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Initiating Injectable Buprenorphine in People Hospitalized With Infections: A Randomized Clinical Trial.

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Injectable long-acting buprenorphine (LAB) did not significantly improve medication for opioid use disorder (MOUD) receipt compared to treatment as usual in hospitalized patients. Treatment as usual showed higher retention than expected, suggesting hospitalization is an opportunity for MOUD initiation.

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Area of Science:

  • Addiction Medicine
  • Infectious Diseases
  • Clinical Trials

Background:

  • Hospitalizations for infections linked to opioid use disorder (OUD) are rising in the US.
  • Medication for opioid use disorder (MOUD) initiation is low among these patients.
  • Injectable long-acting buprenorphine (LAB) may enhance MOUD receipt and treatment completion.

Purpose of the Study:

  • To compare the initiation of LAB with infectious disease (ID) management against treatment as usual (TAU) for improving MOUD receipt at 12 weeks.
  • To evaluate the effectiveness of ID-LAB versus TAU in patients hospitalized with OUD and concurrent infection.

Main Methods:

  • A multisite randomized clinical trial (COMMIT trial) enrolled 171 participants with moderate to severe OUD and infection.
  • Participants were randomized 1:1 to receive ID-LAB or TAU during hospitalization or post-discharge.
  • The primary outcome was MOUD receipt at 12 weeks, with outcomes assessed via intent-to-treat analysis.

Main Results:

  • No statistically significant difference in MOUD receipt at 12 weeks between the ID-LAB (59.3%) and TAU (54.1%) groups.
  • The TAU arm demonstrated higher-than-anticipated patient retention.
  • The study included 171 participants across 3 US hospital systems.

Conclusions:

  • Initiating injectable long-acting buprenorphine (LAB) with infectious disease management in hospitalized patients did not improve medication for opioid use disorder (MOUD) receipt compared to treatment as usual.
  • Treatment as usual showed robust retention, indicating hospitalization is a critical window for identifying OUD and initiating MOUD.
  • Future studies should evaluate the impact of nurse care management services provided to all participants.