Background: Skin and soft tissue infections (SSTI) are common complications of injection drug use. We aimed to determine if rehospitalization and recurrent SSTI differ among persons with opioid use disorder (OUD) hospitalized for SSTI who are initiated on MOUD within 30 days of discharge and those who are not. Methods:We performed a retrospective analysis of commercially insured adults aged 18 years and older in the U.S. with OUD and hospitalization for injection-related SSTI from 2010-2017. The primary exposure was initiation of MOUD in the 30 days following hospitalization for SSTI. The primary outcomes included 30-day and 1-year 1) all-cause rehospitalization and 2) recurrent SSTI. We calculated the incidence rates for the two groups: MOUD group and no MOUD group for the primary outcomes. We developed Cox models to determine if rehospitalization and recurrent SSTI differ between the two groups.Results: Only 5.5% (357/6538) of people received MOUD in the month following their index SSTI hospitalization. 30-day rehospitalization incidence was higher in the MOUD group compared to no MOUD (35.9 vs 27.5 per 100 person-30 days) and one-year SSTI recurrence was lower (10.3 vs 18.7 per 100 person-years). In multivariable modeling, the MOUD group remained at significantly higher risk of 30-day rehospitalization compared to the no MOUD group and at lower risk for one-year SSTI recurrence.

Key Points Question What is the prevalence of HIV preexposure prophylaxis (PrEP) among commercially insured persons with opioid and/or stimulant use disorder by injection drug use (IDU) status? Findings In this cross-sectional study of 547 709 commercially insured persons with opioid and/or stimulant use disorder, including 110 592 persons with evidence of IDU, 0.09% of the population overall and 0.15% of those with evidence of IDU received a PrEP prescription. Meaning In this study, HIV PrEP delivery for persons with substance use disorder, including those who inject drugs, remained low.

This cohort study compares the sociodemographic and clinical characteristics of US youths who have experienced a nonfatal opioid overdose and examines the incidence of nonfatal opioid overdose by sex.

Background and Aims Some adolescents and young adults (termed “youth”) prescribed an opioid will develop opioid use disorder or experience overdose. This study aimed to identify patient and prescription characteristics associated with subsequent risk of opioid use disorder or overdose during the year after an opioid is first dispensed. Design Retrospective cohort study. Setting Commercial health insurance claims in a large United States (US) database from 2006 to 2016. Participants Youth age 11 to 25 years filling an initial opioid prescription (n = 3 278 990). Measurements The primary outcome was development of an ‘opioid‐related complication’ (a diagnosis of opioid use disorder or opioid‐related overdose) during the subsequent 12 months. Exposures of interest were patient (sociodemographic information, and physical and mental health diagnoses) and prescription characteristics (opioid formulation, dose, and duration). Findings Among youth filling an initial opioid prescription, median age was 18 years (interquartile range [IQR] = 16–21) and 56.1% were female. During the subsequent 12 months, 10 405 (0.3%) youth experienced an opioid‐related complication. Conditions associated with increased risk included mood/anxiety disorders (adjusted relative risk [aRR] = 4.45; 95% CI = 4.25–4.66) and substance use (aRR = 20.77; 95% CI = 19.74–21.84). Comorbid substance use disorders were present among 72.8% of youth experiencing an opioid‐related complication and included alcohol (33.4%), cannabis (33.0%), nicotine (43.2%), and other substance use disorders (75.5%). Long‐acting opioids (aRR = 2.59; 95% CI = 2.18–3.09) and longer durations were associated with increased risk (7–14 days: aRR = 1.15; 95% CI = 1.08–1.22; ≥15 days: aRR = 1.96; 95% CI = 1.80–2.12) compared with short‐acting formulations and durations ≤3 days, respectively. Conclusions Among United States youth, complications after an initial opioid prescription appear to be relatively rare and appear to be associated with mood/anxiety disorders, substance use, comorbid substance use disorders, and prescriptions involving long‐acting opioids or long durations.