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J Addict Dis. 2016;35(1):22-35. doi: 10.1080/10550887.2016.1100960. Epub 2015 Oct 14.

Retention in medication-assisted treatment for opiate dependence: A systematic review.

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a Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System , Palo Alto , California , USA.
b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.
c Department of Psychology , Auburn University , Auburn , Alabama , USA.
d Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.
e VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.
f Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.
g Research Service, Veterans Affairs Boston Heathcare System , Brockton , Massachusetts , USA.
h Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System , Palo Alto , California , USA.


Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010-2014) found wide variability in retention rates (i.e., 19%-94% at 3-month, 46%-92% at 4-month, 3%-88% at 6-month, and 37%-91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.


Opiate dependence; behavioral therapies; medication-assisted treatment; systematic review; treatment retention

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