Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial

Area of Science:

• Addiction Medicine
• Clinical Trials
• Public Health

Background:

• Medications for opioid use disorder (MOUD) are effective treatments for opioid use disorder (OUD).
• Hospitalized patients with OUD often do not receive MOUD during their stay or connect with post-discharge treatment.
• This gap in care highlights a need for improved interventions within hospital settings.

Purpose of the Study:

• To evaluate the effectiveness of the Substance Use Treatment and Recovery Team (START) consultation service.
• To determine if START increases MOUD initiation during hospitalization.
• To assess if START improves linkage to follow-up OUD treatment after discharge.

Main Methods:

• A 1:1 randomized clinical trial was conducted across three hospitals.
• Participants with OUD were assigned to either the START intervention or usual care.
• The START intervention involved an addiction specialist and care manager providing motivational counseling and discharge planning, including follow-up calls.

Main Results:

• The START intervention group showed significantly higher rates of MOUD initiation during hospitalization compared to the usual care group (57.3% vs. 26.7%).
• Participants in the START group were also more likely to successfully link to OUD care within 30 days post-discharge (72.0% vs. 48.1%).
• The adjusted risk ratios were 2.10 for MOUD initiation and 1.49 for linkage to care.

Conclusions:

• The hospital-based START consultation service effectively addresses gaps in inpatient care for OUD.
• START improves the receipt of evidence-based MOUD during hospitalization.
• The intervention enhances post-discharge linkage to continued OUD treatment, improving patient outcomes.