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Randomized Controlled Trial
. 2024 Sep 1;184(9):1106-1115.
doi: 10.1001/jamainternmed.2024.3422.

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement: A Randomized Clinical Trial

Jennifer McNeely  1 , Scarlett S Wang  2 , Yasna Rostam Abadi  1 , Charles Barron  3 , John Billings  2 , Thaddeus Tarpey  1 , Jasmine Fernando  1 , Noa Appleton  1 , Adetayo Fawole  1 , Medha Mazumdar  1 , Zoe M Weinstein  4 , Roopa Kalyanaraman Marcello  5 , Johanna Dolle  5 , Caroline Cooke  5 , Samira Siddiqui  3 , Carla King  1   3
Affiliations
Randomized Controlled Trial

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement: A Randomized Clinical Trial

Jennifer McNeely et al. JAMA Intern Med. .

Abstract

Importance: Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment.

Objective: To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement.

Design, setting, and participants: This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization.

Interventions: Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor.

Main outcomes and measures: The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation.

Results: Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18).

Conclusions: This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment.

Trial registration: ClinicalTrials.gov Identifier: NCT03611335.

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Conflict of interest statement

Conflict of Interest Disclosures: The work of all contributors was supported by the National Institutes of Health (NIH)/National Institute on Drug Abuse (NIDA) grant (R01DA045669) that is listed in the Funding/Support section. Drs McNeely and Tarpey received grants from NIH. Dr Weinstein received a grant from NYC Health + Hospitals. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Stepped-Wedge Study Design
The study condition is demonstrated by hospital during each study period. Dates represent the start of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program at each hospital. Each colored box represents 3 months. White boxes represent the 1-month transition period during which the CATCH program was introduced at each hospital. TAU indicates treatment as usual.
Figure 2.
Figure 2.. Description of the Consult for Addiction Treatment and Care in Hospitals (CATCH) Program Model
All 3 members of the CATCH team seek to meet with the patient during hospitalization. MOUD indicates medication for opioid use disorder.
Figure 3.
Figure 3.. Flow Diagram of Patients Eligible for Inclusion in the Analysis
CATCH indicates Consult for Addiction Treatment and Care in Hospitals; TAU, treatment as usual. aHospitalizations in dedicated psychiatric/detoxification units or jail/prison units were not eligible. bA total of 81 individuals (84 admissions) had a gap in Medicaid enrollment during the first 30 days postdischarge.
Figure 4.
Figure 4.. Proportion of Admissions With Treatment Initiation, Engagement, and Retention by Study Period Among the 3225 Eligible Admissions Included in the Analysis
CATCH indicates Consult for Addiction Treatment and Care in Hospitals; TAU, treatment as usual.
See this image and copyright information in PMC

Comment in

References

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