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Introduction. Medication-Assisted Therapy (MAT) for opioid addiction has dramatically increased in Vermont, supported by a novel statewide system that integrates specialty treatment centers ("Hubs") with primary care office-based opioid therapy ("Spokes"). In 2010, Vermont had the highest per capita buprenorphine use in the US. Previous studies of patient perspectives of MAT have identified social barriers, rigid program rules, and concerns about withdrawal and relapse as common causes of treatment failure. Our goal was to elicit patient perspectives on barriers and enablers of successful MAT to further inform system refinement.
Methods. An interview guide was developed based on previous literature as well as discussions with program leadership, staff and clinicians, and community stakeholders. Responses were organized using thematic content analysis with consensus across seven interviewers and two analysts. The interviews were conducted with 44 patients enrolled in MAT at two Hub sites in Burlington, VT in October 2016.
Results. The median age of subjects was 34 years, 34% were employed at least part-time, and 72% were female. Half reported a mental health condition and 20% reported chronic pain. Barriers included transportation (25%), lack of stable housing, and stigma (41%). Enablers included feeling supported (82% felt well-supported; 52% felt supported by healthcare professionals). Subjects expressed high confidence in the treatment system and high self-efficacy for sobriety.
Conclusions. Patients in MAT have complex medical, mental health, social, personal, and work lives. A comprehensive system that addresses this wide range of domains is critical to achieving optimal outcomes.
Elizabeth Cote, University of Vermont AHEC Program
Charles MacLean, The University of Vermont
Jan Carney, The University of Vermont
University of Vermont AHEC Program
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Adkins, Ashley D.; Bachilas, Holly; DiBiase, Florence; Marallo, Michael J.; Nsubuga, John Paul; Patashnick, Lloyd; Uppaluri, Curran; Cote, Elizabeth; and MacLean, Charles, "Patient Perspectives on Medication Assisted Therapy in Vermont" (2017). Public Health Projects, 2008-present. 247.