Treatment Discontinuation and Barriers and Facilitators to Retention Among Individuals Initiating Buprenorphine for Opioid Use Disorder: A Longitudinal Cohort Study.

Abstract

Early discontinuation of medication for opioid use disorder (MOUD) is associated with increased mortality and hinders remission. Combining data from electronic health records (EHRs) and patient questionnaires, we examined buprenorphine discontinuation and barriers and facilitators to retention in outpatient settings. Adults initiating buprenorphine in a Pennsylvania outpatient program (2021-2023) completed 2 questionnaires: at medication initiation (baseline) and 6 months after initiation (follow-up). Among 1189 eligible patients, we evaluated buprenorphine discontinuation (≥30-d gap in medication supply) and compared demographic factors using EHRs. We identified discontinuation reasons among survey participants (baseline n = 374; follow-up n = 197) through medical record review; questionnaires assessed treatment barriers and facilitators. Within 6 months, 629 (53%) patients discontinued buprenorphine, though 15% restarted medication within the 6-month period. Discontinuation was more common among younger patients. Among baseline survey participants, discontinuation was usually unplanned (66%) or against provider advice (19%). Among follow-up participants who discontinued the program during the follow-up period, 54% reported receiving MOUD at 6 months, indicating that many transition to other treatment programs. Those not receiving medication at 6 months cited lack of need (46%). Travel challenges (distance/transportation to clinics), scheduling, and mental health conditions were common barriers to treatment; facilitators centered on improving these factors and clinic processes. Observed patterns reflect dynamic and noncontinuous receipt of medication over time and underscore the early months of treatment as a critical window for supporting buprenorphine engagement. Findings reveal actionable areas to improve retention by reducing logistical burdens, enhancing nonjudgmental therapeutic support, and integrating mental health care.