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Failure to Treat Opioid Use Disorder and Opioid Withdrawal Associated with Patient-Directed Discharge in People with
Edward C Traver1, Oshozimhede E Iyalomhe2, Habib O Ramadhani2
1Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA. etraver@ihv.umaryland.edu.
Background:
People who inject drugs (PWID) are frequently hospitalized with acute infections. Patient-directed discharge (PDD) is common among people with injection-related infections and is associated with rehospitalization and death. Opioid withdrawal and pain are common reasons for PDD among PWID but approaches to reduce PDD among people with injection-related infections are lacking.
Objective:
To measure if inpatient treatment of opioid use disorder (OUD) and opioid withdrawal is associated with lower PDD rates among people hospitalized with infections from injection drug use.
Design:
Multisite retrospective observational cohort. Multivariable Poisson regression models were used to compute adjusted incidence rate ratio (aIRR) for factors associated with PDD.
Participants:
Adults hospitalized for ≥ 2 days at four academic medical centers for a bacterial or fungal infection caused by injection opioid use between January 1, 2018, and March 31, 2023.
Main Measures:
Drug toxicology testing, presence of opioid withdrawal, treatment of opioid withdrawal, receipt of medication for OUD (MOUD; buprenorphine or methadone), duration of hospitalization, and discharge type (planned or patient-directed).
Key Results:
PDD occurred in 25% of the 1447 hospitalizations. Hospitalizations with PDD were shorter than those with planned discharge (median 6 v. 18 days, p < 0.001). Compared to those without opioid withdrawal, PDD rates were highest for participants with untreated opioid withdrawal (aIRR = 2.73, 95%CI: 1.49-5.02) and participants with withdrawal treated with only non-opioids (aIRR = 2.54, 95%CI: 1.89-3.42), and less elevated for participants with withdrawal treated with opioids (aIRR = 2.00, 95%CI: 1.46-2.75). Participants who received MOUD during the hospitalization had lower rates of PDD than those who did not (aIRR = 0.25, 95%CI: 0.19-0.33).
Conclusions:
Among people hospitalized with infections from injection opioid use, over one quarter experienced PDD. Lower rates of PDD were associated with MOUD treatment and opioid withdrawal treatment.
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