Initiation of medication for opioid use disorder across a health system: A retrospective analysis of patient characteristics and inpatient outcomes

O'Rourke, Brian; Hogan, Tory H.; Teater, Julie; Fried, Martin; Williams, Mary B.; Miller, Alison L.; Clark, Aaron; Huynh, Phuong; Kauffman, Emily; Hefner, Jennifer L

doi:10.1016/j.dadr.2022.100114

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…The current study examined specifically patient-level factors (ie, age, sex, and number of comorbidities), but we were unable to determine the characteristics of the hospitals in which individuals were treated. 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%

“… 7 , 8 As a result, some hospitals have begun to implement a range of programs, including specialized teams to start buprenorphine treatment in the hospital and creation of general addiction medicine consultation services. 9 , 10 In one system, inpatients who received MOUD either on or before the admission date (vs those who did not) were less likely to have unplanned readmission (13% vs 22%), 11 and another study found that patients engaging with an inpatient addiction consultation service (vs those who did not) had higher rates of substance use disorder treatment following discharge (39% vs 23%). 12 It is theorized that addiction consultation service expansion would reduce fentanyl-related deaths.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%