Undertreatment of opioid use disorder in patients hospitalized with injection drug use associated infections.

OBJECTIVE: To evaluate the association between medication for opioid use disorder (MOUD) initiation and addiction consultation and outcomes for patients hospitalized with infectious complications of injecting opioids.

DESIGN: Retrospective cohort study.

SETTING: Four academic medical centers in the United States.

PARTICIPANTS: 322 patients hospitalized with infectious complications of injecting opioids in 2018.

EXPOSURES: Inpatient receipt of MOUD, initiation of MOUD, and addiction consultation.

MEASUREMENTS: The main outcomes of interest were: 1) premature discharge; 2) MOUD on discharge; 3) linkage to outpatient MOUD; 4) one-year readmission; 5) death.

RESULTS: 322 patients were predominately male (59%), white (66%), and median age 38, with 36% unstably housed, and 30% uninsured. 145 (45%) patients received MOUD during hospitalization, including only 65 (28%) patients not on baseline MOUD. Discharge was premature for 64 (20%) patients. In the year following discharge, 27 (9%) patients were linked to MOUD, and 159 (50%) patients had at least one readmission. Being on MOUD during hospitalization was significantly associated with higher odds of planned discharge (OR 3.87, P < 0.0001), MOUD on discharge (OR 129.7, P < 0.0001), and linkage to outpatient MOUD (OR 1.25, p < 0.0001), however was not associated with readmission.

LIMITATIONS: Retrospective study. Post-discharge data are likely underestimated.

CONCLUSIONS: There was dramatic undertreatment with MOUD from inpatient admission to outpatient linkage, and high rates of premature discharge and readmission. Engagement in addiction care during hospitalization is a critical first step in improving the care continuum for individuals with opioid use disorder, however additional interventions may be needed to impact long-term outcomes like readmission.