This study examined factors affecting adherence to Suboxone treatment among 50 African American patients through a retrospective chart review. The results showed significantly negative correlations between adherence and concurrent use of opioids, cocaine, and alcohol. Surprisingly, PTSD showed a positive correlation with adherence, contradicting other studies. No correlation was found between adherence and unemployment. The study concluded that while mental health issues and unemployment may impact adherence, the small sample size likely influenced the results. Larger studies are still needed to fully understand factors affecting Suboxone adherence in minority groups.

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Factors Affecting Therapeutic Adherence to Suboxone among Opioid
Dependent African Americans: A Retrospective Chart Review Study
Suneeta Kumari, MD, MPH, Partam Manalai, MD, William. B Lawson, MD, PhD, DLFAPA
Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington DC
ABSTRACT
• Introduction: According to various studies, Suboxone adherence
is lower among African Americans than in other racial groups.
(3,8) The presence of a mental disorder, homelessness, illicit
drug use, and unemployment are all factors that contribute to low
adherence. Still, much more needs to be discovered. The
identification and understanding of the various factors affecting
adherence to Suboxone is needed in order to improve adherence
to Suboxone.
• Hypothesis: Patients with an axis 1 mental disorder, an
unemployment status, and concurrent illicit drug use are less
likely to exhibit adherence to and retention in Suboxone treatment
program than patients without these circumstances.
• Methods: A chart review of 50 patients in the Department of
Psychiatry at Howard University Hospital was conducted. Data
was collected from their charts, including urine toxicology results
from each visit were reviewed. Adherence was then determined
by reviewing the urine toxicology results based on buprenorphine
positive at least 80% of the time. SPSS 22.0 was used to analyze
the data.
• Results: A significantly negative correlation between the use of
opioids (p=.001) cocaine (p=0.002 and alcohol (p=0.038) and
Suboxone adherence was found, along with a positive correlation
between PTSD (p=0.019) and Suboxone adherence. No
correlation between unemployment and adherence was
found.SPSS 22.0 was used to analyze the data.
• Conclusion: Suboxone adherence and its contributing factors is
still a topic that must be studied further. Although the presence of
other axis I mental disorders and unemployment may be
contributory to non-adherence, our data did not find such an
association. Further and larger studies are needed to validate our
findings.
INTRODUCTION
HYPOTHESIS
Patients with an axis 1 mental disorder, an unemployment
status, and/or concurrent drug use are less likely to exhibit
adherence to and retention in Suboxone treatment than
patients without these circumstances.
METHODS
METHODS
RESULTS
• In this chart review study, the data from 50 patient charts
were analyzed. The chi-square analysis revealed that
there was a significantly negative correlation between
the concurrent use of other substances, mainly opioids
(p=.001), cocaine (p=0.002) and alcohol (p=0.038) and
Suboxone adherence among non-adherent group. This
result is congruent with other studies and demonstrates
that as expected, continued opioid use interferes with
the successful treatment of opioid addiction.
• PTSD was the only axis 1 mental disorder that showed
correlation with Suboxone adherence. Surprisingly, the
chart review study found 81.8% of PTSD patients
demonstrated compliance to BUP-naltrexone (p=0.019).
This contradicts the many studies that state that patients
with PTSD are more likely to be non-adherent to their
medication (5). Therefore, one very likely explanation for
this result is our small sample size. This limitation has
most likely greatly influenced the outcome of the study,
and therefore needs to be kept in mind when interpreting
the results.
• Although unemployment has been linked to Suboxone
non-adherence in other studies, no correlation between
the two was present in our chart review.
CONCLUSION
REFERENCES
• Overall, Suboxone adherence and its contributing factors,
especially in minority groups, is still a topic that must be
studied further. In this chart review, significant negative
correlations were found between the use of opioids,
cocaine, alcohol. Although the presence of axis I mental
disorders (Major depression, bipolar disorder ) and
unemployment may be contributory to non-adherence, our
data did not find an association between these factors
and Suboxone adherence. Further and larger studies are
needed to validate and determine the generalizability of
our findings.
• Opioid use disorders are common chronic relapsing disorder
affecting 9% (over 22 million) Americans age 12 & older (1)
• Epidemiological studies report that African American experience
the full range of Psychiatric disorders (Kessler et al. 2005) (8)
• Although the abuse of opioids can be devastating, with the help
of Suboxone, many individuals are successfully being treated
for this problem (2). Unfortunately, disparities in substance
abuse treatment do exist among African American (3, 6)
• In a recent study, Guerroro, et al found African-Americans to be
less likely to complete treatment than whites (3). Other studies
have also highlighted these disparities and the many factors that
contribute to them, such as the presence of a mental disorder,
homelessness, criminal involvement, illicit drug use, low income,
and employment. (3,4)
• Unfortunately, there have been very few studies performed on
the factors that contribute to Suboxone non-adherence in
African Americans. Therefore, the identification and
understanding of these factors is needed if an improvement in
adherence among this population is to be seen.
OBJECTIVES
This chart review study will explore and evaluate the impact
of various factors (axis 1 mental disorders, unemployment,
concurrent illicit drug use) in contributing to therapeutic
adherence to Suboxone.
• A retrospective chart review of 50 patients received
BUP-Nalaxone (BNX) between Jan. 2003 to Dec. 2013
at the Faculty Practice Plan (FPP) Dept. of Psychiatry
and Behavioral Sciences at Howard University Hospital
was conducted.
• All eligible patients were seen at the FPP on a monthly
or biweekly basis and a self-report symptoms checklist
was completed at each visit. The following independent
variables were measured: age, gender, employment
status, concurrent use of illicit drugs, post-traumatic
stress disorder (PTSD) status, Mood Disorder
Questionnaire (MDQ) for depression, and Patient Health
Questionnaire (PHQ-9) for bipolar disorder at the
baseline. The MDQ is a brief self-reported instrument/
tool to screen for mood disorders, while the PHQ-9 is a
nine item scale used to screen for depression and to
screen and monitor for treatment response. The
dependent variable was adherence to BUP-naltrexone
was determined by :
• Analyzing the urine drug screen (UDS) results
(where adherent = negative for opiates and positive
for buprenorphine at least 80% of the time and did not
have positive opioid UDS.
non- adherent = positive for opiates and positive for 7
panel drugs screen including buprenorphine metabolite,
heroin, oxycodone, methadone, cocaine,
benzodiazepine, marijuana, and methamphetamine).
• Analyzing the well-documented Suboxone group
notes for proof of attendance and self-reported
compliance (Table 1).
Although there is no consensual standard for what
constitutes adequate adherence, some trials considered
rate of 80% or greater to be acceptable for adequate
adherence (7).Participants with five or more visits were
included in the data analysis. The data on adherence
was reported as dichotomous variables (adherence vs
non-adherence) based upon urine drug screen (UDS)
findings.
• Urine toxicology (UTOX) results from each visit were
entered into SPSS 22.0, where chi-square tests were
performed to analyze the data.
Male 58%
Female 42%
Mean Age 54.04
Age Range 28-72
African-American 100%
Unemployed 88%
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Immune Defic Syndr. 2011 March 1; 56(Suppl 1): S83–S90.
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abuse treatment between and within racial and groups. Health Services Research, 48(4),
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understanding the role of buprenorphine in addressing heroin addiction in an urban-based
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disorders in the National Comorbidity Survey Replication. Achieves of General Psychiatry
62-593-602
TABLES
Suboxone adherence 48%
Suboxone group attendance 48%
Table 1
TABLES
Participants Characteristics at Baseline and Compliance to
Suboxone
Suboxone Compliance
Yes No Sample% χ2(df) p-value
Gender % ( n) % ( n)
Male 26 (13) 32 (16) 58 0.278(1) 0.598†
Female 22 (11) 20 (10) 42
Unemployment 40 (20) 48 (24) 88% 0.952(1) 0.329†
Suboxone group attended 46 (23) 0 46% 46.14(1) 0.0001***
Illicit Drug Use
Positive Opioid visit 29 (9) 71 (22) 62% 11.759(1) 0.001**
Positive Cocaine 17.6 (3) 82.4(14) 34% 9.507(1) 0.002**
Positive Benzodiazepine 31.6 (6) 68.4(13) 38% 3.311(1) 0.069†
Alcohol 30 (6) 70 (14) 40% 4.327(1) 0.038*
Positive for PCP 0 3.8 (1) 2% 0.942(1) 0.332†
Axis I disorders
Post-traumatic disorder screening questionnaire 81.8 (9) 9.1 (2) 24.40% 5.494(1) 0.019*
Major Depressive Disorder based on PHQ-9* 45.7 (16) 54.3 (19) 77.80% 0.635(1) 0.425†
Self reported Bipolar disorder 52 (13) 48 (12) 56.80% 0.002(1) 0.967†
Medications
Antidepressant 50 (12) 50 (12) 48% 0.074 (1) 0.786†
Antipsychotics 39 (07) 61 (11) 36% 0.935 (1) 0.333†
Mood Stabilizers 66.7 (4) 33.3 (2) 12% 0.952 (1) 0.329†
Benzodiazepine 46.2 (6) 53.8 (7) 26% 0.024 (1) 0.877†
Other Meds 33.3 (5) 66.7 (10) 30% 1.847 (1) 0.174†
Chi-square P-value for categorical variables.
***p<0.001; **p<0.01; *p<0.05; †p<0.10
*PHQ-9: Patient Health Questionnaire-9.