Initiating Buprenorphine Treatment During Hospitalization Improves Engagement in Care and Reduces Illicit Opioid Use
Individuals with substance use disorders (SUD) are at risk for medical problems leading to hospitalization. To determine whether hospitalization may provide an opportunity to engage this population in long-term SUD treatment, researchers randomized 139 hospitalized patients with opioid dependence to receive a 5-day buprenorphine taper (n = 67) or buprenorphine induction with linkage to an outpatient opioid agonist treatment (OAT) program with buprenorphine (n = 72). Participants were interviewed at 1, 3, and 6 months after enrollment; approximately 60% followed up at each interval.
- Fifty-two participants (72%) randomized to linkage entered the OAT program within 6 months, compared with 8 (12%) of those assigned to detoxification.
- At 6-month follow-up, 12 participants (17%) randomized to linkage were enrolled in the OAT program, compared with 2 (3%) randomized to detoxification.
- Compared with controls, participants randomized to linkage were more likely to report no illicit opioid use in the past 30 days at each interval (38% versus 9%) and reported fewer days of illicit opioid use in the past 30 days (mean of 8 versus 14).
Comments:
This study demonstrates that initiating buprenorphine treatment during hospitalization improves engagement in care and reduces illicit opioid use, although the effect was modest. Retention was poorer than what is usually observed, probably because this is a high-risk and vulnerable population that was not necessarily seeking care. Implementing programs like this would require the development of systems to identify and link patients with care, as well as incentives for hospitals and outpatient programs. Making outpatient treatment more accessible may achieve the same goal.
Darius A. Rastegar, MD
Reference:
Liebschutz JM, Crooks D, Herman D, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1369–1376.