Impact of Medication for Opioid Use Disorder on Patient Directed Discharge Among Patients with Opioid Use Disorder.

Abstract

Opioid use disorder (OUD) is responsible for significant morbidity and mortality in the USA. Hospitalization rates for patients with OUD have increased over the recent decades. Those with OUD have a substantially higher rate of patient-directed discharge (PDD) than those without OUD. There have been mixed results when examining the association between inpatient MOUD and PDD. To determine the association between inpatient MOUD and the rate of PDD among patients without evidence of MOUD treatment prior to hospitalization. Retrospective study comparing admissions receiving inpatient MOUD and propensity score-matched control admissions who did not receive MOUD. Two thousand seven hundred seventy-one admissions with a diagnosis of OUD and without evidence of prior MOUD treatment were compared to 2771 propensity-matched admissions. Provision of inpatient MOUD, either buprenorphine or methadone during admission. Primary outcome was patient-directed discharge. Secondary outcomes were buprenorphine prescription at discharge, buprenorphine prescription within 60 days of discharge, admission into an outpatient methadone program within 30 days of discharge, 30-day readmission, and 30-day post-discharge ED visit. Among 5542 admissions with OUD and no evidence of MOUD prior to admission, those that received inpatient MOUD were significantly less likely to have a PDD (11.9% vs 14.4%; OR 0.80 [CI 0.67-0.96]) and significantly more likely to receive a discharge prescription for buprenorphine (8.6% vs 1.2%; OR 8.04 [CI 5.52-11.71]) and another buprenorphine prescription within 60 days of discharge (5.5% vs 1.1%; OR 5.09 [CI 3.35-7.74]), compared with control admissions who did not receive MOUD. Inpatient MOUD was not significantly associated with admission into an outpatient methadone program within 30 days, 30-day readmission, and 30-day post-discharge ED visit. Receipt of inpatient MOUD was associated with a statistically significant reduction in PDD among those with OUD and without evidence of MOUD before admission when compared with propensity-matched admissions which did not receive inpatient MOUD.