p se . M ed ic atio n-a ssis te d t r e atm en ts ( M ATs) - i .e ., t h e
opio id a g onis t m eth ad one ( M MT) o r p artia l a g onis t/a n ta g onis t, b upre n orp hin e/ n altr e x one ( B U P) - - a re
th e m ain te n an ce t r e atm en t o ptio ns w ith t h e b est r e se arc h s u pport f o r p ositiv e o utc o m es. A t h ir d M AT,
in je cta b le e x te n ded -re le ase n altr e x one ( X R-N TX ), w as a p pro ved b y t h e F D A f o r o pio id d ep en den ce i n
2 010 a n d s h ow s p ro m is e . H ow ev er, r e la tiv ely f e w e lig ib le p atie n ts c h oose t o i n itia te o ne o f t h ese M ATs
fo llo w in g i n itia l d eto xif ic atio n t r e atm en t. C onsis te n t w ith t h e H ealth B elie f M odel, w e h ypoth esiz ed
th at b elie fs a b out 1 ) e ff ic acy o f e ach M AT; 2 ) s a fe ty o f e ach M AT; a n d 3 ) p erc eiv ed c o nsis te n cy w ith
b ein g d ru g-fre e w ould p re d ic t s ta te d p ati e n t p re fe re n ces f o r a p artic u la r M AT o r f o r n o M AT. W e a ls o
h ypoth esiz ed t h at p erc eiv ed s tr u ctu ra l b arrie rs ( e .g ., t im e, t r a n sp orta tio n) w ould d ecre ase t h e l ik elih ood
of s ta tin g a p re fe re n ce f o r a g iv en M AT. T o a sse ss t h ese h ypoth ese s, w e s u rv ey ed 3 72 p eo ple
u nderg oin g i n patie n t o pio id d eto xif ic atio n t r e atm en t. R esu lts s u pporte d h ypoth ese s f o r a ll 3 s e ts o f
patie n t b elie fs , w ith t h e p atie n t g ro up s ta tin g t h at t h ey p re fe rre d a p artic u la r M AT h av in g s ig nif ic an tly
m ore p ositiv e b elie fs a b out t h at M AT r e la tiv e t o o th er g ro ups ( p< .0 01). T he g ro up t h at p re fe rre d “ n o
M AT” h ad t h e m ost n eg ativ e b elie fs a b ou t a ll M ATs. P erc eiv ed s tr u ctu ra l b arrie rs w ere n ot r e la te d t o
s ta te d p re fe re n ces, e x cep t t h at p eo ple w ho p re fe rre d B U P w ere m ore l ik ely t o e n dors e b arrie rs t o M MT
th an a n y o f t h e o th er 3 g ro ups. N ota b ly , a r e la tiv ely h ig h p ro portio n ( 3 2% ) o f p artic ip an ts w ere m ost
in te re ste d i n X R-N TX d esp ite a l a ck o f p rio r e x perie n ce w ith t h is m ed ic atio n. T hese r e su lts s u ggest
th at e ff o rts t o i n cre ase M AT e n ro llm en t f o llo w in g d eto xif ic atio n m ig ht b en efit f ro m i n clu din g p atie n t
belie fs a s o ne s e t o f f a cto rs t o a sse ss a n d t a rg et f o r c h an ge.
K ey w ord s: o pio id s, p re fe re n ces, m eth ad one, b upre n orp hin e, n altr e x one
1 . In tr o ductio n
a,b b,c a,b a a,b
a
b
c 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 2/13
In 2 012, 2 .1 m illio n p eo ple i n t h e U .S . m et c rite ria f o r p ast- y ear a b use / d ep en den ce o f p re sc rip tio n p ain
r e lie v ers , a n d h alf a m illio n p eo ple m et c rite ria f o r h ero in u se d is o rd ers . P re sc rip tio n p ain r e lie v er
a b use /d ep en den ce r a te s h av e i n cre ase d b y o ne t h ir d s in ce 2 002, a n d h ero in a b use / d ep en den ce r a te s
d ouble d i n t h e d ecad e a fte r 2 002 ( S ubsta n ce A buse a n d M en ta l h ealth S erv ic es A dm in is tr a tio n, 2 013 ).
A fte r d eto xif ic atio n, m ost p atie n ts a re a d vis e d t o e n gag e i n m ain te n an ce t r e atm en t i n o rd er p re v en t
re la p se . M ed ic atio n a ssis te d t r e atm en ts ( M ATs) – i .e ., t h e o pio id a g onis ts m eth ad one ( M MT) o r p artia l
a g onis t/a n ta g onis t, b upre n orp hin e/ n altr e x one ( B U P) - - a re t h e m ain te n an ce t r e atm en t o ptio ns w ith t h e
best r e se arc h s u pport f o r o utc o m es l ik e r e te n tio n a n d b ein g d ru g-fre e f ro m i llic it d ru gs ( B usc h , H aas,
W eig l, & W ir l, 2 007 ; C onnock e t a l., 2 007 ; D e M aey er, V an derp la ssc h en , & B ro ek aert, 2 010 ;
F eele m yer, D es J a rla is , A ra ste h , P hillip s, & H ag an , 2 014 ; M attic k , B re en , K im ber, & D av oli, 2 014 ). A
t h ir d M AT, i n je cta b le e x te n ded -re le ase n altr e x one ( X R-N TX ) w as a p pro ved b y t h e F D A f o r o pio id
d ep en den ce i n 2 010 a n d s h ow s p ro m is e ( K ru pits k y e t a l., 2 011 ). O bse rv atio nal d ata d em onstr a te s X R-
N TX u se i s a sso cia te d w ith f e w er i n patie n t h osp ita liz atio ns t h an m eth ad one o r B U P ( B ase r, C halk ,
F ie llin , & G astf rie n d, 2 011 ). L onger- te rm t r e atm en t r e se arc h o n X R-N TX i s l im ite d a t t h is p oin t.
H ow ev er, m an y o pio id d ep en den t p atie n ts d o n ot r e ceiv e M ATs e ith er u pon d is c h arg e f ro m a n i n patie n t
deto xif ic atio n p ro gra m o r a t a n o utp atie n t a p poin tm en t w ith a c are p ro vid er. S te in e t a l ( 2 012) a n aly zed
M ed ic aid d ata f ro m 2 007–2009 t h at i n clu ded o ver 1 4,0 00 o pio id d ep en den ce t r e atm en t e p is o des. O f
th ese e p is o des, 1 2% i n volv ed B U P, 2 5% i n volv ed m eth ad one, a n d 6 3% d id n ot i n volv e a n y M AT
desp ite m ost p atie n ts r e ceiv in g c are i n a s p ecia lty a d dic tio n p ro gra m ( S te in e t a l., 2 012 ).
W hy d o s o f e w p atie n ts u se M ATs? T here a re l ik ely m an y f a cto rs o uts id e o f c o ntr o l o f t h e i n div id ual,
s u ch a s c o st, l a ck o f a ccess t o s e rv ic es, l a ck o f t r a in ed p ro vid ers , l a ck o f a w are n ess o f M AT o ptio ns,
e x pre sse d n eg ativ e b elie fs o f f a m ily m em bers , c o m munity m em bers , a n d s u bsta n ce a b use t r e atm en t
pro vid ers ( V olk ow , F rie d en , H yde, & C ha, 2 014 ) o r a w id er c u ltu ra l s tig m a a g ain st t h e u se o f M ATs
(C en te r f o r S ubsta n ce A buse T re atm en t, 2 005 ), p artic u la rly M MT ( P in to e t a l., 2 010 ). O ur p re v io us
re se arc h h as f o und t h at, f o r p eo ple u nderg oin g o pio id d eto xif ic atio n, t h e l o w er t h e p erc eiv ed r is k o f
one’s o w n r e la p se , t h e l o w er t h e l ik elih o od t h at o ne e x pre sse s a d esir e t o s ta rt a n M AT a fte r
d eto xif ic atio n ( B aile y, H erm an , & S te in , 2 013 ). C onsis te n t w ith t h e H ealth B elie f M od el ( R ose n sto ck ,
S tr e ch er, & B eck er, 1 988 ), w e h ypoth esiz ed t h at o th er t y pes o f p atie n t b elie fs – i .e ., b elie fs a b out
barrie rs t o M AT u se ( w hic h i n clu de p erc eiv ed d an ger o r p erc eiv ed e m otio nal d is c o m fo rt) a n d e ff ic acy
o f M ATs - -m ay a ls o p la y a r o le i n p re fe re n ce f o r a p artic u la r M AT f o llo w in g a s h ort- te rm i n patie n t
deto xif ic atio n.
W ith r e sp ect t o p erc eiv ed b arrie rs , p atie n ts m ay v ie w M ATs, a n d p artic u la rly m eth ad one, a s h arm fu l .
A s tu dy o f o pio id d ep en den t i n div id uals , i n clu din g t h ose i n a n d n ot i n t r e atm en t, f o und t h at p artic ip an ts
h ad n um ero us n eg ativ e b elie fs a b out m eth ad one, b elie v in g t h at i t h ad a n eg ativ e i m pact o n p hysic al
h ealth , t h at i t w as a d dic tin g, a n d t h at w ith dra w al f ro m m eth ad one w as v ery d if f ic u lt ( S ch w artz e t a l.,
2 008 ). A s tu dy o f o pio id -d ep en den t p atie n ts f o und t h at b elie fs a b out d ep re ssio n o r a n xie ty a s a
m ed ic atio n s id e e ff e ct w ere a sso cia te d w ith d ecre ase d l ik elih ood o f t a k in g t h at p artic u la r M AT ( R id ge,
G osso p, L in tz eris , W itto n, & S tr a n g, 2 009 ). B elie fs a b out h arm fu l p hysic al e ff e cts o f m eth ad one h av e
als o b een a sso cia te d s p ecif ic ally w ith t h e c h oic e o f B U P o ver M MT ( G ry czy nsk i e t a l., 2 013 ; P in to e t
al., 2 010 ).
S eco nd, p atie n ts m ay v ie w M ATs ( p artic u la rly M MT a n d B U P) a s in co n sis te n t w it h b ein g d ru g-fr e e ,
as p ro m ote d i n s o m e ( b ut n ot a ll) 1 2-s te p p ro gra m s o r b y p eers o r o th er c o unse lo rs , a n d t h ere fo re n ot
an a ccep ta b le t r e atm en t. A lth ough a n yon e w ith a d esir e t o s to p u sin g d ru gs m ay j o in N A, l o cal N A
gro ups h av e t h e o ptio n o f r e str ic tin g p artic ip atio n o f p eo ple u sin g M ATs, n ot a llo w in g t h em t o t a k e
le ad ers h ip r o le s ( W hite , 2 011 ). T his , c o m bin ed w ith w id er c u ltu ra l s ti g m a a g ain st t h e u se o f M ATs
(C en te r f o r S ubsta n ce A buse T re atm en t, 2 005 ), m ig ht l e ad p atie n ts t o b elie v e t h at M ATs a re n ot a n
a ccep ta b le o ptio n. I n deed , i n a s tu dy o f B U P v s. M MT w here p atie n ts w ere a b le t o c h oose w hic h M AT 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 3/13
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th ey w an te d t o t a k e, t h ose w ho c h ose B U P ( v s. t h ose w ho c h ose M MT) w ere m ore l ik ely t o b elie v e
th at m eth ad one w as ― sw ap pin g o n a d dic tio n f o r a n oth erǁ ( P in to e t a l., 2 010 ).
F in ally , p atie n ts m ay v ie w M ATs a s in effe ctiv e . F or e x am ple , i n a s tu dy o f 1 04 o pio id d ep en den t
patie n ts , o nly a p pro xim ate ly o ne t h ir d b elie v ed t h at M MT o r B U P m ain te n an ce t r e atm en t w as s u perio r
to d eto xif ic atio n i n t h e p re v en tio n o f h ero in u se ( L uty , 2 004 ). I n deed , b elie fs t h at t r e atm en t w ill h av e a
p ositiv e i m pact o n o ne’s l if e ( i.e ., b e e ff ic acio us) p re d ic t t h e l ik elih ood o f e n gag in g i n l o ng-te rm
s u bsta n ce u se t r e atm en t a fte r a cu te d eto xif ic atio n ( M ille ry , K le in m an , P olis sa r, M illm an , & S cim eca,
2 002 ). T his w as t r u e e v en w hen c o ntr o llin g f o r o th er p re d ic to rs o f t r e atm en t e n gag em en t, i n clu din g
hom ele ssn ess, b ein g o n p aro le , a n d l o ng-te rm d ru g u se ( M ille ry e t a l., 2 002 ). F urth er, a b elie f t h at
tr e atm en t i s e ff ic acio us – o r t h e c o nvers e , t h at o ne w ill r e la p se w ith out i t – i s a sso cia te d w ith a d esir e
to s ta y i n t r e atm en t l o nger f o r p atie n ts a lr e ad y i n B U P o r M MT m ain te n an ce t r e atm en t ( B en tz le y,
B arth , B ack , A ro nso n, & B ook, 2 015 ; W in sto ck , L in tz eris , & L ea, 2 011 ), a s w ell a s w ith a ctu al
re te n tio n i n M MT ( K ay m an , G old ste in , D ere n , & R ose n blu m , 2 006 ).
A s r e v ie w ed a b ove, t h ere i s s u rp ris in gly l ittle r e se arc h d ocu m en tin g w heth er t h ese b elie fs a re i n f a ct
a sso cia te d w ith s ta te d t r e atm en t p re fe re n ces p rio r t o t h e o nse t o f m ain te n an ce t r e atm en t, a n d n o
re se arc h i n clu din g X R-N TX a s a t r e atm en t o ptio n. T he g oal o f t h is s tu dy w as t o e x am in e w heth er
b elie fs a b out s p ecif ic t r e atm en ts , a s w ell a s p erc eiv ed str u ctu ra l b arrie rs ( e .g ., t im e, t r a n sp orta tio n), a re
a sso cia te d w ith s ta te d p re fe re n ces f o r a s p ecif ic M AT v s. n o M AT f o llo w in g d eto xif ic atio n f o r o pio id
d ep en den ce. W e h ypoth esiz ed t h at b elie fs a b out e ff ic acy, s a fe ty , a n d c o nsis te n cy w ith b ein g d ru g-fre e
w ould b e a sso cia te d w ith a s ta te d p re fe re n ce t o u se o ne M AT v ers u s a n oth er, o r t o u se n o M AT.
F urth er, w e p re d ic te d t h at a p erc eiv ed l a c k o f s tr u ctu ra l b arrie rs t o a p artic u la r M AT w ould b e
asso cia te d w ith a p re fe re n ce f o r t h at M AT. W e c o m pare d w heth er t h e t h re e M ATs d if f e re d i n p erc eiv ed
e ff ic acy, s a fe ty , o r c o nsis te n cy w ith b ein g d ru g-fre e i n t h e s a m ple a s a w hole ( i.e ., r e g ard le ss o f s ta te d
m ed ic atio n p re fe re n ce). F in ally , w e e x am in ed w heth er p re v io us u se o f a M AT w ould b e a sso cia te d
w ith i n te n t t o r e in itia te t h at M AT, a n d w heth er t h ere w as a d if f e re n ce b etw een g ro ups c h oosin g
dif f e re n t M ATs i n t h eir c o nfid en ce t h at t h ey w ould b e a b le t o s ta rt t h at M AT w hen t h ey l e ft
d eto xif ic atio n.
2 . M ate ria l a nd m eth ods
2.1 . P artic ip ants
F ro m A ugust 2 014 t o M arc h 2 015, r e se arc h s ta ff a p pro ach ed c o nse cu tiv e p atie n ts w ith in t h e f ir s t 2 4
hours o f a d m is sio n t o a n i n patie n t o pio id d eto xif ic atio n p ro gra m a t S ta n le y S tr e et T re atm en t A ddic tio n
an d R eso urc es, I n c. ( S STA R), i n F all R iv er, M assa ch use tts . T his p ro gra m i s a 3 8-b ed , 2 4-h our
m ed ic ally s u perv is e d f a cility t h at p ro vid es e v alu atio n a n d w ith dra w al m an ag em en t. A vera g e l e n gth -o f-
s ta y a t t h e d eto xif ic atio n p ro gra m i s 5 .9 d ay s u sin g a m eth ad one t a p er p ro to co l a s w ell a s i n div id ual
a n d g ro up c o unse lin g a n d c ase m an ag em en t. F ollo w -u p c are i s s tr o ngly e n co ura g ed f o r a ll p atie n ts .
C ase m an ag ers a ssis t p atie n ts w ith s e ttin g u p f o llo w -u p t r e atm en t, i n clu din g a d ed ic ate d c ase m an ag er
fo r m ain te n an ce M AT.
2 .2 . P ro ce dure s
O f t h e 3 97 p atie n ts w ho w ere a d m itte d t o S STA R f o r o pio id d eto xif ic atio n d urin g t h e r e cru itm en t
perio d, w ere 1 8 y ears o r o ld er, a n d w ere E nglis h -s p eak in g, 2 5 w ere n ot e n ro lle d i n t h e s tu dy b ecau se
th ey w ere u nab le t o p ro vid e v erb al i n fo rm ed c o nse n t, r e fu se d s tu dy p artic ip atio n, o r w ere d is c h arg ed
b efo re s ta ff c o uld i n te rv ie w t h em . T he r e m ain in g 3 72 p ers o ns c o m ple te d a f a ce-to -fa ce 1 5-m in ute
i n te rv ie w d urin g w hic h n on-tr e atin g r e se arc h s ta ff a d m in is te re d m easu re s d eta ile d b elo w . A t t h e t im e
of t h e i n te rv ie w , p artic ip an ts h ad b een d o se d w ith a n o pio id a g onis t a n d w ere c o m fo rta b le t o c o m ple te
t h e i n te rv ie w . H ow ev er, t h ey h ad n ot h ad e x te n siv e c o nta ct w ith t r e atm en t s ta ff w ho m ig ht i n flu en ce 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 4/13
partic ip an t b elie fs . P artic ip an ts w ere n ot c o m pen sa te d . T his s tu dy w as a p pro ved b y t h e B utle r H osp ita l
In stitu tio nal R ev ie w B oard .
2 .3 . M easu re s
T he i n te rv ie w er f ir s t a sse sse d p artic ip an t d em ogra p hic s. T he i n te rv ie w er a sk ed p artic ip an ts a b out t h eir
g en der, d ate o f b ir th , m arita l s ta tu s, r a ce , e th nic ity , h ig hest g ra d e i n s c h ool c o m ple te d , w ork s ta tu s,
le g al s ta tu s ( e .g ., n one, p ro batio n, p aro le , e tc .) , l iv in g s itu atio n, a n d t y pe o f h ealth i n su ra n ce. N ex t, t h e
in te rv ie w er a sk ed a b out c lin ic al c h ara cte ris tic s, i n clu din g t h e a g e t h e p atie n t b eg an u sin g o pia te s,
w heth er h e/ s h e h ad e v er b een p re sc rib ed B U P o r X R-N TX o r e n ro lle d i n M MT, a n d w heth er h e/ s h e
had e v er b een i n a d eto xif ic atio n p ro gra m p rio r t o t h e c u rre n t a d m is sio n.
In o rd er t o a sse ss p re fe rre d M AT, t h e i n te rv ie w er a sk ed p artic ip an ts : “ If y ou w ere t o s ta rt a m ed ic atio n
afte r y ou l e av e [ in patie n t d eto xif ic atio n], w hic h m ed ic atio n w ould y ou b e m ost l ik ely t o c h oose ?”
P artic ip an ts w ere g iv en t h e c h oic e o f “ m eth ad one,” “ S uboxone,” “ V iv itr o l s h ots ,” a n d “ n one.” T he
in te rv ie w er p ro vid ed s h ort d esc rip tio ns o f e ach o f t h e M ATs t o o rie n t p artic ip an ts w ho m ay n ot h av e
use d a p artic u la r M AT i n t h e p ast. N ex t, t h e i n te rv ie w er a sk ed a b out e ff ic acy, s a fe ty , a n d t h e p erc eiv ed
c o nsis te n cy w ith b ein g d ru g-fre e f o r e ach o f t h e 3 M ATs. T he e ff ic acy s c ale i n clu ded t h re e i te m s,
id en tic al f o r e ach M AT, b ut i llu str a te d h ere u sin g m eth ad one: “ M eth ad one h as b een p ro ven t o h elp
p eo ple s ta y o ff o pia te s,” “ M eth ad one h elp s t o t a k e a w ay t h e c ra v in g f o r o pia te s,” a n d “ I d on’t t h in k
m eth ad one h elp s p eo ple s ta y o ff o f o pia te s” ( re v ers e c o ded .) T he s a fe ty s c ale i n clu ded t h ese i te m s:
“ M eth ad one c au se s d an gero us s id e e ff e c ts ” ( re v ers e c o ded ), “ M eth ad one i s b ad f o r y ou p hysic ally ”
(re v ers e c o ded ) a n d “ It i s s a fe t o t a k e m eth ad one”. T he c o nsis te n cy w ith b ein g d ru g-fre e s c ale
i n clu ded : “ T ak in g m eth ad one i s o nly r e p la cin g o ne a d dic tio n w ith a n oth er” ( re v ers e c o ded ), “ P eo ple
t a k in g m eth ad one a re n ’t r e ally c le an ” ( re v ers e c o ded ), a n d “ M eth ad one i s a t r e atm en t t h at g iv es y ou a
“ h ig h” j u st l ik e h ero in o r p ills ” ( re v ers e c o ded ). P artic ip an ts w ere a sk ed t o r a te e ach i te m o n a s c ale o f
1 t o 5 , w ith 1 i n dic atin g “ str o ngly d is a g re e,” a n d 5 i n dic atin g “ str o ngly a g re e.” F or a ll t h re e s c ale s, w e
av era g ed a cro ss t h e t h re e i te m s t o f o rm a 1 –5 s c ale s c o re , w ith h ig her s c o re s r e fe rrin g t o m ore p ositiv e
attitu des t o w ard M ATs. C ro nbach ’s a lp ha w as s a tis fa cto ry f o r a ll t h re e s c ale s ( s e e T ab le 2 ) . F in ally , t o
a sse ss d eg re e t o w hic h t h ere w ere s tr u ctu ra l b arrie rs t o M ATs, t h e i n te rv ie w er t o ld p artic ip an ts :
“ B arrie rs t o t r e atm en t m ay i n clu de c o st, t r a n sp orta tio n, f in din g a p ro vid er o r p ro gra m , o r h av in g
en ough t im e f o r a p poin tm en ts .” W e t h en a sk ed t h em t o r a te t h e s ta te m en t “ T here a re b arrie rs t o m y
ta k in g m eth ad one [ S uboxone/ V iv itr o l] ” o n t h e s a m e 5 -p oin t s c ale d esc rib ed a b ove, a n d t h en t o c h oose
h is / h er o w n s in gle m ain b arrie r t o t h at p artic u la r M AT. P artic ip an ts c h ose f ro m a l is t t h at i n clu ded
h ealth i n su ra n ce, c o st, t r a n sp orta tio n, c h ild care , t h e w ait- tim e t o e n ro ll i n a p ro gra m , n ot k now in g
w here t o g o, a n d o th er. I f p artic ip an ts c h o se “ o th er,” t h ey w ere a sk ed t o p ro vid e m ore i n fo rm atio n
ab out t h e b arrie r t h at t h ey h ad i n m in d.
Ta ble 2
A ttitu des T ow ard s M AT b y S ta te d M ed ic atio n P re fe re n ce ( n = 3 72).
P R EFE R RED M ED IC AT IO N
Sam ple
( n = 3 72)
M MT
(n = 6 7)
B U P
(n = 1 05)
X R-N TX
(n = 1 1 8)
N on e
(n = 8 2) 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
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Open i n a s e p ara te w in dow
M MT s ig nif ic an tly d if f e re n t t h an B U P.
M MT s ig nif ic an tly d if f e re n t t h an X R-N TX .
M MT s ig nif ic an tly d if f e re n t t h an p re fe re n ce f o r n o m ed ic atio n .
B U P s ig nif ic an tly d if f e re n t t h an X R-N TX .
BU P s ig nif ic an tly d if f e re n t t h an p re fe re n ce f o r n o m ed ic atio n .
X R-N TX s ig nif ic an tly d if f e re n t t h an p re fe re n ce f o r n o m ed ic atio n .
N ote . M MT = m eth ad one m ain te n an ce t r e atm en t; B U P = b upre n o rp h in e/ n altr e x o ne; X R-N TX = i n je cta b le
e x te n ded -re le ase n altr e x one
T he i n te rv ie w er a ls o a sk ed p artic ip an ts t o d esc rib e t h eir c o nfid en ce t h at t h ey w ould b e a b le t o s ta rt
ta k in g t h eir m ed ic atio n o f c h oic e a fte r l e av in g d eto xif ic atio n. P artic ip an ts r a te d c o nfid en ce o n a 1 0
poin t s c ale , r a n gin g f ro m 1 , “ n ot a t a ll c o n fid en t” t o 1 0 “ v ery c o nfid en t.”
2 .4 . D ata a naly sis
W e r e p ort d esc rip tiv e s ta tis tic s t o s u m mariz e d em ogra p hic a n d c lin ic al c h ara cte ris tic s o f t h is s a m ple .
W e e stim ate d t h e i n te rn al c o nsis te n cy o f b elie f s c ale s w ith C ro nbach ’s a lp ha. W e u se d F -te sts f o r
dif f e re n ces i n m ean s a n d t h e χ – t e st o f i n dep en den ce t o s ta tis tic ally c o m pare d em ogra p hic s, b elie fs
C hro n bach ’s
A lp ha
M ea n
(S D ) M ea n ( S D ) M ea n ( S D ) M ea n ( S D )
M ea n
(S D ) F ( p = )
P R EFE R RED M ED IC AT IO N
Sam ple
( n = 3 72)
M MT
(n = 6 7)
B U P
(n = 1 05)
X R-N TX
(n = 1 1 8)
N on e
(n = 8 2)
C hro n bach ’s
A lp ha
M ea n
(S D ) M ea n ( S D ) M ea n ( S D ) M ea n ( S D )
M ea n
(S D ) F ( p = )
E ffic a cy
o f…
M MT .7 2 3.4 0 ( 0 .7 9) 3.9 6
(0 .5 7)
3.4 2 ( 0 .7 2) 3.2 0 ( 0 .8 3) 3.2 1
(0 .7 7)
16.0 9
(< .0 01)
B U P .7 0 3.5 2 ( 0 .7 4) 3.5 4 ( 0 .6 9) 3.9 1
(0 .6 1)
3.3 2 ( 0 .7 7) 3.2 7
(0 .6 9)
X R-N TX .7 4 3.5 3 ( 0 .5 9) 3.4 2 ( 0 .5 7) 3.4 4 ( 0 .6 0) 3.7 9
(0 .5 6)
3.4 1
(0 .5 3)
17.7 9
(< .0 01)
12.7 4
(< .0 01)
Safe ty o f…
M MT .6 4 2.9 8 ( 0 .6 4) 3.3 2
(0 .6 5)
3.0 2 ( 0 .6 3) 2.8 3 ( 0 .5 9) 2.8 5
(0 .6 3)
10.5 6
(< .0 01)
B U P 6 4 3 30 (0 61) 3 46 3 51 3 22 ( 0 52) 3 01 14 01
abc
ade
bdf
abc d
bc de f
a
b
c
d
e
f
2 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 6/13
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ab out e ff ic acy, s a fe ty , c o nsis te n cy w ith b ein g d ru g-fre e, a n d b arrie rs b y p re fe rre d t r e atm en t. W e u se d
re p eate d -m easu re s A NOVA t o c o m pare d if f e re n ces i n p erc eiv ed e ff ic acy, s a fe ty , o r c o nsis te n cy w ith
b ein g d ru g f re e b etw een t h e t h re e M ATs w ith in t h e s a m ple a s a w hole . W e u se d t h e H olm -B onfe rro ni
m eth od ( H olm , 1 979 ) t o c o ntr o l t h e f a m ily w is e e rro r r a te w hen c o nductin g f o llo w -u p p air w is e
c o m paris o ns. F in ally , w e u se d t h e χ – t e st t o c o m pare d if f e re n ces i n p re fe rre d t r e atm en t t y pe b y
tr e atm en t h is to ry .
3 . R esu lt s
T he s a m ple w as p rim arily m ale , w ith a m ean a g e o f 3 1.8 y ears , a n d, c o nsis te n t w ith t h e a re a i n w hic h
w e r e cru ite d t h e s a m ple ( F all R iv er, M A), t h e s a m ple w as p rim arily w hite ( T ab le 1 ) . M ost p eo ple w ere
u nem plo yed a n d m ost w ere i n su re d w ith a M assa ch use tts M ed ic aid p ro duct. A s u bsta n tia l m in ority o f
th e s a m ple h ad p re v io usly b een i n M MT o r b een p re sc rib ed B U P; r e la tiv ely f e w p eo ple h ad p re v io usly
b een p re sc rib ed X R-N TX . W hen a sk ed w hic h m ain te n an ce m ed ic atio n t h ey p re fe rre d f o r o pio id u se
d is o rd er t r e atm en t, 6 8 ( 1 8% o f t h e t o ta l s a m ple ) s ta te d t h at t h ey p re fe rre d M MT, 1 04 ( 2 8% ) p re fe rre d
B U P, 1 1 8 ( 3 2% ) p re fe rre d X R-N TX , a n d 8 2 ( 2 2% ) p re fe rre d n ot t o t a k e a n y M AT ( s e e T ab le 1 ) . W e
fo und g en der a n d r a cia l/e th nic d if f e re n ces i n p atie n t p re fe re n ces. W om en a p peare d m ore l ik ely t o b e
in te re ste d i n M MT a n d X R-N TX , a n d l e ss l ik ely t o b e i n te re ste d i n B U P o r n o M AT, t h an m en . A fric an
A m eric an s w ere m ore l ik ely t o s ta te a p re fe re n ce f o r M MT a n d X R-N TX t h an o th er r a cia l/ e th nic
g ro ups, a n d l e ss l ik ely t o p re fe r B U P o r n o t r e atm en t. W e e x am in ed w heth er p re fe rre d m ed ic atio n w as
a sso cia te d w ith a h is to ry o f u sin g t h at m ed ic atio n; w e d id n ot f in d a s ig nif ic an t a sso cia tio n f o r a n y o f
th e t h re e M ATs, a lth ough t h ere w as a t r e n d f o r p atie n ts w ith a h is to ry o f t a k in g X R-N TX s ta tin g t h at
th ey p re fe rre d X R-N TX .
Ta ble 1
B ack gro und C hara cte ris tic s b y S ta te d M ed ic atio n P re fe re n ce ( n = 3 72).
P R EFE R RED M ED IC AT IO N
Sam ple
( n = 3 72)
M MT
(n = 6 8)
B U P
(n = 1 04)
X R-N TX
(n = 1 1 8)
N on e
(n = 8 2)
F o r χ 2 ( p =
)
Y ears A ge 0.2 9 ( .8 35)
G en der 3 1.8 ( ± 9 .1 ) 32.5 ( ±
9 .0 )
31.7 ( ±
9 .0 )
31.3 ( ± 8 .7 ) 32.2 ( ±
1 0.0 )
19.3 6
(< .0 01)
M ale 2 62
(7 0.4 % )
37 ( 1 4.1 % ) 81 ( 3 0.9 % ) 76 ( 2 9.0 % ) 68 ( 2 6.0 % )
F em ale 1 1 0
(2 9.6 % )
31 ( 2 8.2 % ) 23 ( 2 0.9 % ) 42 ( 3 8.2 % ) 14 ( 1 2.7 % )
Years E ducatio n 12.0 ( ± 1.7 ) 11 .9 ( ± 1.5 ) 12.0 ( ± 1.6 ) 12.0 ( ± 2.1 ) 11 .9 ( ± 1.5 ) 0.1 7 ( .9 16)
R ace/E th nic ity 2 3.3 0 ( .0 06)
A fric an -A m eric an 1 0 ( 2 4% ) 4 ( 4 0.0 % ) 1 ( 1 0.0 % ) 5 ( 5 0.0 % ) 0 ( 0 .0 % )
2
b
a 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
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Open i n a s e p ara te w in dow
N ote . M MT = m eth ad one m ain te n an ce t r e atm en t; B U P = b upre n o rp h in e/ n altr e x o ne; X R-N TX = i n je cta b le
e x te n ded -re le ase n altr e x one.
D en om in ato r f o r p erc en ta g es i n t h is c o lu m n i s t h e t o ta l s a m ple ( n = 3 72).
D en om in ato r f o r p erc en ta g es i n t h is c o lu m n i s t h e t o ta l n um ber o f p artic ip an ts w ith t h at p artic u la r d em ogra p hic
( e .g ., g en der) o r c lin ic al ( e .g ., E ver i n M MT) c h ara cte ris tic .
A s d ocu m en te d i n T ab le 2 , p artic ip an ts w ho s ta te d t h at t h ey p re fe rre d M MT, r e la tiv e t o p artic ip an ts
w ho p re fe rre d B U P, X R-N TX , o r n o M AT, g av e M MT h ig her r a tin gs o n e ff ic acy, s a fe ty , a n d
co nsis te n cy w ith b ein g d ru g-fre e. S im ila rly , p artic ip an ts w ho p re fe rre d B U P r a te d B U P a s h ig her o n
eff ic acy t h an p eo ple w ho p re fe rre d o th er M ATs o r n o M AT, a n d p artic ip an ts p re fe rrin g B U P r a te d B U P
as h ig her o n s a fe ty a n d c o nsis te n cy w ith b ein g d ru g-fre e t h an p eo ple w ho p re fe rre d X R-N TX o r n o
M AT. P artic ip an ts w ho s ta te d t h at t h ey p re fe rre d X R-N TX r a te d X R-N TX m ore h ig hly o n e ff ic acy a n d
co nsis te n cy w ith b ein g d ru g-fre e t h an p eo ple w ho p re fe rre d t h e o th er m ed ic atio ns o r n o m ed ic atio n,
an d m ore h ig hly o n s a fe ty t h an p eo ple w ho p re fe rre d B U P o r n o m ed ic atio n. F in ally , p eo ple w ho
pre fe rre d n o M AT t e n ded t o r a te e ff ic acy, s a fe ty , a n d c o nsis te n cy w ith b ein g d ru g f re e a s l o w f o r a ll
t h re e M ATs.
W e f o und f e w er d if f e re n ces b etw een g ro u ps o n s tr u ctu ra l b arrie rs . P eo ple w ith a s ta te d p re fe re n ce f o r
M MT w ere l e ss l ik ely t o s a y t h at t h ere w ere s tr u ctu ra l b arrie rs t o M MT t h an p eo ple w ho p re fe rre d
B U P. T here w ere n o d if f e re n ces b etw een t h e 4 g ro ups i n p erc en ta g e e n dors in g s tr u ctu ra l b arrie rs t o
B U P o r X R-N TX . A m ongst p artic ip an ts w ho e n dors e d b arrie rs t o t h e M ATs, t r a n sp orta tio n w as t h e
m ost f re q uen tly e n dors e d b arrie r f o r a ll t h re e M ATs, w ith 8 5 o f 1 31 ( 6 5% ) c itin g t r a n sp orta tio n a s a
b arrie r t o M MT, 3 2 o f 8 0 ( 4 0% ) c itin g t r a n sp orta tio n a s a b arrie r t o B U P, a n d 8 o f 2 7 ( 3 0% ) c itin g
tr a n sp orta tio n a s a b arrie r t o X R-N TX . O th er f re q uen tly e n dors e d b arrie rs i n clu ded t h e w ait t o f in d a
p ro vid er f o r B U P, w ith 1 6 o f 8 0 ( 2 0% ) c itin g t h is a s a b arrie r, a n d n ot k now in g w here t o g o t o r e ceiv e a
p re sc rip tio n f o r X R-N TX , w ith 6 o f 2 7 ( 2 2% ) c itin g t h is a s a b arrie r.
W e n ex t e x am in ed d if f e re n ces b etw een p erc ep tio ns o f t h e t h re e M ATs i n t h e s a m ple a s a w hole . ( S ee
T ab le 2 , c o lu m n 2 f o r m ean s). D if f e re n ces w ith r e sp ect t o p erc eiv ed e ff ic acy w ere s ta tis tic ally
s ig nif ic an t ( F = 5 .5 7, p = .0 04); B U P ( t = 3 .1 0, p = .0 02) a n d X R-N TX ( t = 2 .4 8, p = .0 14)
w ere p erc eiv ed a s s ig nif ic an tly m ore e ff ic acio us t h an M MT. P erc eiv ed d if f e re n ces i n t h e e ff ic acy o f
P R EFE R RED M ED IC AT IO N
Sam ple
( n = 3 72)
M MT
(n = 6 8)
B U P
(n = 1 04)
X R-N TX
(n = 1 1 8)
N on e
(n = 8 2)
F o r χ 2 ( p =
)
H is p an ic / L atin o 23 ( 6 .2 % ) 1 ( 4 .4 % ) 6 ( 2 6.1 % ) 8 ( 3 4.8 % ) 8 ( 3 4.8 % )
W hite o r C au casia n 3 20
(8 6.0 % )
62 ( 1 9.4 % ) 94 ( 2 9.4 % ) 100
(3 1.3 % )
64 ( 2 0.0 % )
O th er 1 9 ( 5 .1 % ) 1 ( 5 .3 % ) 3 ( 1 5.8 % ) 5 ( 2 6.3 % ) 10 ( 5 2.6 % )
Em plo ym en t S ta tu s 9.0 1 ( .4 36)
F ull- T im e 52 ( 1 4.0 % ) 5 ( 9 .6 % ) 12 ( 2 3.1 % ) 18 ( 3 4.6 % ) 17 ( 3 2.7 % )
a
b
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B U a n d X R-N TX w ere n ot s ta tis tic ally s ig nif ic an t ( t = − 0.1 2, p = .9 07). T here w ere s ta tis tic ally
s ig nif ic an t d if f e re n ces ( F = 6 7.5 1, p < .0 01) d if f e re n ces i n p erc eiv ed s a fe ty ; B U P ( t = 1 0.9 9, p
< .0 01) a n d X R-N TX ( t = 9 .2 1, p < .0 01) w ere p erc eiv ed a s s a fe r t h an M MT. P erc eiv ed d if f e re n ces
in t h e s a fe ty o f B U P a n d X R-N TX w ere n ot s ta tis tic ally s ig nif ic an t ( t = − 0.1 7, p = .8 64).
D if f e re n ces w ith r e sp ect t o c o nsis te n cy w ith b ein g d ru g-fre e w ere a ls o s ta tis tic ally s ig nif ic an t ( F =
1 07.9 0, p < .0 01); B U P ( t = 7 .8 3, p < .0 01) a n d X R-N TX ( t = 1 4.1 2, p < .0 11 ) w ere p erc eiv ed a s
m ore c o nsis te n t w ith b ein g d ru g-fre e t h an M MT, a n d X R-N TX w as m ore c o nsis te n t w ith b ein g d ru g-
fre e t h an B U P. ( t = − 10.1 2, p < .0 01).
F in ally , w e e x am in ed w heth er c o nfid en ce t h at o ne w ould b e a b le t o s ta rt o ne’s p re fe rre d m ed ic atio n
dif f e re d b y m ed ic atio n ( ra te d o n a s c ale f ro m 1 –10). T he o vera ll m ean l e v el o f c o nfid en ce w as 8 .6 2 ( ±
2 .2 ). A m ajo rity , 6 0.9 % , s a id t h ey w ere v ery c o nfid en t t h ey w ould b e a b le t o s ta rt t h eir p re fe rre d
m ed ic atio n. D if f e re n ces i n c o nfid en ce b y p re fe rre d m ed ic atio n t y pe d id n ot v ary s ig nif ic an tly ( F =
1 .1 4, p = .3 23); m ean s w ere 8 .7 ( ± 2 .2 ), 8 .4 ( ± 2 .5 ) , a n d 8 .8 ( ± 1 .9 ) f o r t h ose w ho p re fe rre d M MT,
B U P, X R-N TX , r e sp ectiv ely .
4 . D is cu ssio n
The p rim ary g oal o f t h is s tu dy w as t o u nders ta n d i n flu en ces o n o pio id u se rs ’ s ta te d p re fe re n ces f o r
M MT, B U P, X R-N TX , o r n o m ain te n an ce M AT a s t h ey e n te re d s h ort- te rm i n patie n t d eto xif ic atio n a n d
w ere a sk ed t o c o nsid er t r e atm en t f o llo w in g r e tu rn t o t h e c o m munity . A s h ypoth esiz ed , b elie fs a b out
eff ic acy, s a fe ty , a n d c o nsis te n cy w ith b ein g d ru g-fre e w ere a sso cia te d w ith p ost- d eto xif ic atio n
tr e atm en t p re fe re n ces. O ur f in din gs w ere c o nsis te n t w ith o ur h ypoth ese s a n d t h e H ealth B elie f m odel:
t h e g ro up o f p artic ip an ts w ho s ta te d a p re fe re n ce f o r a p artic u la r M AT r a te d t h at M AT m ore p ositiv ely
t h an t h ose w ho d id n ot p re fe r t h at M AT. N ot s u rp ris in gly g iv en t h e b urd en o f d aily a p poin tm en ts ,
str u ctu ra l b arrie rs ( p artic u la rly t r a n sp orta tio n a n d t im e) w ere a sso cia te d w ith d is fa v or f o r M MT, w ith
p artic ip an ts w ho p re fe rre d B U P b ein g p artic u la rly l ik ely t o e n dors e b arrie rs t o M MT. H ow ev er, i n
c o ntr a st t o t h e s tr o ng a sso cia tio ns b etw een b elie fs a n d s ta te d p re fe re n ces, t h e f o ur p re fe re n ce g ro ups
did n ot d if f e r b y e n dors e m en t o f s tr u ctu ra l b arrie rs t o B U P o r X R-N TX ; n or d id p re v io us t r e atm en t
ex perie n ce a ff e ct o ne’s c h oic e o f M AT. M ost p artic ip an ts w ere c o nfid en t t h at t h ey w ould b e a b le t o
s ta rt t h eir p re fe rre d m ed ic atio n; t h is d id n ot d if f e r b etw een t h e t h re e M ATs. T hus, p artic u la rly f o r B U P
an d X R-N TX , b elie fs a b out t h e m ed ic atio ns ( ra th er t h an s tr u ctu ra l b arrie rs o r p re v io us e x perie n ce)
m ay b e v ery i n flu en tia l i n p atie n t m ed ic atio n p re fe re n ce. T he i m porta n ce o f t h e p erc ep tio n o f e ff ic acy
fo r p atie n ts ’ s ta te d p re fe re n ces i s c o nsis te n t w ith l ite ra tu re o n c o rre la te s o f r e te n tio n i n M MT ( K ay m an
et a l., 2 006 ) a n d p atie n t p re fe re n ces f o r h ow l o ng t o c o ntin ue M MT ( B en tz le y e t a l., 2 015 ; W in sto ck e t
al., 2 011 ).
S ev en ty -e ig ht p erc en t o f p artic ip an ts s ta te d a p re fe re n ce f o r a m ed ic atio n f o llo w in g i n patie n t
deto xif ic atio n, w ith m ore p eo ple p re fe rrin g X R-N TX a n d B U P t h an M MT. I n t h e s a m ple a s a w hole ,
M MT w as p erc eiv ed a s t h e l e ast s a fe , l e a st e ff ic acio us, a n d l e ast c o nsis te n t w ith b ein g d ru g-fre e o f a ll
t h e M ATs. W e e x am in ed h ow t h ese p re fe re n ces c o rre sp ond t o s c ie n tif ic l ite ra tu re o n e ff ic acy a n d
sa fe ty . T he p erc ep tio n o f p oore r e ff ic acy o f M MT v s. B U P i s n ot i n f a ct s u pporte d b y e x is tin g e ff ic acy
lite ra tu re ( M attic k e t a l., 2 014 ). L ite ra tu re c o m parin g t h e s a fe ty o f M M T a n d B U P i s m ore c o m ple x .
B U P h as l o w er p ote n tia l f o r o verd ose t h an M MT ( W hela n & R em sk i, 2 012 ), a n d t h ere i s s o m e
ev id en ce f ro m p opula tio n b ase d s tu die s t h at t h ere m ay b e a h ig her d eath r a te a sso cia te d w ith M MT
(Connock e t a l., 2 007 ). H ow ev er, s tu die s c o m parin g r a te s o f s e rio us a d vers e e v en ts i n B U P
m ain te n an ce v s M MT f o und n o s ig nif ic an t d if f e re n ces i n r a te s o f s e rio us a d vers e e v en ts ( C onnock e t
al., 2 007 ).T here fo re , t h e q uestio n o f r e la tiv e s a fe ty i s c le arly a c o m ple x o ne.
A lth ough i t i s a f a ir ly n ew o ptio n, p artic ip an ts i n t h is s tu dy d em onstr a te c o nsid era b le i n te re st i n X R-
N TX . D esp ite ( o r p erh ap s b ecau se o f) t h e f a ct t h at f e w p eo ple h av e t r ie d X R-N TX i n t h e p ast, i t w as
371
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371
371
2,3 71
371 371
371
2,2 78 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
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th e m ost c o m monly c h ose n p re fe rre d M AT. X R-N TX a ls o r e q uir e s o nly m onth ly v is its , a n d g iv en t h at
tr a n sp orta tio n a n d t im e a re i m porta n t s ta te d b arrie rs t o M MT, i t r e p re se n ts a c o nven ie n t o ptio n. ( L ik e
M MT a n d B U P, X R-N TX i s a ls o c o vere d b y i n su ra n ce i n M assa ch use tts ). O th er s tu die s h av e
docu m en te d p atie n t w illin gness t o t r y X R-N TX a s w ell ( A ham ad e t a l., 2 015 ), w ith d aily h ero in
in je ctio n u se b ein g a sso cia te d w ith h ig her i n te re st i n X R-N TX . W e d o n ot k now w heth er a ttitu des
to w ard , o r i n te re st i n X R-N TX w ill c h an ge o nce a s u bsta n tia l p ro portio n o f e lig ib le p eo ple h av e h ad
e x perie n ce w ith i t. I t i s p ossib le t h at t h e l e v el o f i n te re st i n X R-N TX i s s im ply a f u nctio n o f i ts n ovelty
a s a t r e atm en t. H ow ev er, r e g ard le ss o f e x perie n ce, i f p atie n ts u nders ta n d t h at X R-N TX d oes n ot
co nta in a s y nth etic o pio id , t h ey m ay b e m ore l ik ely t o b elie v e i t i s c o nsis te n t w ith b ein g d ru g-fre e.
In deed , r a tin gs f o r “ co nsis te n cy w ith b ein g d ru g-fre e” f o r X R-N TX w ere h ig her t h an f o r B U P a n d
M MT i n t h e s tu dy s a m ple a s a w hole
T here i s s ig nif ic an t c o ncern t h at o pio id -d ep en den t p atie n ts f re q uen tly d o n ot i n itia te t h e t r e atm en t
ch oic es w ith t h e s tr o ngest e ff ic acy d ata – i .e ., M MT o r B U P ( V olk ow e t a l., 2 014 ), l e av in g p ers o ns a t
ris k f o r o pio id o verd ose i n t h e d ay s f o llo w in g d eto xif ic atio n ( V olk ow e t a l., 2 014 ). I n deed , t w en ty -tw o
perc en t o f o ur s a m ple s ta te d a p re fe re n ce f o r n o M AT, a n d u ndoubte d ly s o m e o f t h e i n div id uals w ho
sta te d a p re fe re n ce o f a n M AT d id n ot g o o ne t o s ta rt o ne. A lth ough b arrie rs t o M AT u se e x is t o n a
n um ber o f l e v els — fro m s o cia l s u pport t o t r e atm en t a v aila b ility — our s tu dy s u ggests t h at a tte n tio n t o
p atie n ts ’ b elie fs a b out M ATs m ay b e a n i m porta n t c o m ponen t o f a m ulti- fa cto ria l p la n t o i n cre ase t h e
use o f M ATs a m ong o pio id u se rs w ho a re n ot s e ek in g l o ng-te rm r e sid en tia l t r e atm en t. O ne m eth od f o r
ad dre ssin g p atie n ts ’ p re -e x is tin g k now le d ge, c o m munic atin g r is k i n fo rm atio n, a n d i n clu din g p atie n ts ’
v alu es i n d ecis io ns a b out t r e atm en t i s s h are d d ecis io n m ak in g p ro cesse s a n d d ecis io n s u pport t o ols ( L in
& F ag erlin , 2 014 ). T o d ate , t h ere i s v ery l ittle r e se arc h o n s h are d d ecis io n m ak in g i n te rv en tio ns f o r
tr e atm en t f o r s u bsta n ce u se , a lth ough o n e s u ch i n te rv en tio n h as b een s h ow n t o i m pro ve o utc o m es f o r
in div id uals i n d ru g t r e atm en t p ro gra m s ( J o oste n , d e J o ng, d e W eert- v an O en e, S en sk y, & v an d er S ta ak ,
2009 ). C erta in ly , i t w ould s e em v alu ab le t o d ev elo p a n d e v alu ate s tr u ctu re d e d ucatio n p ro gra m s t h at
c o rre ct f a ctu ally i n co rre ct a ttitu des ( e .g ., a b out e ff ic acy ) a s w ell a s h elp p atie n ts t o a ccu ra te ly
u nders ta n d a n d w eig h r is k s a n d b en efits o f a ll t r e atm en t o ptio ns, i n clu din g n o a fte rc are t r e atm en t.
O th ers h av e o utlin ed p rin cip le s f o r e ff e ctiv ely c o m munic atin g h ealth r is k i n fo rm atio n ( L in & F ag erlin ,
2014 ). F urth er, t o t h e e x te n t t h at t h ere i s a d om in an t c u ltu ra l n arra tiv e t h at M ATs a re i n co nsis te n t w ith
b ein g d ru g-fre e, i n clu din g s to rie s f ro m p eers ( e .g ., t h ro ugh t h e u se o f v id eo ) t h at c h alle n ge t h at
n arra tiv e m ay b e a n i m porta n t c o m ponen t o f e d ucatio nal t o ols ( H ousto n, C herrin gto n, e t a l., 2 011 ).
In deed , v id eo s o f p eer s to rie s h av e b een s h ow n t o i m pro ve c o ntr o l o f o th er h ealth p ro ble m s s u ch a s
h yperte n sio n ( H ousto n, A llis o n, e t a l., 2 011 ). F in ally , n ot a ll s u bsta n ce u se c o unse lo rs h av e p ositiv e
attitu des t o w ard s M ATs ( R ie ck m an n, D ale y, F ulle r, T hom as, & M cC arty , 2 007 ) o r e n dors e t h e
im porta n ce o f e v id en ce-b ase d c are ( R ie ck m an n, F are n tin os, T illo ts o n, K ocarn ik , & M cC arty , 2 011 ).
C ounse lo rs m ay b en efit f ro m a ccu ra te e d u catio n a b out r is k s a n d b en efits o f M ATs a s w ell.
I n t h is s tu dy, t h e p ro portio n o f p eo ple s ta tin g a p re fe re n ce f o r a n y M AT ( 7 8% ) w as h ig her t h an t h e
pro portio n t h at w e f o und i n p re v io us r e se arc h i n p ers o ns u nderg oin g i n patie n t d eto xif ic atio n a t t h e
sa m e s ite c o nducte d i n 2 011 . I n t h e p re v io us p ro je ct ( B aile y e t a l., 2 013 ), w hen a sk ed , “ W hen y ou
le av e d eto xif ic atio n t h is t im e, d o y ou w an t t o t a k e m ed ic atio n s u ch a s S uboxone, m eth ad one, o r
V iv itr o l f o r y our o pia te a d dic tio n?” 6 3% i n dic ate d a n i n te re st i n M AT. T he d if f e re n ce i n p ro portio ns
m ay b e d ue t o m ore p ositiv e a ttitu des t o w ard s M ATs o ver t im e; h ow ev er, w e c an not r u le o ut t h e
dif f e re n t p hra sin g o f t h e q uestio n a s a p ossib le e x pla n atio n. I n t h e c u rre n t s tu dy, p artic ip an ts w ere
e x plic itly g iv en t h e o pportu nity t o “ o pt o ut” o f t h e q uestio n a b out M AT p re fe re n ces ( i.e ., c h oose
“ n one”), b ut a l im ita tio n o f t h e c u rre n t s tu dy i s t h at t h e w ay t h at t h e p re fe re n ce q uestio n w as w ord ed ,
partic ip an ts m ay h av e s e n se d t h at i t w as m ore d esir a b le t o c h oose a n M AT r a th er t h an c h oose t h e
re sp onse “ n one.” 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 10/13
Go to :
G o to :
W hile t h eo rie s o f b eh av io r c h an ge s u ggest t h at s ta te d p re fe re n ces, c o nfid en ce, p erc eiv ed b en efits , a n d
perc eiv ed b arrie rs i n flu en ce a ctu al b eh av io r ( W eb b, S nie h otta , & M ic h ie , 2 010 ), a n d t h ere i s e m pir ic al
su pport t h at p re fe re n ces ( L am booij e t a l., 2 015 ; S ala m pessy e t a l., 2 015 ) d o i n f a ct p re d ic t v ario us
health b eh av io rs i n clu din g c h oic e o f m eth ad one v s. B U P ( R id ge e t a l., 2 009 ), o ur s tu dy d id n ot a sse ss
w heth er p artic ip an ts a ctu ally s ta rte d t h eir p re fe rre d , o r a n y, M AT. A l im ita tio n o f t h is s tu dy i s t h at i t i s
q uite l ik ely t h at s o m e o f t h e p artic ip an ts s ta tin g a p re fe re n ce f o r a p artic u la r M AT d id n ot s ta rt t h at
M AT. A n a d ditio nal l im ita tio n w as t h at a lth ough w e m easu re d w heth er p artic ip an ts h ad r e ceiv ed a
t r e atm en t p re v io usly , w e d id n ot m easu re t h e n atu re o f t h at e x perie n ce. I t i s p ossib le t h at t h e p ositiv e
an d/o r n eg ativ e a sp ects o f t h at e x perie n ce w ould i n flu en ce c u rre n t a ttitu des a n d p re fe re n ces. S om e
pre v io us r e se arc h h as f o und t h at p re v io us e x perie n ce i s r e la te d t o c h oosin g M MT v s. B U P, a n d t h at
p re v io us e x perie n ce i s m ore l ik ely t o b e c o nsid ere d n eg ativ e t h an p ositiv e ( P in to e t a l., 2 010 ). F in ally ,
w e d id n ot a sse ss a n oth er p ote n tia l p erc eiv ed h arm – c o ncern s a b out t h e d if f ic u lty o f w ith dra w al f ro m
a M AT – t h at m ay a ls o h av e a n i m pact o n w heth er p atie n ts p re fe r t o s ta rt t h at t r e atm en t.
T his s tu dy c o ntr ib ute s t o t h e e x is tin g l ite ra tu re i n s e v era l w ay s. F ir s t, w e u se d a w ell- k now n c o ncep tu al
m odel t o p re d ic t s ta te d t r e atm en t p re fe re n ces. T he s c ale s w e c re ate d t o m easu re b elie fs a b out M ATs
had s a tis fa cto ry i n te rn al c o nsis te n cy, f a ce v alid ity , a n d w ere c o nsis te n t w ith s ta te d M AT p re fe re n ce,
su pportin g t h e u tility o f t h e H ealth B elie f M odel a n d t h ese s c ale s i n t h is p opula tio n. S eco nd, p re v io us
stu die s o n p atie n t b elie fs a b out M ATs e it h er e x am in ed h ow b elie fs p re d ic te d a p re fe re n ce f o r ( o r a ctu al
c h oic e o f) M MT v s. B U P ( G ry czy nsk i e t a l., 2 013 ; P in to e t a l., 2 010 ; R id ge e t a l., 2 009 ) o r e x am in ed
re te n tio n i n ( K ay m an e t a l., 2 006 ) o r i n te n ded d ura tio n o f ( B en tz le y e t a l., 2 015 ; W in sto ck e t a l., 2 011 )
m ain te n an ce t r e atm en t w ith e ith er M MT o r B U P. A noth er s tu dy c o ntr a ste d a ttitu des t o w ard B U P o r
M MT a m ongst p atie n ts e n ro llin g i n M MT o r p eo ple n ot i n t r e atm en t ( S ch w artz e t a l., 2 008 ). T hus, o ur
stu dy i s u niq ue i n t h at w e w ere a b le t o c o ntr a st s ta te d p re fe re n ce f o r M MT o r B U P t o b oth X R-N TX
an d n o M AT. F urth er, w e w ere a b le t o d o s o a t a m om en t w hen t h at d ecis io n w as v ery i m med ia te ly
r e le v an t t o p atie n ts ( i.e ., w hen t h ey w ere i n a d eto xif ic atio n p ro gra m ). F in ally , w e n ote t h at t h ere w as
e x celle n t p artic ip atio n, w ith a p pro xim ate ly 9 4% o f e lig ib le p atie n ts t a k in g p art i n t h e s tu dy. T his
s u pports t h e g en era liz ab ility o f o ur r e su lts t o p atie n ts i n d eto xif ic atio n p ro gra m s.
5 . C onclu sio ns
In s u m , t h is s tu dy d em onstr a te s t h at, d urin g i n p atie n t d eto xif ic atio n, b elie fs a b out m ed ic atio ns’
e ff ic acy, s a fe ty , a n d c o nsis te n cy w ith b ein g d ru g-fre e a re a sso cia te d w ith p atie n ts p re fe re n ces f o r M AT
optio ns a fte r d eto xif ic atio n, a n d t h ere fo re m ay c o ntr ib ute t o w heth er p atie n ts s ta rt a n M AT f o llo w in g
deto xif ic atio n, a n d, i f s o , w hic h M AT t h ey c h oose . P atie n ts w ho s ta te d a p re fe re n ce f o r n o M AT h ad
th e m ost n eg ativ e b elie fs a b out a ll o f t h e M ATs. A lth ough s tr u ctu ra l, n on-a ttitu din al b arrie rs a re s u re t o
p la y a r o le i n t r e atm en t p re fe re n ce a n d p o st- d eto xif ic atio n t r e atm en t i n itia tio n, e ff o rts t o i n cre ase M AT
upta k e m ig ht b en efit f ro m m ore f o cu se d a tte n tio n t o p atie n t b elie fs a n d e d ucatio nal i n te rv en tio ns t o
p ro m ote a p pro pria te a fte rc are e n ro llm en t.
H ig hlig hts
O pio id -d ep en den t p atie n ts r a te d p re fe re n ces f o r m ed ic atio n-a ssis te d t r e atm en ts
P ositiv e b elie fs a b out a m ed ic atio n w ere a sso cia te d w ith p re fe re n ce f o r t h at m ed ic atio n
P atie n ts p re fe rrin g n o m ed ic atio n-a ssis te d t r e atm en ts h ad t h e m ost n eg ativ e b elie fs
A s u bsta n tiv e p ro portio n p re fe rre d n altr e x one d esp ite l ittle p rio r e x perie n ce w ith i t
A ckn ow le dgm ents 4/26/2018 Patients’ beliefs about medications are associated with stated preference for methadone, buprenorphine, naltrexone, or no medication-as …
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892369/ 11/13
G o to :
G o to :
T his s tu dy w as f u nded b y t h e N atio nal I n stitu te o n D ru g A buse ( R O 1 D A034261). D r. S te in i s a
r e cip ie n t o f a N ID A M id -C are er I n vestig ato r A w ard ( K 24 D A00512). T hese f u ndin g s o urc es h ad n o
ro le i n t h e s tu dy d esig n, w ritin g o f t h e m an usc rip t, o r d ecis io n t o s u bm it i t f o r p ublic atio n.
F ootn ote s
Publis h er's D is cla im er: T his is a P D F file o f a n u nedit e d m anuscrip t t h at h as b een a cce pte d fo r p ublic a tio n . A s a
s e rv ic e to o ur c u sto m ers w e a re p ro vid in g th is e arly v e rs io n o f th e m an uscrip t. T he m an uscrip t w ill u nderg o
co pye dit in g, ty p ese ttin g, a nd r e vie w o f th e r e su lt in g p ro of b efo re it is p ublis h ed in it s fin a l c it a ble fo rm . P le ase n ote
t h at d urin g th e p ro ductio n p ro ce ss e rro rs m ay b e d is co ve re d w hic h c o uld a ff e ct th e c o nte nt, a nd a ll le gal
dis cla im ers th at a pply to th e jo urn al p erta in .
7 . R efe re nce s
1. A ham ad K , M illo y M J, N guyen P , U hlm an n S , J o hnso n C , K orth uis T P, W ood E . F acto rs
a sso cia te d w ith w illin gness t o t a k e e x te n ded r e le ase n altr e x one a m ong i n je ctio n d ru g u se rs .
A ddic t S ci C lin P ra ct. 2 015; 10 :1 2. [P M C f re e a rtic le ] [P ubM ed ]
2. B aile y G L, H erm an D S, S te in M D. P erc e iv ed r e la p se r is k a n d d esir e f o r m ed ic atio n a ssis te d
tr e atm en t a m ong p ers o ns s e ek in g i n patie n t o pia te d eto xif ic atio n. J S ubst A buse T re at.
2 013; 45 (3 ):3 02–305. [P M C f re e a rtic le ] [P ubM ed ]
3. B ase r O , C halk M , F ie llin D A, G astf rie n d D R. C ost a n d u tiliz atio n o utc o m es o f o pio id -
dep en den ce t r e atm en ts . A m J M an ag C are . 2 011 ; 17 (S uppl 8 ):S 235–S 248. [P ubM ed ]
4. B en tz le y B S, B arth K S, B ack S E , A ro nso n G , B ook S W . P atie n t P ers p ectiv es A ss o cia te d w ith
I n te n ded D ura tio n o f B upre n orp hin e M ain te n an ce T hera p y. J S ubst A buse T re at. 2 015; 56 :4 8–53.
[P M C f re e a rtic le ] [P ubM ed ]
5. B usc h M , H aas S , W eig l M , W ir l C . L ong t e rm s u bstitu tio n t r e atm en t ( m ain te n an ce t r e atm en t) o f
opio id d ep en den t p ers o ns. G M S H ealth T ech nol A sse ss. 2 007; 3 D oc0 4. [P M C f re e a rtic le ]
[P ubM ed ]
6. C en te r f o r S ubsta n ce A buse T re atm en t. M ed ic atio n-a ssis te d t r e atm en t f o r o pio id a d dic tio n i n
o pio id t r e atm en t p ro gra m s. A T re atm en t I m pro vem en t P ro to co l ( T IP ) S erie s 4 3. D H HS
Public atio n N o. ( S M A) 0 5-4 048. R ock ville , M D: S ubsta n ce A buse a n d M en ta l H ealth S erv ic es
A dm in is tr a tio n; 2 005.
7. C onnock M , J u are z-G arc ia A , J o w ett S , F re w E , L iu Z , T ay lo r R J, T ay lo r R S. M eth ad one a n d
bupre n orp hin e f o r t h e m an ag em en t o f o p io id d ep en den ce: a s y ste m atic r e v ie w a n d e co nom ic
e v alu atio n. H ealth T ech nol A sse ss. 2 007; 11 (9 ):1 –171. i ii- iv . [P ubM ed ]
8. D e M aey er J , V an derp la ssc h en W , B ro ek aert E . Q uality o f l if e a m ong o pia te -d ep en den t
in div id uals : A r e v ie w o f t h e l ite ra tu re . I n t J D ru g P olic y. 2 010; 21 (5 ):3 64–380. [P ubM ed ]
9. F eele m yer J P , D es J a rla is D C, A ra ste h K , P hillip s B W , H ag an H . C han ges i n q uality o f l if e
( W HOQOL-B REF) a n d a d dic tio n s e v erity i n dex ( A SI) a m ong p artic ip an ts i n o pio id s u bstitu tio n
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