Opioid Agonist Therapy During Hospitalization Within the Veterans Health Administration: a Pragmatic Retrospective Cohort Analysis

Abstract

Background: Hospitalization of patients with opioid use disorder (OUD) is increasing, yet little is known about opioid agonist therapy (OAT: methadone and buprenorphine) administration during admission. Objective: Describe and examine patient-and hospital-level characteristics associated with OAT receipt during hospitalization in the Veterans Health Administration (VHA). Participants: 12,407 unique patients, ≥ 18 years old, with an OUD-related ICD-10 diagnosis within 12 months prior to or during index hospitalization in fiscal year 2017 from 109 VHA hospitals in the continental United States. Main Measure: OAT received during hospitalization. Key Results: Few admissions received OAT (n = 1,914; 15%) and when provided it was most often for withdrawal management (n = 834; 7%). Among patients not on OAT prior to admission who survived hospitalization (n = 10,969), 2.0% (n = 203) were newly initiated on OAT with linkage to care after hospital discharge. Hospitals varied in the frequency of OAT delivery (range 0% to 43% of qualified admissions). Patients with pre-admission OAT (Adjusted Odds Ratio [AOR] = 15.30; 95% CI [13.2, 17.7]), acute OUD diagnosis (AOR = 2.3; 95% CI [1.99, 2.66]), and male gender (AOR 1.52; 95% CI [1.16, 2.01]) had increased odds of OAT receipt. Patients who received non-OAT opioids (AOR 0.53; 95 CI [0.46, 0.61]) or surgical procedures (AOR 0.75; 95 CI [0.57, 0.99]) had decreased odds of OAT receipt. Large (AOR = 2.0; 95% CI [1.39, 3.00]) and medium-sized (AOR = 1.9; 95% CI [1.33, 2.70]) hospitals were more likely to provide OAT. Conclusions: In a sample of VHA inpatient medical admissions, OAT delivery was infrequent, varied across the health system, and was associated with specific patient and hospital characteristics. Policy and educational interventions should promote hospital-based OAT delivery.

Assessment of Annual Cost of Substance Use Disorder in US Hospitals

“… 19 , 20 This study’s results suggest that SUD creates substantial costs for hospitals and payers, yet few hospital patients receive SUD treatment services. 4 , 21 , 22 Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for medical costs associated with SUD in hospitals and other health care settings may encourage prevention investment.…”

Treating Withdrawal and Pain in Inpatients With Opioid Use Disorder: A Brief Educational Intervention for Internal Medicine Residents

“…4 However, delivery of OAT in the inpatient setting is infrequent and varies widely, which has led to calls for educational interventions to promote hospital-based OAT delivery. 6 Internal medicine (IM) residents, as the primary physicians caring for many inpatients with OUD, are optimally positioned to facilitate inpatient use of OAT. Although residents who are not waiver trained cannot prescribe OAT on discharge, inpatient clinicians are exempt from these regulations and may provide both methadone and buprenorphine for maintenance and withdrawal treatment in the inpatient setting.…”

“… 4 However, delivery of OAT in the inpatient setting is infrequent and varies widely, which has led to calls for educational interventions to promote hospital-based OAT delivery. 6 …”

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality

“…Medications for opioid use disorder (MOUD) delivered in the hospital can treat withdrawal symptoms and reduce overdose risk (7), and are often necessary, but not sufficient, to help keep patients engaged in inpatient care. Despite this, most hospitalized patients with OUD are not started on MOUD (8, 9), though, when offered, nearly three-quarters of patients with OUD choose to start MOUD (10). Interventions to improve initiation of MOUD among hospitalized patients are urgently needed (11).…”