Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration

Gordon, Adam J.; Saxon, Andrew J.; Kertesz, Stefan G.; Wyse, Jessica J.; Manhapra, Ajay; Lin, Lewei Allison; Chen, Wei; Hansen, Jared M.; Pinnell, Derek; Huynh, Tina; Baylis, Jacob D; Cunningham, Francesca; Ghitza, Udi E.; Bart, Gavin; Yang, Hong; Sauer, Brian C.

doi:10.1016/j.drugalcdep.2023.109902

Cited by 9 publications

(2 citation statements)

References 58 publications

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“…This is similar to what has been reported nationally for people living with OUD, where less than 20% receive any treatment for OUD and even less receive medication-based treatment [ 35 ]. MOUD prescriptions for buprenorphine or methadone historically are provided to more than 15% of veterans with OUD, but as of 2020 more than 40% of veterans receive formulations of MOUD (buprenorphine, methadone, and naltrexone) for OUD treatment at any given point [ 36 ]. Within the VHA in 2017, only 15% of admissions with OUD received MOUD and mostly for withdrawal management [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs

Goodman-Meza,

Goto,

Salimian

et al. 2024

Open Forum Infectious Diseases

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Introduction Initiation of medications for opioid use disorder (MOUD) within the hospital setting may improve outcomes for people who inject drugs (PWID) hospitalized due to an infection. Many studies used International Classification of Diseases (ICD) codes to identify PWID, although these may be misclassified and thus, inaccurate. We hypothesized that bias from misclassification of PWID using ICD codes may impact analyses of MOUD outcomes. Methods We analyzed a cohort of 36,868 cases of patients diagnosed with Staphylococcus aureus bacteremia at 124 US Veterans Health Administration (VHA) hospitals between 2003 and 2014. To identify PWID, we implemented an ICD code-based algorithm and a natural language processing (NLP) algorithm for classification of admission notes. We analyzed outcomes of prescribing MOUD as an inpatient using both approaches. Our primary outcome was 365-day all-cause mortality. We fit mixed effects Cox regression models with receipt or not of MOUD during the index hospitalization as the primary predictor and 365-day mortality as the outcome. Results NLP identified 2,389 cases as PWID, while ICD codes identified 6,804 cases as PWID. In the cohort identified by NLP, receipt of inpatient MOUD was associated with a protective effect on 365-day survival (AHR 0.48, 95%CI 0.29-0.81, p<0.01) compared to those not receiving MOUD. There was no significant effect of MOUD receipt in the cohort identified by ICD codes (AHR 1.00, 95%CI 0.77-1.30, p=0.99). Conclusion MOUD was protective of all-cause mortality when NLP was used to identify PWID, but not significant when ICD codes were used to identify the analytic subjects.

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Section: Discussionmentioning

confidence: 99%

Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs

Goodman-Meza,

Goto,

Salimian

et al. 2024

Open Forum Infectious Diseases

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“…In 2021, estimated annual opioid-related overdose deaths in the United States reached an all-time high of more than 80,000 individuals 5 ; opioid-related overdose deaths in 2022 were projected to be even higher 6 . As such, addressing OUD and opioid-related morbidity and mortality is a major clinical priority 7-10 …”

mentioning

confidence: 99%

Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder

Wyse,

Eckhardt,

Waller

et al. 2024

J Addict Med

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Objectives Buprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, with half of patients discontinuing in the first year of treatment. Addressing OUD is a major clinical priority, yet little is known about the causes of medication discontinuation from the patient perspective. Methods From March 2021 to April 2022, we conducted qualitative interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past 12 months. Eligible participants were selected from 2 Veterans Health Administration Health Care Systems in Oregon. Coding and analysis were guided by conventional qualitative content analysis. Results Twenty participants completed an interview; 90% were White and 90% were male, and the mean age was 54.2 years. Before discontinuation, participants had received buprenorphine for 8.3 months on average (range, 1–40 months); 80% had received buprenorphine for less than 12 months. Qualitative analysis identified the following themes relating to discontinuation: health system barriers (eg, logistical hurdles, rules and policy violations), medication effects (adverse effects; attributed adverse effects, lack of efficacy in treating chronic pain) and desire for opioid use. Patient description of decisions to discontinue buprenorphine could be multicausal, reflecting provider or system-level barriers in interaction with patient complexity or medication ambivalence. Conclusions Study results identify several actionable ways OUD treatment could be modified to enhance patient retention.

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Identification of opioid use disorder using electronic health records: Beyond diagnostic codes

Poulsen,

Nordberg,

Troiani

et al. 2023

Drug and Alcohol Dependence

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Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration

Cited by 9 publications

References 58 publications

Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs

Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs

Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder

Identification of opioid use disorder using electronic health records: Beyond diagnostic codes

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