Failure to Treat Opioid Use Disorder and Opioid Withdrawal Associated with Patient-Directed Discharge in People with Injection-Related Infections.

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.