Hospitalisations related to opioid use disorder (OUD) provide critical opportunities for initiating medication for OUD (MOUD). A recent population-based cohort study assessed whether starting MOUD after a hospitalisation or emergency department (ED) visit is associated with the odds of fatal and nonfatal opioid overdose at 6 and 12 months.

Study Design and Participants

The study utilised data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to various administrative health datasets. The analysis included individuals aged 18 years or older with diagnosis codes related to OUD recorded at an index ED visit or hospitalisation from January 2017 to December 2019. Data were analysed between May 2023 and January 2024.

Exposures

The primary exposure was the receipt of MOUD within 7 days after an OUD-related hospital visit.

Main Outcomes and Measures

The main outcomes measured were fatal or nonfatal opioid overdoses at 6 and 12 months post-discharge. Sample characteristics were stratified by whether patients received MOUD within 7 days after their OUD-related hospital visit. Factors considered included age, sex, insurance plan, number of comorbidities, and prior opioid-related overdose events. A logistic regression model was used to investigate the association between receipt of MOUD and the occurrence of an opioid overdose event.

Key Findings

Patient Demographics

The study included 22,235 patients:

• Sex: 53.1% female
• Age Distribution: 25.0% aged 25-39 years

MOUD Receipt

• Overall MOUD Initiation: 1,184 patients (5.3%) received MOUD within 7 days of their ED visit or hospitalisation.
  • Buprenorphine: 683 patients (57.7%)
  • Methadone: 463 patients (39.1%)
  • Long-acting Injectable Naltrexone: 46 patients (3.9%)

Overdose Outcomes

• At 6 Months:
  
  
  • Patients who received MOUD within 7 days had lower adjusted odds of fatal or nonfatal overdose compared to those who did not (AOR, 0.63; 95% CI, 0.41-0.97).
  • Buprenorphine use was significantly associated with a lower risk of fatal or nonfatal overdose (AOR, 0.50; 95% CI, 0.27-0.95).
  • Methadone use showed no significant association with reduced overdose risk (AOR, 0.57; 95% CI, 0.28-1.17).
• At 12 Months:
  
  
  • No significant difference in the adjusted odds of fatal or nonfatal overdose was found between those who received MOUD and those who did not (AOR, 0.79; 95% CI, 0.58-1.08).

Conclusion

In this cohort study, initiating MOUD within 7 days after an OUD-related hospital visit was associated with reduced odds of opioid-related overdose at 6 months. However, no significant difference was observed at 12 months. These findings suggest that hospitals should consider implementing protocols to offer initiation of MOUD to patients with OUD who present for care.

Source: JAMA Network