Variation in Use of Medications for Opioid Use Disorder in Critically Ill Patients Across the United States

Abstract

Objectives: To describe practice patterns surrounding the use of medications to treat opioid use disorder (MOUD) in critically ill patients. Design: Retrospective, multicenter, observational study using the Premier AI Healthcare Database. Setting: The study was conducted in U.S. ICUs. Patients: Adult (≥ 18 yr old) patients with a history of opioid use disorder (OUD) admitted to an ICU between 2016 and 2020. Interventions: None. Measurements and Main Results: Of 108,189 ICU patients (658 hospitals) with a history of OUD, 20,508 patients (19.0%) received MOUD. Of patients receiving MOUD, 13,745 (67.0%) received methadone, 2,950 (14.4%) received buprenorphine, and 4,227 (20.6%) received buprenorphine/naloxone. MOUD use occurred in 37.9% of patients who received invasive mechanical ventilation. The median day of MOUD initiation was hospital day 2 (interquartile range [IQR] 1–3) and the median duration of MOUD use was 4 days (IQR 2–8). MOUD use per hospital was highly variable (median 16.0%; IQR 10–24; range, 0–70.0%); admitting hospital explained 8.9% of variation in MOUD use. A primary admitting diagnosis of unintentional poisoning (aOR 0.41; 95% CI, 0.38–0.45), presence of an additional substance use disorder (aOR 0.66; 95% CI, 0.64–0.68), and factors indicating greater severity of illness were associated with reduced odds of receiving MOUD in the ICU. Conclusions: In a large multicenter, retrospective study, there was large variation in the use of MOUD among ICU patients with a history of OUD. These results inform future studies seeking to optimize the approach to MOUD use during critical illness.