Opioid Agonist Therapy is Infrequent for Veterans with Opioid Use Disorder Admitted to a VA Hospital
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 retrospective cohort 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. Pharmacotherapy variables were coded for three time periods: 1) 30 days pre-admission, 2) during admission, and 3) 30 days post-admission. In addition, investigators examined patient demographics and diagnoses, including co-occurring mental health or SUD diagnoses. They also assessed hospital characteristics including admission volume, location, size, and acute OUD diagnosis volume.
- 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.
- Veterans on pre-admission OAT, those with an acute opioid use disorder diagnosis, and who were male had increased odds of receiving OAT. Veterans who received non-OAT opioids or surgical procedures had decreased odds of receiving OAT.
- Veterans admitted to large and medium-sized VA hospitals had increased odds of OAT receipt compared with those admitted to small VA hospitals. Veterans admitted to hospitals located in the Northeast and West had increased odds of OAT receipt compared with those in the South.
- Findings may motivate practice improvement, future research (i.e., barriers to OAT initiation during hospitalization), and inform policy to increase hospital-based OAT delivery.
- This observational study did not allow for an analysis of causal relationships.
- Patients in the study cohort may have been misclassified with an OUD and, thus, were not valid candidates for OAT.
Dr. Lovejoy is part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.
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. April 14, 2020; Epub ahead of print.