Factors Associated with Long-Term Retention in Buprenorphine-Based Addiction Treatment Programs: a Systematic Review

J Gen Intern Med. 2022 Feb;37(2):332-340. doi: 10.1007/s11606-020-06448-z. Epub 2021 Jan 19.


Background: The average length of buprenorphine treatment for opioid use disorder is less than 6 months.

Objective: We conducted a systematic review to determine what factors were associated with longer retention in buprenorphine treatment.

Design: We searched Medline, Embase, and Cochrane Database of Systematic Reviews in February 2018. Articles were restricted to randomized controlled trials on human subjects, written in English, which contained ≥ 24 weeks of objective data on retention in buprenorphine treatment.

Main measures: We assessed whether dose of buprenorphine, treatment setting, or co-administration of behavioral therapy was associated with retention rates.

Key results: Over 14,000 articles were identified. Thirteen articles (describing 9 studies) met inclusion criteria. Measures of retention varied widely. Three studies compared doses of buprenorphine between 1 and 8 mg and showed significantly higher rates of retention with higher doses (p values < 0.01). All other studies utilized buprenorphine doses between 8 and 24 mg daily, without comparison. No study found a significant difference in retention between buprenorphine alone and buprenorphine plus behavioral therapy (p values > 0.05). Initiating buprenorphine while hospitalized or within criminal justice settings prior to outpatient treatment programs was significantly associated with retention in buprenorphine treatment (p values < 0.01 respectively).

Conclusions: Setting of treatment initiation and a higher buprenorphine dose are associated with improved long-term treatment retention. More objective data on buprenorphine treatment programs are needed, including a standardized approach to defining retention in buprenorphine treatment programs.

Registration: This review was registered with PROSPERO (#CRD42019120336) in March 2019.

Keywords: buprenorphine; long-term; opioid use disorder; retention; systematic review.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Behavior, Addictive*
  • Buprenorphine* / therapeutic use
  • Humans
  • Opiate Substitution Treatment
  • Opioid-Related Disorders* / drug therapy


  • Buprenorphine