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

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.

Fig. 1

Study enrollment: 1285 patients were identified with ICD codes for opioid use disorder and infection within 2018, of whom 322 (25%) met inclusion criteria and had full data collected.

Fig. 2

Out of 322 patients, 93 (29%) patients were on medication for opioid use disorder prior to admission (methadone 68, 73%; buprenorphine 25, 27%), and 80 (86%) were continued on medication for opioid use disorder during hospitalization.

Fig. 3

Medication for opioid use disorder continuum showing percentage of patients who received medication for opioid use disorder during hospitalization, had medication for opioid use disorder on discharge medication list, and linked to medication for opioid use disorder within a year of discharge for all patients (a), patients on medication for opioid use disorder prior to admission (b), and patients not on medication for opioid use disorder prior to admission (c).