Opioid Agonist Therapy Needed for Veterans with Opioid Use Disorder During Hospital

January 29, 2021

Takeaway: Only 15% of Veterans with an opioid use disorder received any opioid agonist therapy (OAT) during VA hospital admission. Findings should motivate practice improvement, future research (i.e., barriers to OAT initiation during hospitalization), and inform policy to increase hospital-based OAT delivery.

The national opioid crisis, as well as a growing prevalence of opioid use disorder (OUD) diagnoses among Veterans, resulted in a system-wide requirement that all VA facilities provide access to opioid agonist therapy (OAT). This study sought to describe and examine patient- and hospital-level characteristics associated with the receipt of OAT during VA hospitalization. Researchers identified 12,407 patients across 109 VA hospitals who were admitted for various reasons but also had an opioid use disorder diagnosis within 12 months prior to or during FY2017 hospitalization. Findings from this study show:

• The delivery of OAT was infrequent, varied across the VA healthcare system, and was associated with specific patient and hospital characteristics. Only 15% of the entire study cohort received any OAT during hospital admission.
• Of 10,969 Veterans who had an OUD diagnosis at the time of hospitalization but were not already being treated for it, only 203 (2%) received OAT along with a link to care after their discharge. Instead, most of these patients (80%) received opioid withdrawal management, representing a missed opportunity to continue OUD treatment beyond hospitalization.
• Hospital admission interrupted ongoing outpatient OUD treatment, with more than one-third of Veterans having their outpatient OAT discontinued during admission.

Impact

A sub-analysis of this study cohort is in preparation; it will explore differential access to buprenorphine and methadone in the inpatient context by racial category. Additionally, upon request, investigators wrote a commentary about what non-VA organizations could learn from this work and ways to expand access to medications for opioid use disorder (MOUD). They suggested that decision-makers should consider the following four elements: 1) identify and implement person-centered MOUD delivery systems; 2) recognize and address MOUD delivery gaps; 3) broaden the definition of the MOUD delivery system; and 4) expand MOUD options.*

*Priest K, McCarty D, and Lovejoy T. Expanding access to medications for opioid use disorder: Program and policy approaches from outside the Veterans Health Administration. Journal of General Internal Medicine. November 2020;35:886-890.

Priest K, Lovejoy T, Englander H, Shull S, and McCarty D. Opioid agonist therapy during hospitalization within the Veterans Health Administration: A pragmatic retrospective cohort analysis. Journal of General Internal Medicine. August 2020;35(8):2365-2374.