Successful engagement in buprenorphine treatment among hospitalized patients with opioid use disorder and trauma

• Published in: Drug and alcohol dependence 2020-10, Vol.215, p.108253-108253, Article 108253
• Main Authors: Bhatraju, Elenore P., Ludwig-Barron, Natasha, Takagi-Stewart, Julian, Sandhu, Harveen K., Klein, Jared W., Tsui, Judith I.
• Format: Article
• Language: English
• Subjects: Acute services; Addictions; Adult; Aftercare; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; Cannabis; Cohort analysis; Drug abuse; Drug addiction; Electronic health records; Electronic medical records; Epidemics; Female; Hospitalization; Humans; Injuries; Male; Marijuana; Morbidity; Narcotics; Opiate Substitution Treatment - methods; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioids; Patient admissions; Patient Discharge; Patients; Physical trauma; Referral and Consultation; Regression analysis; Retrospective Studies; Statistical analysis; Substance use disorder; Tobacco; Trauma; Urine tests; Young Adult
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108253

•Nearly 1/3 of patients started on buprenorphine in the hospital were admitted for traumatic injuries.•75 % of patients had known follow up, of which 50 % successfully linked to outpatient buprenorphine treatment.•Trauma patients were as likely as non-trauma patients to link to outpatient buprenorphine treatment. The opioid epidemic continues to cause significant morbidity and mortality. Although there are effective medications for opioid use disorder (OUD), a minority of patients receive these treatments. OUD is common among patients hospitalized for traumatic injury and hospitalization could be an opportunity to initiate medications and link to ongoing buprenorphine care. This retrospective cohort study based on electronic health record review included patients who were: (1) hospitalized between January 1, 2018 and June 30, 2019, (2) age ≥18 years, (3) seen by an Addiction Medicine Consult Service, and (4) initiated on buprenorphine with plans for continuation post-discharge. Descriptive statistics identified differences between trauma and non-trauma groups and regression analysis identified predictors of 30 day buprenorphine follow up. Of 197 eligible patients, 60 (30.5 %) were hospitalized for traumatic injuries. Compared to non-trauma patients, trauma patients were younger, more likely to be employed, more likely to report using cannabis and tobacco, less likely to have recently injected drugs, and hospitalized longer. Among patients with follow-up data available (n = 147), 63.2 % of trauma patients were seen within 30 days, compared to 48.2 % of non-trauma patients (p = 0.16). There were no significant differences between the two groups with regards to urine drug test results or acute care utilization in the follow-up period. Among hospitalized patients with OUD who initiate buprenorphine, those who were hospitalized for trauma were at least as likely to link to out-patient treatment. Trauma admissions represent an important opportunity for diagnosing and linking patients with OUD to buprenorphine treatment.