Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients

Liebschutz, Jane M.; Crooks, Denise; Herman, Debra S.; Anderson, Bradley J.; Tsui, Judith I.; Meshesha, Lidia Z.; Dossabhoy, Shernaz S.; Stein, Michael D.

doi:10.1001/jamainternmed.2014.2556

Cited by 293 publications

(281 citation statements)

References 30 publications

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“…8 Our findings suggest that when MAT is offered in the hospital, it is important to provide an array of treatment options, and that MAT Bmay not be for everybody.^These findings support literature reports of patients wanting an individualized approach to treatment. 18 However, while earlier studies have supported the feasibility of initiating MAT in the hospital, 4,7,8 our study highlights key barriers that could limit the generalizability of these interventions. Specifically, the gap between discharge and entry into treatment can be substantial, and systems need rapid-access pathways from inpatient hospitalization to community SUD treatment.…”

Section: Iscussionmentioning

confidence: 71%

“…Our study builds upon existing work showing that it is feasible to initiate MAT among hospitalized adults, including treatment for opioid use disorder with methadone 4,17 and buprenorphine, 7 and treatment for alcohol use disorder with naltrexone. 8 Our findings suggest that when MAT is offered in the hospital, it is important to provide an array of treatment options, and that MAT Bmay not be for everybody.^These findings support literature reports of patients wanting an individualized approach to treatment.…”

Section: Iscussionmentioning

confidence: 94%

“…A handful of interventions have shown that it is feasible to initiate medication-assisted treatment (MAT) for SUD in the hospital, 4,7,8 and that doing so can increase the likelihood of patients engaging in SUD treatment after discharge. However, these interventions have shown high rates of attrition in treatment.…”

Section: Introductionmentioning

confidence: 99%

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“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

et al. 2016

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BACKGROUND: Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. OBJECTIVE: To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change. DESIGN: We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment. PARTICIPANTS AND SETTING: Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener. APPROACH: We conducted a thematic analysis, using an inductive approach at a semantic level. KEY RESULTS: Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge. CONCLUSIONS: This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment.

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Section: Iscussionmentioning

confidence: 71%

Section: Iscussionmentioning

confidence: 94%

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“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

et al. 2016

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“…Patients who received inpatient buprenorphine initiation and linkage-ofcare had improved buprenorphine treatment retention and reported less illicit opioid use. 48 The development of partnerships between hospitals, inpatient clinicians, and outpatient addiction specialists is essential and could lead to significant advances in treating hospitalized patients with OUD.…”

Section: Special Populationsmentioning

confidence: 99%

Inpatient Management of Opioid Use Disorder: A Review for Hospitalists

Theisen‐Toupal

Ronan

Moore

et al. 2017

Journal of Hospital Medicine

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The United States is experiencing an epidemic of nonmedical opioid use and opioid overdose-related deaths. As a result, there have been a number of public health interventions aimed at addressing this epidemic. However, these interventions fail to address care of individuals with opioid use disorder during hospitalizations and, therefore, miss a key opportunity for intervention. The role of hospitalists in managing hospitalized patients with opioid use disorder is not established. In this review, we discuss the inpatient management of individuals with opioid use disorder, including the treatment of withdrawal, benefits of medication-assisted treatment, and application of harm-reduction strategies.

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“…29,49,50 Available evidence suggests that opioid agonist therapy, when paired with referral to outpatient addiction services, may reduce discharge against medical advice and increase engagement in postdischarge addiction treatment. [51][52][53][54][55] One observational study of in patients with opioid use disorder showed that initiation of methadone during the hospital stay, coupled with linkage to an outpatient addiction program, led to a high rate (82%) of postdischarge follow-up. 54 A randomized controlled trial showed that inpatient initiation of buprenorphine and referral to an outpatient addiction provider led to significantly better rates of long-term treatment for opioid use disorder than inpatient detoxification alone (16.7% v. 3%, p = 0.007, at 6 months after the hospital stay).…”

Section: Is There Benefit To Inpatient Initiation Of Opioid Agonist Tmentioning

confidence: 99%