Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder

Addiction Science & Clinical Practice

Case Study

Rachel McFadden¹  Peggy Compton¹  M. Kit Delgado²  Jeanmarie Perrone²  Margaret Lowenstein³  Tanya J. Uritsky⁴  Anna Winston⁵  Jennifer M. Olenik⁵  Cara Christopher⁶  Ashish P. Thakrar⁷  Anne Caputo⁸  Anna Lee Sigueza⁸  Kaitlin Ronning⁸ 

[1] Center for Addiction Medicine & Policy, University of Pennsylvania, Philadelphia, USA;Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA;Center for Addiction Medicine & Policy, University of Pennsylvania, Philadelphia, USA;Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA;Center for Addiction Medicine & Policy, University of Pennsylvania, Philadelphia, USA;Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA;Center for Addiction Medicine & Policy, University of Pennsylvania, Philadelphia, USA;Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, USA;Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA;Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, USA;National Clinician Scholars Program at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, USA;Center for Addiction Medicine & Policy, University of Pennsylvania, Philadelphia, USA;School of Nursing, University of Pennsylvania, Philadelphia, USA;

关键词: Opioid use disorder;    Hospitalized patients;    Fentanyl;    Opioid agonist treatment;    Short-acting opioids;    Methadone;    Buprenorphine;    Opioid withdrawal;   

DOI  :  10.1186/s13722-023-00368-z

 received in 2022-09-14, accepted in 2023-02-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPatients with opioid use disorder (OUD) frequently leave the hospital as patient directed discharges (PDDs) because of untreated withdrawal and pain. Short-acting opioids can complement methadone, buprenorphine, and non-opioid adjuvants for withdrawal and pain, however little evidence exists for this approach. We described the safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with OUD at an academic hospital in Philadelphia, PA.MethodsFrom August 2021 to March 2022, a pharmacist guided implementation of a pilot sOAT protocol consisting of escalating doses of oxycodone or oral hydromorphone scheduled every four hours, intravenous hydromorphone as needed, and non-opioid adjuvants for withdrawal and pain. All patients were encouraged to start methadone or buprenorphine treatment for OUD. We abstracted data from the electronic health record into a secure platform. The primary outcome was safety: administration of naloxone, over-sedation, or a fall. Secondary outcomes were PDDs and respective length of stay (LOS), discharges on methadone or buprenorphine, and discharges with naloxone. We compared secondary outcomes to hospitalizations in the 12 months prior to the index hospitalization among the same cohort.ResultsOf the 23 cases, 13 (56.5%) were female, 19 (82.6%) were 40 years or younger, and 22 (95.7%) identified as White. Twenty-one (91.3%) regularly injected opioids and four (17.3%) were enrolled in methadone or buprenorphine prior to hospitalization. sOAT was administered at median doses of 200–320 morphine milligram equivalents per 24-h period. Naloxone administration was documented once in the operating room, over-sedation was documented once after unsanctioned opioid use, and there were no falls. The PDD rate was 44% with median LOS 5 days (compared to PDD rate 69% with median LOS 3 days for prior admissions), 65% of sOAT cases were discharged on buprenorphine or methadone (compared to 33% for prior admissions), and 65% of sOAT cases were discharged with naloxone (compared to 19% for prior admissions).ConclusionsPilot implementation of sOAT was safe. Compared to prior admissions in the same cohort, the PDD rate was lower, LOS for PDDs was longer, and more patients were discharged on buprenorphine or methadone and with naloxone, however efficacy for these secondary outcomes remains to be established.

【 授权许可】

CC BY   
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023

【 图 表 】

42004_2023_830_Article_IEq31.gif