Medications for opioid use disorder prescribed at hospital discharge associated with decreased opioid agonist dispensing in patients with opioid use disorder requiring critical care: A retrospective study.

Oct 02, 2023

Contributors: Aurora Quaye,Chelsea Wampole,Richard R Riker,David B Seder,William J Sauer,Janelle Richard,Wendy Craig,David J Gagnon

Buprenorphine is highly effective for the treatment of opioid use disorder (OUD), and, in recent years, the rates of patients maintained on buprenorphine requiring critical care have been steadily increasing. Currently, no unified guidance exists for buprenorphine management during critical illness. Likewise, we do not know if patients maintained on buprenorphine for OUD are prescribed medications for OUD (MOUD) following hospital discharge or if buprenorphine management influences mu opioid agonist dispensing.
In our cohort of adults over the age of 18 with OUD, receiving buprenorphine formulations in the 3 months preceding their ICU admission, we sought to investigate the relationship between receipt of MOUD and non-MOUD opioid prescribing up to 12 months following hospital discharge. This was a single-center, retrospective cohort study approved by the MaineHealth institutional review board. The study analyzed differences in prescription rates between discharge and subsequent time points using chi square or Fisher’s exact test, as appropriate. We performed analyses using SPSS Statistical Software version 28 (IBM SPSS Inc., Armonk, NY) with significance set at p < 0.05.
We identified a statistically significant increase in MOUD prescribing 3 months posthospital discharge in patients who received MOUD at time of discharge (87.9 % vs 40 % p = 0.002.) The study found a significant increase in nonbuprenorphine opioid prescribing in patients who did not receive an MOUD prescription at time of discharge (24.2 % vs 70 % p = 0.007). This trend persisted at the 6-month and 12-month time points; however, it did not reach statistical significance. Additionally, the study identified a significant reduction in the incidence of non-MOUD opioid dispensing in patients prescribed MOUD at each time point measured (p = 0.007, p < 0.001. p < 0.001 and p = 0.008 at discharge, 3, 6, and 12 months, respectively).
These findings support continuing buprenorphine dispensing following hospital discharge.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE CONTRIBUTORS

Aurora Quaye,Chelsea Wampole,Richard R Riker,David B Seder,William J Sauer,Janelle Richard,Wendy Craig,David J Gagnon
Aurora Quaye

Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Spectrum Healthcare Partners, 324 Gannett Dr, Suite 200, South Portland, ME 04106, USA. Electronic address: aurora.quaye@spectrumhcp.com.

Chelsea Wampole

Department of Pharmacy, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA.

Richard R Riker

Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.

David B Seder

Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA.

William J Sauer

Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Spectrum Healthcare Partners, 324 Gannett Dr, Suite 200, South Portland, ME 04106, USA; Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467, USA.

Janelle Richard

Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA.

Wendy Craig

Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA; Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467, USA.

David J Gagnon

Department of Pharmacy, Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA; Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA; MaineHealth Institute for Research, 81 Research Dr, Scarborough, ME 04074, USA.