PMH67 REFUSAL OF ANCILLARY SUPPORT SERVICES EARLY IN TREATMENT PREDICTS SIX MONTH OUTCOMES AMONG BUPRENORPHINE-MEDICATION ASSISTED TREATMENT PATIENTS

Abstract

OBJECTIVES: Multiple treatment options exist for chemical dependence patients including medication, counseling, and self-help groups. Prior research indicates that outcomes may be affected by choices patients make early in treatment. The purpose of this study was to examine patient differences among those who chose to participate in an ancillary patient support program early in opioid dependence (OD) treatment compared to those who chose not to. METHODS: OD patients new to B-MAT (N = 1426) were randomized to receive B-MAT plus a patient support program (experimental group, n = 987) or B-MAT alone (standard care, n = 439). The experimental group was divided into 2 groups based on patient choice: 1. refused to participate in the intervention (n = 336); 2. agreed to participate (n = 651). Subjects completed the Addiction Severity Index (ASI) at baseline, 1, 2, 3, and 6 months post-enrollment. The ASI is a semi-structured interview designed to measure problem severity in 7 functional areas known to be affected by alcohol and drug dependence. RESULTS: At month six, subjects who refused the intervention were less likely to be compliant with B-MAT (51.4%) compared to both the accepted intervention group (70.1%) and the standard care group (64.7%; c2(2, n = 1062) = 25.24, p < .001). Further, at baseline, those who refused the intervention had lower legal, psychiatric, and family composite scores, which indicates lower problem severity in these areas, (p's < .05) compared to experimental cases who agreed to participate. CONCLUSIONS: Subjects who refused the intervention reported the lowest rate of B-MAT compliance at month six making refusal a potential triage indicator. However, as a group, refusers also reported lower problem severity in several functional areas at baseline compared to those who agreed to participate. Refusal of ancillary services alone is not an adequate triage indicator as refusals are heterogeneous in problem severity make-up.