Medications for opioid use disorder prescribed at hospital discharge associated with decreased opioid agonist dispensing in patients with opioid use disorder requiring critical care: A retrospective study

Abstract

Introduction: Buprenorphine is highly effective for the treatment of opioid use disorder (OUD), and, in recent years, the rates of patients maintained on buprenorphine requiring critical care have been steadily increasing. Currently, no unified guidance exists for buprenorphine management during critical illness. Likewise, we do not know if patients maintained on buprenorphine for OUD are prescribed medications for OUD (MOUD) following hospital discharge or if buprenorphine management influences mu opioid agonist dispensing.

Methods: In our cohort of adults over the age of 18 with OUD, receiving buprenorphine formulations in the 3 months preceding their ICU admission, we sought to investigate the relationship between receipt of MOUD and non-MOUD opioid prescribing up to 12 months following hospital discharge. This was a single-center, retrospective cohort study approved by the MaineHealth institutional review board. The study analyzed differences in prescription rates between discharge and subsequent time points using chi square or Fisher's exact test, as appropriate. We performed analyses using SPSS Statistical Software version 28 (IBM SPSS Inc., Armonk, NY) with significance set at p < 0.05.

Results: We identified a statistically significant increase in MOUD prescribing 3 months posthospital discharge in patients who received MOUD at time of discharge (87.9 % vs 40 % p = 0.002.) The study found a significant increase in nonbuprenorphine opioid prescribing in patients who did not receive an MOUD prescription at time of discharge (24.2 % vs 70 % p = 0.007). This trend persisted at the 6-month and 12-month time points; however, it did not reach statistical significance. Additionally, the study identified a significant reduction in the incidence of non-MOUD opioid dispensing in patients prescribed MOUD at each time point measured (p = 0.007, p < 0.001. p < 0.001 and p = 0.008 at discharge, 3, 6, and 12 months, respectively).

Conclusions: These findings support continuing buprenorphine dispensing following hospital discharge.

Keywords: Analgesics; Buprenorphine; Intensive care unit; Opioid; Opioid-related disorders.

Figure 1:

CONSORT diagram of patient prescribed medications for opioid use disorder following hospital discharge Abbreviations: OUD-opioid use disorder; PMP-prescription monitoring program; MOUD-medications for opioid use disorder

Figure 2:

The relationship between MOUD and non-MOUD opioid prescriptions at discharge and at 3, 6, and 12 months post-discharge, among patients with PMP data available at 3 months post-discharge Data were available for n=76 patients at discharge (66 (87%) were prescribed MOUD) and at 3 months post-discharge (62 (82%) were prescribed MOUD); for n=73 patients at 6 months post discharge (62 (85%) were prescribed MOUD); and, for n=62 at 12 months post discharge (49 (79%) were prescribed MOUD). Differences in the percentage of patients with prescriptions for opioids other than MOUD were compared at each time point between MOUD and no-MOUD subgroups by Fisher’s exact test.