Patients Seldom Receive Medications for Opioid Use Disorder in Hospital
But consultation significantly increases treatment and outpatient follow-up
Medications for opioid use disorder (MOUD) are effective, but hospitalized people with opioid use disorder (OUD) seldom receive MOUD while in hospital or link with follow-up treatment.
So concluded researchers in a START (Substance Use Treatment and Recovery Team) randomised clinical trial reported by JAMA, Hospital Addiction Consultation Service and Opioid Use Disorder Treatment.
The trial grouped participants into intervention or usual care. Eligible individuals were 18 years and older and met criteria for OUD.
The study was between November 2021 and September 2023 at three hospitals in: Los Angeles, California; Albuquerque, New Mexico; and Springfield, Massachusetts. The last follow-up was in December 2023.
Intervention consisted of an addiction medicine specialist and a care manager delivering a motivational and addiction-focused discharge planning intervention and follow-up calls.
Primary outcomes were measured by the proportions of patients initiating MOUD (naltrexone, buprenorphine, or methadone) during hospitalization (per electronic medical record data); and successfully linking to OUD treatment within 30 days after discharge (per patient by self-report).
A total of 325 patients were consented and randomized to START (164) or usual care (161). Median age was 41; 213 participants (65.5%) were male at birth, 28 (8.6%) were American Indian or Alaska Native, 21 (6.5%) were Black, 156 (48%) were Hispanic, and 125 (38.5%) were White. More than half, 175 (53.8%) were unhoused in the past year, and 163 (50.2%) were unemployed.
START participants were more likely than usual care participants to initiate MOUD during hospitalization (94/164 [57.3%] vs 43/161 [26.7%], respectively; and to link to OUD care after discharge (90/125 [72.0%] vs 50/104 [48.1%], respectively.
“By addressing gaps in inpatient care, the hospital-based addiction-focused consultation service presented in this randomized clinical trial improved receipt of evidence-based treatment for people with OUD in the hospital and linkage to treatment after discharge,” reported the researchers.
