Proportional Hazards Frailty Models for Recurrent Methadone Maintenance Treatment

The authors’ objective in this study was to identify determinants of time to discontinuation of methadone maintenance treatment (MMT) across multiple treatment episodes. Population-level data on drug dispensations for all patients receiving methadone for opioid maintenance throughout the tenure of t...

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Bibliographic Details
Published in:American journal of epidemiology 2009-09, Vol.170 (6), p.783-792
Main Authors: Nosyk, Bohdan, MacNab, Ying C., Sun, Huiying, Fischer, Benedikt, Marsh, David C., Schechter, Martin T., Anis, Aslam H.
Format: Article
Language:English
Subjects:
Addictive behaviors
Adult
Adult and adolescent clinical studies
Analgesics, Opioid - therapeutic use
Analysis. Health state
Biological and medical sciences
British Columbia - epidemiology
Clinical outcomes
Confidence Intervals
Databases, Factual
Drug addiction
Epidemiology
Female
General aspects
heroin dependence
Heroin Dependence - mortality
Heroin Dependence - rehabilitation
Humans
Kaplan-Meier Estimate
Male
Medical sciences
Methadone
Methadone - therapeutic use
Multivariate Analysis
Narcotics
opioid-related disorders
Proportional Hazards Models
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
Recurrence
Statistics as Topic
Substance abuse treatment
Substance Abuse Treatment Centers
survival analysis
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Summary:The authors’ objective in this study was to identify determinants of time to discontinuation of methadone maintenance treatment (MMT) across multiple treatment episodes. Population-level data on drug dispensations for all patients receiving methadone for opioid maintenance throughout the tenure of the British Columbia, Canada, methadone program to date (1996–2007) were extracted from an administrative database. Proportional hazards frailty models were developed to assess factors associated with time to discontinuation from recurrent MMT episodes. A total of 17,005 patients experienced 32,656 treatment episodes over the 11-year follow-up period. Age, medical comorbidity, and physician patient load, as well as neighborhood-level socioeconomic status indicators, were significant predictors of time to discontinuation of treatment; treatment adherence and average daily doses up to and above 120 mg per day were also associated with longer treatment episodes. Studies have shown that while successfully retained in MMT, clients decrease their illicit drug use and criminal activity, and their risk of mortality is substantially lower; however, the majority of clients relapse. Many reenter treatment. The primary finding of this study was that patients experiencing multiple treatment episodes tended to stay in treatment for progressively longer periods in later episodes.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kwp186