Low Dose Buprenorphine Induction With Full Agonist Overlap in Hospitalized Patients With Opioid Use Disorder

Objective: Inform readers of the use of a clinical pathway that includes initiation of methadone in hospitalized patients with acute pain who have untreated opioid use disorder (OUD).Design: A retrospective chart review with frequency distributions and descriptive statistics calculated to describe demographic and clinical characteristics of the sample.Setting: Urban academic hospital.Patients: One hundred twenty consecutive patients with untreated OUD cared for by the Acute Pain Service (APS).Interventions: APS leadership spearheaded development of a clinical pathway to standardize pain management and optimize outcomes. The authors outline pathway development and describe 120 patients managed using this pathway, initiated on methadone for OUD.Results: The sample included patients, average age 40 years, predominantly non-Hispanic white (74.2 percent), male (61.7 percent), unemployed (88.2 percent), and on Medicaid (84.2 percent). 96.7 percent had a history of heroin use, and 52.1 percent had engaged in previous medication-assisted treatment (MAT). Methadone or other opioids were held for signs of intoxication/sedation in 10.9 percent or for prolonged corrected QT interval in 1.7 percent. The majority received at least one other analgesic agent. For those prescribed opioids upon discharge, the average maximum morphine equivalent dose was 68.2 mg/day for approximately 3 days. 68.3 percent agreed to schedule post-discharge MAT, and of these, 68 percent attended their intake appointment. A small percentage (4.7 percent) left the hospital against medical advice.Conclusion: This pathway provides an example of an effective and safe response to address the opioid epidemic and provide quality care to patients with OUD and pain.

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Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Cureus ◽

10.7759/cureus.10203 ◽

2020 ◽

Author(s):

Adeolu O Oladunjoye ◽

Olubunmi O Oladunjoye ◽

Jean Gauvin ◽

Maria Ruiza Yee ◽

Eduardo D Espiridion

Keyword(s):

Associated Factors ◽

Opioid Use Disorder ◽

Hospitalized Patients ◽

Opioid Use

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Low-dose Buprenorphine Initiation in Hospitalized Adults With Opioid Use Disorder

Journal of Addiction Medicine ◽

10.1097/adm.0000000000000864 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Dana Button ◽

Jennifer Hartley ◽

Jonathan Robbins ◽

Ximena A. Levander ◽

Natashia J. Smith ◽

...

Keyword(s):

Low Dose ◽

Opioid Use Disorder ◽

Opioid Use

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Diagnosis and Management of Opioid Use Disorder in Hospitalized Patients

Medical Clinics of North America ◽

10.1016/j.mcna.2020.03.003 ◽

2020 ◽

Vol 104 (4) ◽

pp. 695-708

Author(s):

Michael Herscher ◽

Matthew Fine ◽

Reema Navalurkar ◽

Leeza Hirt ◽

Linda Wang

Keyword(s):

Opioid Use Disorder ◽

Hospitalized Patients ◽

Opioid Use ◽

Diagnosis And Management

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Low-Dose Ketamine Infusion for Post-Cesarean Delivery Analgesia in Patients with Opioid Use Disorder

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2021.103170 ◽

2021 ◽

pp. 103170

Author(s):

J. Cobb ◽

W. Craig ◽

J. Richard ◽

E. Snow ◽

H. Turcotte ◽

...

Keyword(s):

Cesarean Delivery ◽

Low Dose ◽

Opioid Use Disorder ◽

Opioid Use ◽

Ketamine Infusion

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Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE): study protocol for a randomized controlled trial of a bridge clinic compared with usual care for patients with opioid use disorder

Trials ◽

10.1186/s13063-021-05698-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

David E. Marcovitz ◽

Katie D. White ◽

William Sullivan ◽

Heather M. Limper ◽

Mary Lynn Dear ◽

...

Keyword(s):

Usual Care ◽

General Hospital ◽

Opioid Use Disorder ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Opioid Use ◽

Consult Service ◽

Readmission Rates ◽

Randomized Controlled ◽

Link Type

Abstract Background Patients with substance use disorders are overrepresented among general hospital inpatients, and their admissions are associated with longer lengths of stay and increased readmission rates. Amid the national opioid crisis, increased attention has been given to the integration of addiction with routine medical care in order to better engage such patients and minimize fragmentation of care. General hospital addiction consultation services and transitional, hospital-based “bridge” clinics have emerged as potential solutions. We designed the Bridging Recovery Initiative Despite Gaps in Entry (BRIDGE) trial to determine if these clinics are superior to usual care for these patients. Methods This single-center, pragmatic, randomized controlled clinical trial is enrolling hospitalized patients with opioid use disorder (OUD) who are initiating medication for OUD (MOUD) in consultation with the addiction consult service. Patients are randomized for referral to a co-located, transitional, multidisciplinary bridge clinic or to usual care, with the assignment probability being determined by clinic capacity. The primary endpoint is hospital length of stay. Secondary endpoints include quality of life, linkage to care, self-reported buprenorphine or naltrexone fills, rate of known recurrent opioid use, readmission rates, and costs. Implementation endpoints include willingness to be referred to the bridge clinic, attendance rates among those referred, and reasons why patients were not eligible for referral. The main analysis will use an intent-to-treat approach with full covariate adjustment. Discussion This ongoing pragmatic trial will provide evidence on the effectiveness of proactive linkage to a bridge clinic intervention for hospitalized patients with OUD initiating evidence-based pharmacotherapy in consultation with the addiction consult service. Trial registration ClinicalTrials.govNCT04084392. Registered on 10 September 2019. The study has been approved by the Vanderbilt Institutional Review Board. The current approved protocol is dated version May 12, 2021.

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

PLoS ONE ◽

10.1371/journal.pone.0256793 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256793

Author(s):

Caroline A. King ◽

Honora Englander ◽

P. Todd Korthuis ◽

Joshua A. Barocas ◽

K. John McConnell ◽

...

Keyword(s):

Markov Model ◽

Opioid Use Disorder ◽

Hospitalized Patients ◽

Opioid Use ◽

Post Discharge ◽

Logistic Regression Models ◽

Improve Patient Survival ◽

Bayesian Logistic Regression ◽

The Impact ◽

Related Mortality

Introduction Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD. Methods We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards. Results There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity. Discussion Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.

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