Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder

Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder

Published: May/June 2024
Journal Article

Overview

This one-hour, on-demand, journal article-based activity explores original qualitative research on patient perspectives regarding buprenorphine discontinuation in the treatment of opioid use disorder (OUD). Little is currently known about the causes of medication discontinuation from the patient perspective. Despite buprenorphine and other medications for OUD being the recommended standard care of treatment for OUD and the benefits of positive health and addiction-related outcomes associated with them, half of patients discontinue medication use in the first year of treatment. Emerging in interviews with patients with OUD treated with buprenorphine were three main themes related to medication discontinuation: health system barriers, adverse effects (or apparent adverse events) associated with the medication, and patient motivations. The purpose of this activity is to better understand patient perspectives around themes of discontinuation and to explore some clinical strategies to enhance patient retention.

The target audience for this intermediate continuing education activity includes: physicians, nurse practitioners, PAs, pharmacists, social workers, counselors, and other clinicians, researchers, students, and policymakers.

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice.

Article Abstract

Objectives: Buprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, with half of patients discontinuing in the first year of treatment. Addressing OUD is a major clinical priority, yet little is known about the causes of medication discontinuation from the patient perspective.

Methods: From March 2021 to April 2022, we conducted qualitative interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past 12 months. Eligible participants were selected from 2 Veterans Health Administration Health Care Systems in Oregon. Coding and analysis were guided by conventional qualitative content analysis.

Results: Twenty participants completed an interview; 90% were White and 90% were male, and the mean age was 54.2 years. Before discontinuation, participants had received buprenorphine for 8.3 months on average (range, 1–40 months); 80% had received buprenorphine for less than 12 months. Qualitative analysis identified the following themes relating to discontinuation: health system barriers (eg, logistical hurdles, rules and policy violations), medication effects (adverse effects; attributed adverse effects, lack of efficacy in treating chronic pain) and desire for opioid use. Patient description of decisions to discontinue buprenorphine could be multicausal, reflecting provider or system-level barriers in interaction with patient complexity or medication ambivalence.

Conclusion: Study results identify several actionable ways OUD treatment could be modified to enhance patient retention.

Learning Objectives

Upon completion, learners will be able to:

1. Identify major themes emerging from interviews with patient about their perspectives on buprenorphine discontinuation for opioid use disorder (OUD) treatment.
2. Identify several actionable ways that opioid use disorder (OUD) treatment can be modified to enhance patient retention in treatment. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

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Open Registration: 06/03/2024 - 06/01/2027

Close Access Date: 07/01/2027

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click View Journal Article and read the journal article in its entirety. 
3. Click Complete Post Test to answer multiple choice questions. Participants will have 10 attempts to pass and must answer 3 out of 4 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credit Designation Statements

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians

The American Society of Addiction Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses

This activity awards 1 Nursing contact hours.

Pharmacy

This activity will offer 1 pharmacy contact hours (1 CEUs). Pharmacists will be asked to provide identifying information (e-Profile ID and DOB in MMDD format) in order to receive credit and allow reporting to CPE Monitor. (UAN: JA0000141-0000-24-017-H99)

PAs

ASAM has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. Approval is valid until 06/01/2027. PAs should only claim credit commensurate with the extent of their participation.

Social Workers

As a Jointly Accredited Organization, ASAM is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1 general continuing education credits.

IPCE Credit

This activity was planned by and for the healthcare team, and learners will receive 1 Interprofessional Continuing Education (IPCE) credits for learning and change.

National Board for Certified Counselors ACEP

The American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. The American Society of Addiction Medicine is solely responsible for all aspects of the programs.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-1224.

Continuing Education Credits (CEUs)

Upon completion of the activity and online evaluation, all other participants may request a certificate of participation. Participants may submit this certificate of participation to their professional organization/institute as documentation for completing this accredited continuing activity.

Maintenance of Certification (MOC) or Continuing Certification Programs (CCP)

This activity meets the requirements for MOC/CCP for the following primary physician boards and for state licensing CME requirements. MOC Credit is only reported for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• American Board of Medical Specialties (ABMS)
• American Board of Preventive Medicine (ABPM)
• American Board of Internal Medicine (ABIM)
• American Board of Pediatrics (ABP)
• American Board of Surgery (ABS)
• American Board of Psychiatry and Neurology (ABPN)
• American Board of Addiction Medicine (ABAM)
• Royal College of Physicians and Surgeons of Canada (RCPSC)
  • Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons in Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Disclosure Information

In accordance with disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all CME/CE activities. These policies include mitigating all relevant financial relationships with ineligible companies for the Planning Committees and Presenters. All activity Planning Committee members and Presenters have disclosed all financial relationship information. The ASAM CE Committee has reviewed these disclosures and determined that the relationships are not inappropriate in the context of their respective presentations and are not inconsistent with the educational goals and integrity of the activity.