Drugs for opioid use disorder that are underused after injection-related infections

Deaths from injection-related infections such as endocarditis have increased among young people, likely due to the increase in injection drug use and the stronger, shorter-acting fentanyl. While opioid use disorder medications reduce the risk of death, starting and keeping patients on these life-saving treatments is difficult. Researchers at Boston Medical Center (BMC) recently found that opioid use disorder medications after hospitalizations for injection-related infections are still underused in Massachusetts, even though they improve outcomes. The findings were published in JAMA Network Open on July 24, 2024.

Our findings underscore the critical need for physicians to proactively engage and support patients with evidence-based treatments for opioid use disorder whenever they present to the hospital, including serious injection-related infections.”

Simeon Kimmel, MD, first author on the paper and an attending physician of general internal medicine and infectious diseases at BMC

The team found that the number of patients receiving opioid use disorder medication increased after hospitalization for injection-related infections, although there were differences in who received treatment during hospitalization and retention remained difficult.

Researchers used data from the Massachusetts Public Health Data Repository to assess the relationship between serious injection-related infections — endocarditis, osteomyelitis, septic arthritis, epidural abscess, or bloodstream infections — and use of use disorder medications of opioids. Their analysis included data from January 2014 to December 2020 and people aged 18 to 64.

In the week before hospitalization for injection-related infections, less than 18% of patients received opioid use disorder medication. Three months after discharge, about 25% of patients were being treated with these drugs. Overall, only about half of the patients had received at least one week of opioid use disorder medication treatment at any point in the year after being hospitalized for a serious infection.

“Clinicians and health systems need to do a better job of both initiating and keeping patients on opioid use disorder medications after hospitalization,” says Kimmel, assistant professor of medicine at Chobanian University & Avedisian School of Medicine in Boston.

The research team also found differences among patients who received opioid use disorder medication after infection: younger people, people who had previously been treated, people who had experienced homelessness or overdose, and those with Medicaid were more likely to receive opioid use disorder medication. opioid use disorder. Black patients were less likely to receive opioid use disorder medication. “Black patients experience increasing rates of overdose, and disparities in receiving opioid use disorder medication could contribute. Efforts to address these disparities in opioid use disorder care are imperative for health equity,” says Kimmel.

BMC is already taking steps to address these disparities through innovative substance use disorder initiatives. The Anti-Racist Approaches to Addiction Treatment (AAAT) team examined factors affecting Black, Indigenous, and other people of color with substance use disorder, held focus groups to understand lived experiences, and hosted summits to disseminate findings. Findings from this initiative, which includes hiring, training, and promoting diverse staff, focusing on the experiences of Black patients in clinical programs, and using strengths-based approaches are key lessons that have informed BMC’s addiction programs.

To improve opioid use disorder medication use more broadly, the hospital’s Addiction Counseling Service supports patients in the hospital with addiction treatment medication initiation, pain management recommendations, and transition to community-based addiction treatment programs after leaving the hospital. BMC’s Faster Paths to Treatment offers low-barrier access to opioid use disorder medications that can facilitate linkage to post-hospital care. The Office Based Addiction Treatment (OBAT) Program provides specialized treatment for patients with substance use disorders integrated into a primary care setting, allowing all medical needs to be addressed by a team of providers. In addition, the Multidisciplinary Endocarditis Task Force coordinates multidisciplinary care after endocarditis, one of the serious injection-related infections from the study, and Project TRUST offers harm reduction services to reduce the risk of injection-related infections. injection.

Kimmel now aims to launch a new study to test whether a mobilization intervention called recovery management screening further improves opioid use disorder drug treatment retention after injection-related infections.

“We work to improve patient outcomes and support patients on their recovery journeys through our innovative research. At Boston Medical Center, we are committed to studies that advance and set new standards in addiction care,” says Kimmel.