Undertreatment of opioid use disorder in patients hospitalized with injection drug use-associated infections

• Type of Material: Article
• Authors: Elana S. Rosenthal, University of Maryland; Christopher Brokus, University of Maryland; Junfeng Sun, National Institutes of Health; Joseph Carpenter, Emory University; Jillian Catalanotti, George Washington University; Ellen F. Eaton, University of Alabama Birmingham; Alaina Steck, Emory University; Irene Kuo, Milken Institute School of Public Health; Greer A. Burkholder, University of Alabama Birmingham; Hana Akselrod, George Washington University; Keanan McGonigle, George Washington University; Tim Moran, Emory University; William Mai, George Washington University; Melissa Notis, George Washington University; Carlos del Rio, Emory University; Alan Greenberg, Milken Institute School of Public Health; Michael S. Saag, University of Alabama Birmingham; Shyamasundaran Kottilil, University of Maryland; Henry Masur, National Institutes of Health; Sarah Kattakuzhy, University of Maryland
• Language: English
• Date: 2023-10-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0000000000003629
• Title of Journal or Parent Work: AIDS (London, England)
• Volume: 37
• Issue: 12
• Start Page: 1799
• End Page: 1809
• Grant/Funding Information: NIAID, OAR, Emory CFAR, DC CFAR, UAB CFAR. This project was funded by the National Institute of Allergy and Infectious Diseases and the manuscript resulted in part from research supported by the Office of AIDS Research (HHSN269201400012C), Center for AIDS Research, Emory University (P30AI050409), District of Columbia Center for AIDS Research (P30AI117970), and Center for AIDS Research, University of Alabama, Birmingham (P30AI027767). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
• Keywords: Male; Female; Opioid-Related Disorders; Premature Birth; Opiate Substitution Treatment; Patient Discharge; Analgesics, Opioid; Adult; Aftercare; Humans; HIV Infections; Retrospective Studies
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVE: To evaluate the association between medication for opioid use disorder (MOUD) initiation and addiction consultation and outcomes for patients hospitalized with infectious complications of injecting opioids. METHOD: This was a retrospective cohort study performed at four academic medical centers in the United States. The participants were patients who had been hospitalized with infectious complications of injecting opioids in 2018. Three hundred and twenty-two patients were included and their individual patient records were manually reviewed to identify inpatient receipt of medication for opioid use disorder (MOUD), initiation of MOUD, and addiction consultation. The main outcomes of interest were premature discharge, MOUD on discharge, linkage to outpatient MOUD, one-year readmission and death. RESULTS: Three hundred and twenty-two patients were predominately male (59%), white (66%), and median age 38 years, with 36% unstably housed, and 30% uninsured. One hundred and forty-five (45%) patients received MOUD during hospitalization, including only 65 (28%) patients not on baseline MOUD. Discharge was premature for 64 (20%) patients. In the year following discharge, 27 (9%) patients were linked to MOUD, and 159 (50%) patients had at least one readmission. Being on MOUD during hospitalization was significantly associated with higher odds of planned discharge [odds ratio (OR) 3.87, P  < 0.0001], MOUD on discharge (OR 129.7, P  < 0.0001), and linkage to outpatient MOUD (OR 1.25, P  < 0.0001), however, was not associated with readmission. Study limitations were the retrospective nature of the study, so post-discharge data are likely underestimated. CONCLUSION: There was dramatic undertreatment with MOUD from inpatient admission to outpatient linkage, and high rates of premature discharge and readmission. Engagement in addiction care during hospitalization is a critical first step in improving the care continuum for individuals with opioid use disorder; however, additional interventions may be needed to impact long-term outcomes like readmission.