213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

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A Comparison of Medication for Opioid Use Disorder Treatment Strategies for Persons Who Inject Drugs With Invasive Bacterial and Fungal Infections

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz516 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S513-S520

Author(s):

Laura R Marks ◽

Satish Munigala ◽

David K Warren ◽

David B Liss ◽

Stephen Y Liang ◽

...

Keyword(s):

Methadone Maintenance ◽

Fungal Infections ◽

Care Center ◽

Tertiary Care ◽

Treatment Strategies ◽

Opioid Use Disorder ◽

Opioid Use ◽

Readmission Rates ◽

Persons Who Inject Drugs ◽

Invasive Infections

Abstract Background Patients with opioid use disorder (OUD) are frequently admitted for invasive infections. Medications for OUD (MOUD) may improve outcomes in hospitalized patients. Methods In this retrospective cohort of 220 admissions to a tertiary care center for invasive infections due to OUD, we compared 4 MOUD treatment strategies: methadone, buprenorphine, methadone taper for detoxification, and no medication to determine whether there were differences in parenteral antibiotic completion and readmission rates. Results The MOUDs were associated with increased completion of parenteral antimicrobial therapy (64.08% vs 46.15%; odds ratio [OR] = 2.08; 95% CI, 1.23–3.61). On multivariate analysis, use of MOUD maintenance with either buprenorphine (OR = 0.38; 95% CI, .17–.85) or methadone maintenance (OR = 0.43; 95% CI, .20–.94) and continuation of MOUD on discharge (OR = 0.35; 95% CI, .18–.67) was associated with lower 90-day readmissions. In contrast, use of methadone for detoxification followed by tapering of the medication without continuation on discharge was not associated with decreased readmissions (OR = 1.87; 95% CI, .62–5.10). Conclusions Long-term MOUDs, regardless of selection, are an integral component of care in patients hospitalized with OUD-related infections. Patients with OUD should have arrangements made for MOUDs to be continued after discharge, and MOUDs should not be discontinued before discharge.

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199. Prospective Observational Cohort Of Transition to Oral Antibiotics in Persons Who Inject Drugs with Invasive Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.401 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S207-S208

Author(s):

Sophia Lewis ◽

Laura Marks ◽

Liang Stephen ◽

Nathan Nolan ◽

Michael Durkin

Keyword(s):

Bacterial Infections ◽

Oral Antibiotic ◽

Oral Antibiotics ◽

Readmission Rates ◽

Persons Who Inject Drugs ◽

Increased Risk ◽

Significant Difference ◽

Health Coaches ◽

Observational Cohort ◽

The Impact

Abstract Background Persons who inject drugs (PWID) are at increased risk of invasive bacterial infections. Increasing data supports the efficacy of transition to oral antibiotic therapy to complete treatment of invasive bacterial infections including osteomyelitis and endocarditis. The aim of this study is to evaluate the impact of transition to oral antibiotics on a prospective observational cohort of PWID. Methods We prospectively analyzed PWID admitted 2/2020 - 2/2021 at Barnes-Jewish Hospital in St. Louis with osteomyelitis, endocarditis, epidural abscesses or septic arthritis. All patients were offered multidisciplinary support during their inpatient hospitalization including addiction medicine consultation and medications for opioid use disorder, if appropriate. Health coaches and case managers met with patients during their hospitalization and followed patients for up to 90 days after discharge. Patients were offered the option of transition to oral antibiotics if they were not able to complete recommended IV antibiotics. Patients discharged on oral antibiotics were offered post-discharge infectious diseases follow-up. Antibiotic adherence was documented by health coaches through phone out-reach. We collected data on demographics, comorbidities, microbiologic data, antibiotic selection, mortality and readmission rates. We compared 90-day readmission rates between PWID who completed IV antibiotics inpatient and those who discharged early with oral antibiotics. Results Of 166 PWID, 61 completed IV antibiotics inpatient (37%) while 105 were discharged with oral antibiotics (63%). Causative pathogens were not significantly different between inpatient IV vs oral antibiotics; MSSA (34.4% vs 35.2%, p= 0.92), MRSA (34.4% vs. 28.6%, p=0.43), or streptococcal species (26.6% vs. 24.8%, p=0.85). Of patients discharged on oral antibiotics 7.6% had documented non-adherence to therapy, 23% had unknown adherence and 67% had documented adherence. There was no significant difference in all-cause 90-day readmission rates (p=0.819) (Figure 1). All-cause readmissions by antibiotic strategy Conclusion Oral antibiotic regimens provided similar efficacy to IV antibiotics in our prospective cohort analysis of PWID. Disclosures All Authors: No reported disclosures

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A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone

Substance Abuse Research and Treatment ◽

10.4137/sart.s37030 ◽

2016 ◽

Vol 10 ◽

pp. SART.S37030 ◽

Cited By ~ 5

Author(s):

Leen Naji ◽

Brittany B. Dennis ◽

Monica Bawor ◽

Carolyn Plater ◽

Guillaume Pare ◽

...

Keyword(s):

Health Care Providers ◽

Addiction Treatment ◽

Protective Factor ◽

Methadone Maintenance ◽

Opioid Use Disorder ◽

Opioid Abuse ◽

Care Providers ◽

Opioid Use ◽

Increased Risk ◽

The Impact

Introduction Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free). Methods Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model. Results History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003). Conclusion This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.

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Evaluating the Impact of the Bridge Clinic in Patients With Opioid Use Disorder

Case Medical Research ◽

10.31525/ct1-nct04084392 ◽

2019 ◽

Author(s):

Keyword(s):

Opioid Use Disorder ◽

Opioid Use ◽

The Impact

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Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa386 ◽

2020 ◽

Author(s):

Taylor Kirby ◽

Robert Connell ◽

Travis Linneman

Keyword(s):

Multivariate Analysis ◽

Hospital Admission ◽

Intervention Group ◽

Opioid Use Disorder ◽

Control Group ◽

Opioid Use ◽

Motivation To Change ◽

Heroin Use ◽

Ed Visits ◽

The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

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Online Opioid Stewardship Training for Long-Term Care Staff

Innovation in Aging ◽

10.1093/geroni/igaa057.1721 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 533-533

Author(s):

Linda Edelman ◽

Troy Andersen ◽

Cherie Brunker ◽

Nicholas Cox ◽

Jorie Butler ◽

...

Keyword(s):

Staff Training ◽

Long Term Care ◽

Treatment Strategies ◽

Care Staff ◽

Video Content ◽

Opioid Use ◽

Term Care ◽

Increased Risk ◽

Pain Management Strategy

Abstract Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

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Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: an application of the social ecological model

Addiction Science & Clinical Practice ◽

10.1186/s13722-020-00210-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ethan Cowan ◽

Maria R. Khan ◽

Siri Shastry ◽

E. Jennifer Edelman

Keyword(s):

Structural Changes ◽

Ecological Model ◽

Disease Incidence ◽

Opioid Use Disorder ◽

Social Ecological Model ◽

Physical And Mental Health ◽

Opioid Use ◽

Social Ecological ◽

The Social ◽

The Impact

AbstractThe COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic’s broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.

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The impact of COVID-19 on emergency surgical presentations in a university teaching hospital

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02709-w ◽

2021 ◽

Author(s):

Ahmed M. Kamil ◽

Matthew G. Davey ◽

Fadi Marzouk ◽

Rish Sehgal ◽

Amy L. Fowler ◽

...

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Historical Data ◽

Severe Disease ◽

University Teaching ◽

Readmission Rates ◽

Descriptive Data ◽

Operative Complications ◽

Hospital Patients ◽

The Impact

Abstract Introduction The Coronavirus-19 (COVID-19) pandemic has led to a 50–70% reduction in acute non-COVID-19 presentations to emergency departments globally. Aim To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital. Methods Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March–May 2020 to March–May 2019. Results Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019. Conclusion COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data.

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