Opioid Agonist Treatment Rarely Used or Started During Opioid-related Hospitalizations

With increasing opioid-related hospitalizations in the US, how often is opioid agonist therapy (OAT) initiated or used for withdrawal management during admission? This retrospective cohort study examined the frequency of OAT receipt among 12,407 patients with opioid use disorder (OUD) during hospitalization in 109 Veterans Health Administration hospitals in 2017. Multi-level regression was used to determine patient and hospital-level characteristics associated with receiving OAT.

  • Patients with OUD received OAT in only 15% of admissions.
  • Hospitals varied widely in delivery of OAT, ranging from 0 to 43% of qualified admissions; large and medium-sized hospitals were more likely to provide OAT than small hospitals.
  • Nearly 90% of patients were not receiving OAT at the time of admission; of these, only 2% initiated OAT and were linked to care following hospitalization.
  • Patient-level characteristics associated with OAT receipt included: male gender, admission diagnosis related to OUD or OUD-related infection, OAT receipt prior to admission, and absence of a co-occurring substance use disorder diagnosis.

Comments: Hospitalization is a missed opportunity to initiate OAT among patients who are not receiving OUD treatment at the time of admission. Failure to continue previously prescribed OAT or manage withdrawal symptoms with OAT could also cause harm—for example, if patients leave the hospital against medical advice. Increasing appropriate OAT prescribing should be a goal for all health care systems, which may necessitate specific guidelines, provider education, and efforts to reduce stigma.

Aaron D. Fox, MD

Reference: Priest KC, Lovejoy TI, Englander H, et al. Opioid agonist therapy during hospitalization within the Veterans Health Administration: a pragmatic retrospective cohort analysis. J Gen Intern Med. 2020 [Epub ahead of print]. doi: 10.1007/s11606-020-05815-0.

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