Prevention of 90-day Detox Readmission for Opioid Use Disorder by a Community-based Life-changing Individualized Medically Assisted Evidence-based Treatment (C.L.I.M.B.) Program: a Quasi-experimental Design

Abstract

Background: Evidence for community-based detox readmission prevention strategies for opioid use disorder (OUD) is scant. We evaluated a pilot program designed to provide individualized and structured treatment plan, including addressing prolonged withdrawal symptoms, family/systems assessment, contingency management, and medically assisted treatment. Methods: A non-randomized quasi-experimental design was used to compare the pilot sites (treatment) and comparison sites before and after the program started, i.e., a simple difference-in-differences (DID) strategy. Adults 18 years and older who meet the Diagnostic and Statistical Manual of Mental Disorders version 5 criteria for OUD and had a detox admission at any facility in two study periods between 5/2018 and 12/2019 are included. Readmission in 90-days after an inpatient detox was the primary outcome. Multiple statistical estimation methods were used to adjust for potential confounding factors between treatment and control groups.Results: A total of 2,320 unique patients with 2,443 index detox admission in the pre- and post-periods were compared. The C.L.I.M.B. patients had higher readmission compared with the controls in the pre-period (unadjusted readmission rates16.4% vs. 10.0%) and similar rates in the post-period (11.8% vs. 10.1%). All DID estimates were not statistically significant (adjusted estimates ranged from 6.0 to 9.2 percentage points difference favoring the C.L.I.M.B. program). Conclusions: While not statistically significant, wrap-around services reduced detox readmission. It may be that the added services helped to inform people that inpatient detox is not necessary for OUD and withdrawal can be managed with a structured treatment plan.