Inpatient Opioid Use Disorder Treatment by Generalists is Associated With Linkage to Opioid Treatment Programs After Discharge

Abstract

Objectives: Describe clinical and demographic associations with inpatient medication for opioid use disorder (MOUD) initiation on general medicine services and to examine associations between inpatient MOUD initiation by generalists and subsequent patient healthcare utilization. Methods: This is a retrospective study using medical record data from general medicine services at an urban safety-net hospital before an inpatient addiction consultation service. The patients were adults hospitalized for acute medical illness who had an opioid-related ICD-10 code associated with the visit. Associations with MOUD initiation were assessed using multivariable logistic regression. Hospital readmission, emergency department use, linkage to opioid treatment programs (OTP), and mortality at 30-and 90-days postdischarge were compared between those with and without hospital MOUD initiation using x 2 tests. Results: Of 1,284 hospitalized patients with an opioid-related code, 59.81% received MOUD and 31.38% of these were newly initiated in-hospital. In multivariable logistic regression, Black race, mood disorder, psychotic disorder, and alcohol use disorder were negatively associated with MOUD initiation, while being aged 25-34, having a moderate hospital severity of illness score, and experiencing homelessness were positively associated. There were no bivariate associations between MOUD initiation and postdischarge emergency department use, hospital readmission, or mortality at 30-and 90days, but those initiated on MOUD were more likely to present to an OTP within 90 days (30.57% vs 12.80%, P < 0.001). Conclusions: MOUD prescribing by inpatient generalists may help to increase the number of patients on treatment for opioid use disorder after hospital discharge. More research is needed to understand the impact of inpatient MOUD treatment without addiction specialty consultation.

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

“…The finding that buprenorphine and ER naltrexone MOUD prescriptions reduced the likelihood of unplanned readmissions is an important contribution to the literature. Our findings contradict other similar studies: Tierney et al. (2022) found no significant change in hospital readmissions following MOUD initiation.…”

“…Notably, MOUD can be prescribed across various care settings, which may aid in overcoming traditional barriers to treatment that people with OUD frequently face. While MOUD is effective at reducing both illicit opioid use and mortality ( National Institute on Drug Abuse, 2020 ; Weimer et al., 2019 ), studies examining the impact of MOUD initiation on subsequent hospital utilization metrics have shown mixed results ( Moreno et al., 2019 ; Tierney et al., 2022 ). This existing work also tends to focus on MOUD initiation at a single care site ( Tierney et al., 2022 ).…”

“…While MOUD is effective at reducing both illicit opioid use and mortality ( National Institute on Drug Abuse, 2020 ; Weimer et al., 2019 ), studies examining the impact of MOUD initiation on subsequent hospital utilization metrics have shown mixed results ( Moreno et al., 2019 ; Tierney et al., 2022 ). This existing work also tends to focus on MOUD initiation at a single care site ( Tierney et al., 2022 ). Therefore, there are open questions about the impact of MOUD that can only be answered by studying the utilization patterns of large samples of OUD patients initiating across an entire health system.…”

Methadone treatment and patient-directed hospital discharges among patients with opioid use disorder: Observations from general medicine services at an urban, safety-net hospital

“…The setting, study population, identification of hospitalizations, demographic and index admission measures are described in a previous article based on the same dataset ( Tierney et al., 2021 ). To summarize, the setting is an urban, academic county hospital prior to the implementation of an addiction consultation service.…”

“…To summarize, the setting is an urban, academic county hospital prior to the implementation of an addiction consultation service. Details around provider training on MOUD are described elsewhere ( Tierney et al., 2021 ). There were no formal inpatient protocols for methadone until the end of the study time period.…”