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

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.

Department

Medicine

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