Interventions for Hospitalized Medical and Surgical Patients with Opioid use Disorder: A Systematic Review

French, Rachel; Aronowitz, Shoshana V.; Carthon, J. Margo Brooks; Schmidt, Heath D.; Compton, Peggy

doi:10.1080/08897077.2021.1949663

Cited by 22 publications

(17 citation statements)

References 38 publications

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“…Opioid use disorder (OUD) is a serious public health problem because of its high disease burden, as measured by hospitalization and drug overdose death rates 1 , and involvement in the criminal justice system based on the high incarceration rates 2 . In the U.S., opioid overdose deaths reach 17.8 per 100,000 individuals.…”

Section: Introductionmentioning

confidence: 99%

Profiling Neuronal Methylome and Hydroxymethylome of Opioid Use Disorder in the Human Orbitofrontal Cortex

Rompala

Nagamatsu

Martínez‐Magaña

et al. 2022

Preprint

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Opioid use disorder (OUD) is influenced by genetic and environmental factors. While recent research suggests that there are epigenetic disturbances in OUD, these studies were limited to DNA methylation (5mC). DNA hydroxymethylation (5hmC) has been understudied in psychiatric disorders and addiction, despite being highly enriched in the brain where it regulates critical functions, including neural plasticity. Here, we conducted a multi-omic profiling of the orbitofrontal cortex (OFC) of OUD, integrating neuronal-specific 5mC and 5hmC as well as within-subject correlations with gene expression profiles from human postmortem samples (OUD=12; controls=26). Further, co-methylation modules and GWAS enrichment were analyzed for 5mC and 5hmC. Evaluation of single locus methylomic alterations identified 397 and 1740 differentially 5mC and 5hmC CpGs, respectively. Enrichment for neuronal function was observed for 5hmC, while no significant pathways were observed for 5mC. 5mC and 5hmC co-methylation analysis identified modules associated with OUD enriched for Pre-NOTCH Transcription and Translation, and WNT signaling. Transcriptomic analysis identified HBB as significantly associated with OUD. Finally, drug interaction analysis showed seven differential 5hmC genes and one differential 5mC gene interacting with opioid use. Our multi-omic findings suggest an important role of 5hmC and reveal novel loci epigenetically dysregulated in OFC neurons of individuals with OUD.

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Section: Introductionmentioning

confidence: 99%

Profiling Neuronal Methylome and Hydroxymethylome of Opioid Use Disorder in the Human Orbitofrontal Cortex

Rompala

Nagamatsu

Martínez‐Magaña

et al. 2022

Preprint

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“…The addiction consult team, along with the evidenced-based tools and resources adapted for the START intervention, offers a novel, comprehensive approach for facilitating MOUD initiation in the hospital and linking patients to follow-up care for OUD. While other consult services described in the literature have additional professionals such as peer navigators and nurses on the team, [97,98] we chose to test a foundational low-resource model, as many hospitals do not have the volume of patients with OUD to justify larger, more complex multidisciplinary consultation services. In future research additional models can be tested to identify core team members and components.…”

Section: Discussionmentioning

confidence: 99%

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Ober

Murray‐Krezan

Page

et al. 2022

Addict Sci Clin Pract

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Background People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. Methods This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. Discussion The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. Trial registration: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist =

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“…This study offers an evidence-based solution (ie, bolster nursing resources) to improve outcomes for surgical patients with OUD, an at-risk population that experiences high morbidity, mortality, and high healthcare-related costs. 4 , 5 Employing evidence-based and person-centered approaches to care for these patients, like ensuring adequate pain and withdrawal management and connection to medications for OUD as appropriate, is essential 60 as we seek to optimize care for these patients when they undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder

French

McHugh

Aiken

et al. 2022

Annals of Surgery Open

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Objectives: To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD). Background: Hospitalized patients with OUD are at increased risk of adverse outcomes. Evidence suggests that adverse postsurgical outcomes may be mitigated in hospitals with better nursing resources, but this has not been evaluated among surgical patients with OUD. Methods: Cross-sectional (2015–2016) data were utilized from the RN4CAST-US survey of hospital nurses, the American Hospital Association Annual Survey of hospitals, and state patient hospital discharge summaries. Multivariate logistic and zero-truncated negative binomial regression models were employed to examine the association between nursing resources and 30-day readmission, 30-day in-hospital mortality, and length of stay for surgical patients with OUD. Results: Of 919,601 surgical patients in 448 hospitals, 11,610 had identifiable OUD. Patients with compared to without OUD were younger and more often insured by Medicaid. Better nurse education, staffing, and work environment were each associated with better outcomes for all surgical patients. For patients with OUD, each 10% increase in the proportion of nurses with a bachelor’s degree in nursing was associated with even lower odds of 30-day readmission (odds ratio [OR] = 0.88; P = 0.001), and each additional patient-per-nurse was associated with even lower odds of 30-day readmission (OR = 1.09; P = 0.024). Conclusions: All surgical patients fare better when cared for in hospitals with better nursing resources. The benefits of having more nurses with a bachelor’s degree and fewer patients-per-nurse in hospitals appear greater for surgical patients with OUD.

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Interventions for Hospitalized Medical and Surgical Patients with Opioid use Disorder: A Systematic Review

Cited by 22 publications

References 38 publications

Profiling Neuronal Methylome and Hydroxymethylome of Opioid Use Disorder in the Human Orbitofrontal Cortex

Profiling Neuronal Methylome and Hydroxymethylome of Opioid Use Disorder in the Human Orbitofrontal Cortex

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder

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