Preferences for opioid agonist treatment among people who regularly use opioids in Australia: the prefer study

Author: Louisa Degenhardt Jason Grebely Frederick Altice Anna Conway Tom Hassett Jodi Van Dyk Marianne Byrne Samantha Colledge Phillip Read Mark Montebello Gilbert Whitton Jeremy Hayllar Gregory Dore Michael Farrell Jason Grebely

Theme: Clinical Research Year: 2021

Background: Methadone and buprenorphine are established as effective opioid agonist treatments (OAT). The availability of extended-release buprenorphine (XR-BUP) has the potential to transform OAT for some people, but research evaluating OAT preferences is limited. This study evaluated OAT preferences and associated factors. Methods: PREFER is a cross-sectional cohort study of opioid dependent people (opioids used in 21 of the past 28 days) recruited in Australia from needle and syringe programmes, OAT services, snowballing, and wordof-mouth. Participants completed an interviewer-administered questionnaire including demographics, injecting drug use characteristics, drug treatment history, and preferences for OAT. Preferences for OAT and associated factors were evaluated. Results: Between October 2020-April 2021, 360 participants were enrolled (mean age 45, 42% female), with 77% injecting drugs in the last month, 96% having ever received OAT, and 80% currently receiving OAT (61% methadone, 15% oral buprenorphine+naloxone, and 5% XR-BUP). Methadone was preferred by 54% (n=195), buprenorphine by 34% (n=122), no OAT preference by 9% (n=33), and 3% did not want OAT. Among those who preferred buprenorphine (n=122), oral buprenorphine + naloxone was preferred by 50% (n=61) and XR-BUP by 50% (n=61). Among those with a preference for OAT, injecting drug use in the last month was associated with reduced odds of preferring buprenorphine treatment (vs methadone) (aOR 0.51, 95% CI 0.30-0.87) adjusting for age and gender. Among those with a preference for buprenorphine, currently receiving methadone was associated with a preference for XR-BUP (aOR 6.16, 95% CI 1.73-21.89) adjusting for age and gender. Discussion: In this sample, 54% and 34% indicated a preference for methadone and buprenorphine, respectively. Among those with a preference for buprenorphine, 50% indicated a preference for XR-BUP. Further work is needed to better understand factors influencing patient preferences for XR-BUP to guide clinical decision making.

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