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Prior use of medications for opioid use disorder in ED patients with opioid overdose: prevalence, misuse and overdose

Siri Shastry1, Ishak Nobel2, Lisa R Allen1

  • 1Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.

The American Journal of Emergency Medicine
|November 4, 2021
PubMed
Abstract

Insights

Medications for opioid use disorder (MOUD) prescriptions increased, but misuse was noted with methadone. Prior buprenorphine use was linked to shorter opioid overdose (OD) lengths of stay.

Area of Science:

  • Emergency Medicine
  • Addiction Medicine
  • Pharmacology

Background:

  • Medications for opioid use disorder (MOUD) are crucial for reducing opioid overdose (OD) mortality.
  • The prevalence and misuse patterns of MOUD among emergency department (ED) patients presenting with OD are not well-understood.
  • The impact of existing MOUD prescriptions on subsequent OD severity requires further investigation.

Purpose of the Study:

  • To determine the prevalence and trends of MOUD use in ED patients with opioid overdose.
  • To investigate the misuse of different MOUD formulations in this patient population.
  • To assess the association between prior MOUD prescriptions and OD severity, including length of stay (LOS) and in-hospital mortality.

Main Methods:

  • A prospective observational cohort study was conducted involving ED patients with confirmed opioid overdose at two tertiary-care hospitals between 2015 and 2019.
  • Patients were included based on confirmed opioid OD via urine toxicology; exclusions included alternate diagnoses, insufficient data, age < 18, and prisoners.
  • Opioid overdose severity was measured by hospital LOS and in-hospital mortality. Time trends and associations between MOUD and outcomes were analyzed.

Main Results:

  • Of 696 patients with confirmed opioid OD, 17% had a prior MOUD prescription, with prevalence increasing significantly from 2016 to 2019.
  • Methadone showed higher odds of misuse (OR 3.96) compared to buprenorphine (OR 1.16).
  • Patients on buprenorphine had significantly shorter LOS (IRR -0.44) after adjustment. While any MOUD was associated with lower odds of death (OR 0.70), methadone had the highest odds (OR 0.82).

Conclusions:

  • MOUD prevalence in ED patients with opioid overdose significantly increased during the study period.
  • Misuse was observed, particularly with methadone, while buprenorphine was associated with reduced hospital LOS.
  • These findings highlight the evolving landscape of MOUD use and its varied impact on OD outcomes in the ED setting.
Keywords:
Drug misuseMedications for opioid use disorderOpioid overdose

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