Barriers to initiate buprenorphine and methadone for opioid use disorder treatment with postdischarge treatment linkage

Calcaterra, Susan L.; Lockhart, Steven; Natvig, Crystal; Mikulich, Susan

doi:10.1002/jhm.13193

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…These findings build on previous qualitative work among hospital providers focusing on OUD specifically or substance use more broa dly. 13,15,27,[32][33][34] We also found that the specific substances involved in "polysubstance use" were rarely differentiated, likely limiting providers' ability to develop effective, substance-specific treatment plans in the hospital. 35,36 Stigmatizing views and behaviors toward people with OUD are a well-documented barrier to accessing treatment.…”

Section: Discussionmentioning

confidence: 95%

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Shearer,

Hernandez,

Beebe

et al. 2024

Substance Use & Addiction Journal

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Background: The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management for stimulant use disorders, most individuals with these co-occurring conditions are not engaged in treatment. Hospitalization is an important opportunity to engage patients and initiate treatment, however existing hospital addiction care is not tailored for patients with co-use and may not meet the needs of this population. Methods: Semi-structured interviews were conducted with hospital providers about their experiences and perspectives treating patients with opioid and stimulant co-use. We used directed content analysis to identify common experiences and opportunities to improve hospital-based treatment for patients with co-use. Results: From qualitative interviews with 20 providers, we identified 4 themes describing how co-use complicated hospital-based substance use treatment: (1) patients’ unstable circumstances impacting the treatment plan, (2) co-occurring withdrawals are difficult to identify and treat, (3) providers holding more stigmatizing views of patients with co-use, and (4) stimulant use is often “ignored” in the treatment plans. Participants also described a range of potential opportunities to improve hospital-based treatment of co-use that fall into 3 categories: (1) provider practice changes, (2) healthcare system changes, and (3) development and validation of clinical tools and treatment approaches. Conclusions: We identified unique challenges providing hospital addiction medicine care to patients who use both opioids and stimulants. These findings inform the development, implementation, and testing of hospital-based interventions for patients with co-use.

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Section: Discussionmentioning

confidence: 95%

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Shearer,

Hernandez,

Beebe

et al. 2024

Substance Use & Addiction Journal

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“… 9 , 10 , 11 There may also be reasons why patients do not want to start MOUD even when it is recommended, such as fear of precipitated withdrawal from buprenorphine 36 ; recent opioid use, which would preclude naltrexone use; or when the patient is not yet ready for OUD treatment. 37 …”

Section: Discussionmentioning

confidence: 99%

“…Medication is only one consideration; hospitals that use other techniques, such as bridge clinics to facilitate ongoing outpatient treatment, substance navigators and/or peer recovery coaches, and dedicated addiction consultation teams, may have more success linking patients to ongoing treatment and encouraging patients to start MOUD . There may also be reasons why patients do not want to start MOUD even when it is recommended, such as fear of precipitated withdrawal from buprenorphine; recent opioid use, which would preclude naltrexone use; or when the patient is not yet ready for OUD treatment …”

Section: Discussionmentioning

confidence: 99%

Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit

Weiner,

Little,

Yoo

et al. 2024

JAMA Netw Open

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ImportanceHospitalizations related to opioid use disorder (OUD) represent an opportunity to initiate medication for OUD (MOUD).ObjectiveTo assess whether starting MOUD after a hospitalization or emergency department (ED) visit is associated with the odds of fatal and nonfatal opioid overdose at 6 and 12 months.Design, Setting, and ParticipantsThis population-based cohort study used data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other administrative health datasets, for individuals aged 18 years or older who had diagnosis codes related to OUD recorded at an index ED visit or hospitalization from January 2017 to December 2019. Data were analyzed between May 2023 and January 2024.ExposuresReceipt of MOUD within the 7 days after an OUD-related hospital visit.Main Outcomes and MeasuresThe primary outcome was fatal or nonfatal overdose at 6 and 12 months after discharge. Sample characteristics, including age, sex, insurance plan, number of comorbidities, and opioid-related overdose events, were stratified by receipt or nonreceipt of MOUD within 7 days after an OUD-related hospital visit. A logistic regression model was used to investigate the association between receipt of MOUD and having an opioid overdose event.ResultsThe study included 22 235 patients (53.1% female; 25.0% aged 25-39 years) who had an OUD-related hospital visit during the study period. Overall, 1184 patients (5.3%) received MOUD within 7 days of their ED visit or hospitalization. Of these patients, 683 (57.7%) received buprenorphine, 463 (39.1%) received methadone, and 46 (3.9%) received long-acting injectable naltrexone. Patients who received MOUD within 7 days after discharge had lower adjusted odds of fatal or nonfatal overdose at 6 months compared with those who did not (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.97). At 12 months, there was no difference in adjusted odds of fatal or nonfatal overdose between these groups (AOR, 0.79; 95% CI, 0.58-1.08). Patients had a lower risk of fatal or nonfatal overdose at 6 months associated with buprenorphine use (AOR, 0.50; 95% CI, 0.27-0.95) but not with methadone use (AOR, 0.57; 95% CI, 0.28-1.17).Conclusions and RelevanceIn this cohort study of individuals with an OUD-related hospital visit, initiation of MOUD was associated with reduced odds of opioid-related overdose at 6 months. Hospitals should consider implementing programs and protocols to offer initiation of MOUD to patients with OUD who present for care.

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Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization: A Modified Delphi Process

Krawczyk,

Miller,

Englander

et al. 2024

J GEN INTERN MED

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Barriers to initiate buprenorphine and methadone for opioid use disorder treatment with postdischarge treatment linkage

Cited by 3 publications

References 36 publications

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit

Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization: A Modified Delphi Process

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