In-hospital illicit drug use, substance use disorders, and acceptance of residential treatment in a prospective pilot needs assessment of hospitalized adults with severe infections from injecting drugs (original) (raw)
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Journal of Substance Abuse Treatment, 2011
Population-based data indicate that rates of nonmedical use of prescription opioids (POs) have increased dramatically over the past decade. However, data are lacking on nonmedical use of POs in individuals seeking treatment for substance use disorders. Patients (N = 351) seeking treatment from a residential drug and alcohol treatment program were assessed for nonmedical use of POs prior to treatment entry. Approximately 68% (65% men and 78% women) of patients reported at least some nonmedical PO use in the 30 days prior to treatment. Our results indicate that nonmedical PO use was more common in those with higher levels of depressive symptoms and pain intensity and in those with lower physical functioning. Treatment programs should consider actively screening participants for nonmedical PO use and consider how nonmedical use of pain medications might influence their treatment planning for patients. Published by Elsevier Inc.
Pain physician, 2004
Multiple aberrant behaviors have been described to identify patients abusing opioids and using illicit drugs. However, patient behavior encompassing aggressive seeking or complaining about the need for higher doses of opioids has not yet been evaluated with regards to misuse or abuse patterns of prescription drugs and illicit drug usage. The objective of this study was to evaluate and identify the prevalence of illicit drug use and prescription drug abuse or misuse in patients seeking higher doses of opioids and compare to a group of patients not seeking higher doses of opioids. A prospective, non-randomized, consecutive, observational study. A total of 200 patients from an interventional pain management setting with 100 consecutive patients in each group either not seeking additional opioids (Group I) or seeking higher doses of opioids (Group II) were evaluated with urine testing for illicit drug use, and/or misuse or abuse of opioids. Drug testing was carried out by Rapid Drug Scr...
Opioid usage trends in treatment – Trends from the field
International Journal of Healthcare, 2019
Objective: As legislative changes limiting access to prescription opioids were enacted, the population of opioid use disorder patients seeking private residential treatment also changed. This study is designed to examine some of the specific changes that were observed between opioid used disorder patients entering treatment before and after the legislative restrictions were enacted. Study design: Retrospective cross-sectional cohort design. Results: Significant changes from Group 1 (patients presenting for treatment in 2009-2011) to Group 2 (patients presenting for treatment in 2014) include a substantial decrease in the usage of prescription opiates. Alongside this reduction, a significant increase was shown in reported heroin abuse with concurrent polysubstance abuse (Cannabis, Amphetamines, and Sedatives), as well as noted employment and family issues. Conclusions: The identified patient presenting to treatment for Opioid Use Disorder has changed over the last several years and treatment should reflect those changes. Not only has this disease become one of opioid usage but of polysubstance abuse and disruption in other areas of life as heroin usage becomes more prominent in patients.
Journal of Substance Abuse Treatment
Background-Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation. Methods-We assessed patient, payer, and clinical characteristics of nationally-representative 2011-2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis. Results-Annual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges). Conclusions-Now nearly half a million yearly US hospital discharges for a range of primary treatment include patients' diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.
Medications for Opioid Use Disorder Save Lives - Consensus Study Report
2019
The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
Determinants of long-term opioid use in hospitalized patients
PLOS ONE
Background Long-term opioid use is an increasingly important problem related to the ongoing opioid epidemic. The purpose of this study was to identify patient, hospitalization and system-level determinants of long term opioid therapy (LTOT) among patients recently discharged from hospital. Design To be eligible for this study, patient needed to have filled at least one opioid prescription three-months post-discharge. We retrieved data from the provincial health insurance agency to measure medical service and prescription drug use in the year prior to and after hospitalization. A multivariable Cox Proportional Hazards model was utilized to determine factors associated with time to the first LTOT occurrence, defined as time-varying cumulative opioid duration of ≥ 60 days. Results Overall, 22.4% of the 1,551 study patients were classified as LTOT, who had a mean age of 66.3 years (SD = 14.3). Having no drug copay status (adjusted hazard ratio (aHR) 1.91, 95% CI: 1.40–2.60), being a LTO...
Opioid-related US hospital discharges by type, 1993–2016
Journal of Substance Abuse Treatment, 2019
Objective: To classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid overdose with rehabilitation services. Methods: Survey-weighted national analysis of hospital discharges in the Healthcare Cost and Utilization Project National Inpatient Sample yielded age-adjusted annual rates per 100,000 population. Annual percentage change (APC) in the rate of opioid-related discharges by type during 1993-2016 was assessed. Results: The annual rate of hospital discharges documenting OUD without opioid overdose, detoxification, or rehabilitation services quadrupled during 1993-2016, and at an increased rate (8% annually) during 2003-2016. The discharge rate for all types of opioid overdose increased an average 5-9% annually during 1993-2010; discharges for non-heroin overdoses declined 2010-2016 (3-12% annually) while heroin overdose discharges increased sharply (23% annually). The rate of discharges including detoxification services among OUD and overdose patients declined (−4% annually) during 2008-2016 and rehabilitation services (e.g., counselling, pharmacotherapy) among those discharges decreased (−2% annually) during 1993-2016. Conclusions: Over the past two decades, the rate of both OUD diagnoses and opioid overdoses increased substantially in US hospitals while rates of inpatient detoxification and rehabilitation services identified by diagnosis codes declined. It is critical that inpatients diagnosed with OUD or treated for opioid overdose are linked effectively to substance use disorder treatment at discharge.
The American Journal on Addictions, 2020
Background and Objectives: The impact of medications for opioid use disorder (MOUD) on AMA discharges among people who inject drugs (PWID) hospitalized for endocarditis is unknown. Methods: A retrospective review of all PWID hospitalized for endocarditis at our institution between 2016 to 2018 (n=84). Results: PWID engaged with MOUD at admission, compared to those who were not, were less likely to be discharged AMA but this did not reach statistical significance in adjusted analysis (OR 0.22, 95%CI 0.033 to 1.41, p=0.11). Among out-of-treatment individuals, newly initiating MOUD did not lead to significantly fewer AMA discharges (OR 0.98, OR 0.98, 95%CI 0.26 to 3.7, p=0.98).
Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department
Annals of Emergency Medicine, 2021
The treatment of opioid use disorder with buprenorphine and methadone reduces morbidity and mortality in patients with opioid use disorder. The initiation of buprenorphine in the emergency department (ED) has been associated with increased rates of outpatient treatment linkage and decreased drug use when compared to patients randomized to receive standard ED referral. As such, the ED has been increasingly recognized as a venue for the identification and initiation of treatment for opioid use disorder, but no formal American College of Emergency Physicians (ACEP) recommendations on the topic have previously been published. The ACEP convened a group of emergency physicians with expertise in clinical research, addiction, toxicology, and administration to review literature and develop consensus recommendations on the treatment of opioid use disorder in the ED. Based on literature review, clinical experience, and expert consensus, the group recommends that emergency physicians offer to initiate opioid use disorder treatment with buprenorphine in appropriate patients and provide direct linkage to ongoing treatment for patients with untreated opioid use disorder. These consensus recommendations include strategies for opioid use disorder treatment initiation and ED program implementation. They were approved by the ACEP board of directors in January 2021.