Successful engagement in buprenorphine treatment among hospitalized patients with opioid use disorder and trauma

Bhatraju, Elenore P.; Ludwig-Barron, Natasha; Takagi-Stewart, Julian; Sandhu, Harveen K.; Klein, Jared W.; Tsui, Judith I.

doi:10.1016/j.drugalcdep.2020.108253

Cited by 18 publications

(27 citation statements)

References 13 publications

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“…96 Finally, low retention in MOUDs remains a constant and unaddressed problem. Retention is fundamental to achieving successful outcomes of MOUDs, 97,98 as MOUD discontinuation may result in return to opioid use and increased overdose risk. 99,100 However, the grand majority of patients who start MOUDs discontinue in less than 6 months, the minimum recommended length of care.…”

Section: Ongoing Challengesmentioning

confidence: 99%

The Future of the United States Overdose Crisis: Challenges and Opportunities

Cerdá¹,

Krawczyk²,

Keyes

2023

Milbank Quarterly

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People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm‐reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm‐reduction services. Priorities for action include investing in evidence‐based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.

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Section: Ongoing Challengesmentioning

confidence: 99%

The Future of the United States Overdose Crisis: Challenges and Opportunities

Cerdá¹,

Krawczyk²,

Keyes

2023

Milbank Quarterly

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“…12,13 Some hospitals are expanding access to medications for opioid use disorder by implementing addiction consult services. 14 In addition to access to medications for opioid use disorder, addiction consult services provide counselling, medication dose titrations to long-term (versus acute) regimens, and referrals with linkage to outpatient care. 15 Many addiction consult services have restricted capacity to care for the growing number of hospitalised patients with substance use disorders.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact, costs, and cost-effectiveness of hospital-based strategies for addressing the US opioid epidemic: a modelling study

Barocas

Savinkina

Adams

et al. 2022

The Lancet Public Health

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BackgroundThe syndemic of injection drug use and serious injection-related infections is leading to increasing mortality in the USA. Although outpatient treatment with medications for opioid use disorder reduces overdose risk and recurrent infections, hospitalisation remains common. We evaluated the clinical impact, costs, and costeffectiveness of hospital-based strategies to address the US opioid epidemic. MethodsWe developed a microsimulation model to compare the cost-effectiveness of: standard hospital caredetoxification for opioids, no addiction consult service (status quo); expanded inpatient prescribing of medications for opioid use disorder, including bridge prescriptions (ie, medication until they can see an outpatient provider) when possible (medications for opioid use disorder with bridge); implementation of addiction consult services within the hospital (addiction consult services alone); and a combined medication for opioid use disorder with addiction consult services strategy (combined). We used clinical trials and observational cohorts to inform model inputs. Outcomes were life-years, discounted costs, incremental cost-effectiveness ratios, hospitalisations, and deaths. We did deterministic sensitivity analyses on key model inputs related to costs and sequelae of drug use and probabilistic sensitivity analysis to further address uncertainty. Findings Among people who inject opioids in the USA, we estimated that expanding medications for opioid use disorder with bridge prescriptions would reduce hospitalisations and overdose deaths by 3•2% and 3•6%, respectively, and the combination of expanded medications with opioid use disorder along with addiction consult sevices would reduce hospitalisations and overdoses by 5•2% and 6•6%, respectively, compared with the status quo. Mean lifetime costs ranged from US$731 400 (95% credible interval 447 911-859 189 for the medications for opioid use disorder strategy) to $741 200 (470 930-868 551 for the combined strategy) per person. Assuming a willingness-to-pay threshold of $100 000 per life-year gained, medications for opioid use disorder with bridge and combined strategies were cost-effective ($7600 and $14 300, respectively). A scenario that assumed ideal access to harm reduction services came to the same conclusions as the base case and our results were robust in deterministic and probabilistic sensitivity analyses.Interpretation The combined interventions of expanding hospital-based prescribing of medications for opioid use disorder and implementing addiction consult services could improve life expectancy, be cost-effective, and could be the basis for a comprehensive hospital-based strategy for addressing the opioid epidemic in the USA and countries with similar opioid epidemics.

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Section: Resultsmentioning

confidence: 99%

“…Among included studies, the most commonly evaluated outcomes were post-discharge linkage to care (11 studies), 13 , 16 – 20 , 22 , 24 – 26 , 33 readmission (6 studies), 15 , 18 , 21 , 25 – 27 and in-hospital MOUD initiation (6 studies) 15 , 19 , 24 , 25 , 27 , 33 . Regarding outcome measures for the 12 studies with a control group, most studies identified outcomes through chart review 13 , 15 , 18 , 25 , 27 or diagnosis codes, 17 , 21 , 23 , 24 , 26 while others used research staff 20 including through timeline follow-back 34 . Wang and colleagues defined linkage to care as when a provider discharged a patient with a buprenorphine prescription and a scheduled outpatient buprenorphine appointment, 25 while others defined it as post-hospital OUD treatment engagement 18 , 24 , 34 within 30, 13 , 20 34, 17 or 90 days 20 .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.

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Successful engagement in buprenorphine treatment among hospitalized patients with opioid use disorder and trauma

Cited by 18 publications

References 13 publications

The Future of the United States Overdose Crisis: Challenges and Opportunities

The Future of the United States Overdose Crisis: Challenges and Opportunities

Clinical impact, costs, and cost-effectiveness of hospital-based strategies for addressing the US opioid epidemic: a modelling study

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

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