Journal of general internal medicine · 2026
Failure to Treat Opioid Use Disorder and Opioid Withdrawal Associated with Patient-Directed Discharge in People with Injection-Related Infections.
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Traver Edward C, Iyalomhe Oshozimhede E, Ramadhani Habib O, Stevens Jasmine, Derenoncourt Meghan, Vaish Ishan, Flores Hannah, Fujita A Wendy, Raman Sumitha, Steck Alaina, Kuo Irene, Catalanotti Jillian S, Carpenter Joseph E, Reece Rebecca, Masur Henry, Lavoie Marie-Claude C, Kattakuzhy Sarah M, Rosenthal Elana S
Аннотация
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.
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.