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

Authors

• Elana S. Rosenthal, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.
• Christopher Brokus, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.
• Junfeng Sun, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
• Joseph E. Carpenter, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States.
• Jillian Catalanotti, The George Washington University School of Medicine and Health Sciences, Washington DC, United States.
• Ellen F. Eaton, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States.
• Alaina R. Steck, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States.
• Irene Kuo, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, United States.
• Greer A. Burkholder, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States.
• Hana Akselrod, The George Washington University School of Medicine and Health Sciences, Washington DC, United States.
• Keanan Mcgonigle, The George Washington University School of Medicine and Health Sciences, Washington DC, United States.
• Timothy Moran, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States.
• William Mai, The George Washington University School of Medicine and Health Sciences, Washington DC, United States.
• Melissa Notis, The George Washington University School of Medicine and Health Sciences, Washington DC, United States.
• Carlos Del Rio, Rollins School of Public Health and Emory School of Medicine, Emory University, Atlanta, GA, United States.
• Alan Greenberg, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, United States.
• Michael S. Saag, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States.
• Shyamasundaran Kottilil, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.
• Henry Masur, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
• Sarah Kattakuzhy, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.

Document Type

Journal Article

Publication Date

6-21-2023

Journal

AIDS (London, England)

DOI

10.1097/QAD.0000000000003629

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. DESIGN: Retrospective cohort study. SETTING: Four academic medical centers in the United States. PARTICIPANTS: 322 patients hospitalized with infectious complications of injecting opioids in 2018. EXPOSURES: Inpatient receipt of MOUD, initiation of MOUD, and addiction consultation. MEASUREMENTS: The main outcomes of interest were: 1) premature discharge; 2) MOUD on discharge; 3) linkage to outpatient MOUD; 4) one-year readmission; 5) death. RESULTS: 322 patients were predominately male (59%), white (66%), and median age 38, with 36% unstably housed, and 30% uninsured. 145 (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 (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. LIMITATIONS: Retrospective study. Post-discharge data are likely underestimated. CONCLUSIONS: 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.

APA Citation

Rosenthal, Elana S.; Brokus, Christopher; Sun, Junfeng; Carpenter, Joseph E.; Catalanotti, Jillian; Eaton, Ellen F.; Steck, Alaina R.; Kuo, Irene; Burkholder, Greer A.; Akselrod, Hana; Mcgonigle, Keanan; Moran, Timothy; Mai, William; Notis, Melissa; Del Rio, Carlos; Greenberg, Alan; Saag, Michael S.; Kottilil, Shyamasundaran; Masur, Henry; and Kattakuzhy, Sarah, "Undertreatment of opioid use disorder in patients hospitalized with injection drug use associated infections" (2023). GW Authored Works. Paper 2695.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2695

Department

Medicine