Buprenorphine Interrupted or Discontinued Among a Majority of Inpatients in Veterans Administration Hospitals

In this longitudinal cohort study, investigators tracked inpatient buprenorphine administration and subsequent post-discharge outpatient buprenorphine prescriptions among all patients with active buprenorphine prescriptions at the time of medical or surgical admission to a US Veterans Association hospital between October 2018 and March 2020. The primary outcome was receipt of an outpatient buprenorphine prescription between one day prior, to 60 days following discharge. Patients receiving sublingual buprenorphine (likely for opioid use disorder) were analyzed separately from those receiving buccal or transdermal formulations (likely for chronic pain).

  • Only 44 percent of patients (N=830) were administered any buprenorphine during their hospital admission.
  • More patients receiving sublingual buprenorphine (61 percent, or 243/401) were administered buprenorphine during admission than those receiving buccal (51 percent, or 26/51) or transdermal (25 percent, or 95/378) formulations.
  • Of 273 patients who received full opioid agonist medications in the first 36 hours of admission, only 18 percent received buprenorphine concomitantly.
  • Of 216 patients who were hospitalized for >72 hours and discontinued buprenorphine during admission, only 16 percent restarted buprenorphine in the 36 hours before discharge.
  • Of 766 patients who were discharged from medical or surgical units, 74 percent received an outpatient buprenorphine prescription, which was significantly higher among those administered buprenorphine 36 hours before discharge (94 percent or 251/267), compared with those who were not (64 percent, or 318/499).

Comments: Buprenorphine was discontinued during hospitalization for more than half of patients in this cohort, and a substantial fraction did not appear to restart treatment post-discharge. The Society of Hospital Medicine recommends* continuing buprenorphine during hospitalization, including in the setting of acute pain or perioperatively. US regulations allow all DEA-licensed providers to prescribe buprenorphine, and opioid or non-opioid analgesics can be safely administered to patients continuing buprenorphine during hospitalization.

Aaron D. Fox, MD

References: Mosher HJ, Hadlandsmyth K, Alexander B, Lund BC. Continuation of buprenorphine during hospitalization and subsequent retention in therapy: an observational study in Veterans Administration hospitals. J Gen Intern Med. 2024;39(2):207-213.

*Calcaterra SL, Martin M, Bottner R, et al. Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine. J Hosp Med. 2022;17(9):744-756.

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