Association Between Receipt of Antidepressants and Retention in Buprenorphine Treatment for Opioid Use Disorder: A Population-Based Retrospective Cohort Study

Kun Zhang, PhD^a ; Christopher M. Jones, PharmD, DrPH^a ; Wilson M. Compton, MD, MPE^b ; Gery P. Guy, PhD, MPH^a ; Mary E. Evans, MD^a ; Nora D. Volkow, MD^b

J Clin Psychiatry 2022;83(3):21m14001

ABSTRACT

Objective: Clinical interventions targeting co-occurring psychiatric disorders may represent a tangible target for improving retention in buprenorphine treatment for opioid use disorder. The aims of this study are to characterize receipt of antidepressants among patients receiving buprenorphine treatment and to examine the association between receiving antidepressants and retention in treatment.

Methods: A retrospective cohort design was used. Using data from a large national commercially insured population, the cohort was selected as adults aged 18 to 64 years who initiated buprenorphine treatment in outpatient settings between January 1, 2016, and June 30, 2017. Receiving antidepressants was identified as prescription fills in the period between 6 months prior to buprenorphine initiation and during buprenorphine treatment. Buprenorphine discontinuation was defined as no buprenorphine prescription supply for at least 60 days following the end of the last buprenorphine prescription.

Results: The cohort consisted of 11,619 individuals who initiated buprenorphine treatment and met our inclusion criteria. The cohort had a mean age of 36.3 years, 63% were male, and 55.7% received at least 1 antidepressant prescription at any time between 6 months prior to buprenorphine initiation and during treatment. Compared with those receiving no antidepressants at all, individuals starting antidepressants during buprenorphine treatment had an adjusted hazard ratio (HR) for treatment discontinuation of 0.72 (95% CI = 0.67–0.77), while receiving antidepressants only prior to buprenorphine initiation was associated with an increased risk of treatment discontinuation (HR = 1.40, 95% CI = 1.28–1.53).

Conclusions: Findings suggest that receiving antidepressants during buprenorphine treatment is associated with improved retention. This highlights the critical importance of screening for and treating mental disorders concomitantly with treatment of opioid use disorder.

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