Inpatient Addiction Consultation Service Promotes MOUD in Patients with OUD
Hospital patients with opioid use disorder (OUD) who received care from an inpatient addiction consultation service were more likely to initiate medication for OUD (MOUD) during their hospital stay and transition to community-based treatment after discharge compared to those who received usual care, according to randomized clinical trial findings published in JAMA Internal Medicine.
“Hospital admissions offer a crucial opportunity to engage patients in evidence-based treatments for OUD. Patients may be more receptive to care during hospitalization, particularly when their admission relates to opioid use complications,” wrote corresponding author Allison J. Ober, PhD, RAND Corporation, Santa Monica, California, and study coauthors.
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The study tested whether the Substance Use Treatment and Recovery Team (START) addiction consultation service model in 3 hospitals: Cedars-Sinai Medical Center in Los Angeles, California; the University of New Mexico Hospital in Albuquerque, New Mexico; and Baystate Medical Center in Springfield, Massachusetts.
START consists of motivational interviewing and addiction-focused discharge planning delivered by an addiction medicine specialist and a care manager team, as well as follow-up calls over 1 month. Among 325 adult inpatients with OUD, 164 were randomized to START and 161 to the hospital’s usual care for inpatients with OUD. A follow-up interview took place 30 days after discharge.
According to the study, 57.3% of participants randomized to START began MOUD—defined as the use of any US Food and Drug Administration-approved pharmacotherapy for OUD including, buprenorphine, naltrexone, and methadone—during hospitalization, compared to 26.7% of those who received usual care. The adjusted risk ratio (aRR) for initiating MOUD during hospitalization was 2.10 for the START group.
Among START participants, 72.0% were linked to OUD care after discharge compared with 48.1% of usual care participants, researchers reported, for an aRR of 1.49.
The study also found that START participants had a higher likelihood of having an OUD-focused discharge plan in their medical record (aRR of 1.8), initiating or continuing MOUD after hospital discharge (aRR of 1.71), and seeing a clinician for their OUD after discharge (aRR of 1.89).
“This patient-centered approach has the potential to reduce the consequences of opioid use, including overdose and mortality,” researchers wrote, “as well as mitigate the numerous other adverse effects associated with ongoing opioid use.”
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