Understanding the Moderators of Quality of Life for People who Initiate Methadone: A Comparison Between Initiation in Jail and in the Community

Opioid use disorder (OUD) is highly prevalent in the United States (US) in the community and among those within carceral systems. Measuring quality of life (QoL) as an outcome of OUD treatment is rarely explored in research in the US. QoL offers insight regarding how patients are faring outside of metrics around abstinence and treatment attendance. This paper compares demographic and baseline characteristics of participants who initiated methadone treatment in jail and community settings and examines potential moderators in the relationship between initiation setting and QoL.

This secondary analysis of adult study participants with OUD were recruited through two separate RCTs in Baltimore, MD; (1) jail setting, (2) community setting. The World Health Organization’s QoL measure (WHOQoL-BREF) was used as the QoL outcome measure with four domains of QoL: physical, psychological, social, and environmental. The two study samples were first compared on baseline characteristics obtained from the Addiction Severity Index (ASI) using bivariate statistics (e.g., t tests, x2). Linear regression was conducted utilizing the significant variables from the bivariate analysis with each QoL domain as the dependent variable.

The full sample consisted of 520 unique individuals, 225 participants who participated in the jail study and 295 who participated in the community study. There were significant differences between study settings on 18 of the 24 demographic and participant characteristics of interest. Out of the four QoL domains only physical QoL was moderated and was moderated by age and initiation setting (p < .001). All moderated relationships persisted in multivariable linear regression.

Community-initiated participants had lower physical QoL at treatment entry, potentially lending to structural issues in the community that do not support people who are in treatment for OUD. Understanding QoL can help researchers to understand systemic issues contributing to QoL and clinicians to better form treatment plans around patients’ needs.