Opioid agonist therapy during hospitalization within the Veterans Health Administration: a pragmatic retrospective cohort analysis.
Open accessAbstract
Background Hospitalization of patients with opioid use disorder (OUD) is increasing, yet little is known about opioid agonist therapy (OAT: methadone and buprenorphine) administration during admission.Objective Describe and examine patient- and hospital-level characteristics associated with OAT receipt during hospitalization in the Veterans Health Administration (VHA).Participants A total of 12,407 unique patients, ≥ 18 years old, with an OUD-related ICD-10 diagnosis within 12 months prior to or during index hospitalization in fiscal year 2017 from 109 VHA hospitals in the continental U.S.Main measure OAT received during hospitalization.Key results Few admissions received OAT (n = 1914; 15%) and when provided it was most often for withdrawal management (n = 834; 7%). Among patients not on OAT prior to admission who survived hospitalization (n = 10,969), 2.0% (n = 203) were newly initiated on OAT with linkage to care after hospital discharge. Hospitals varied in the frequency of OAT delivery (range, 0 to 43% of qualified admissions). Patients with pre-admission OAT (adjusted odds ratio [AOR] = 15.30; 95% CI [13.2, 17.7]), acute OUD diagnosis (AOR = 2.3; 95% CI [1.99, 2.66]), and male gender (AOR 1.52; 95% CI [1.16, 2.01]) had increased odds of OAT receipt. Patients who received non-OAT opioids (AOR 0.53; 95% CI [0.46, 0.61]) or surgical procedures (AOR 0.75; 95% CI [0.57, 0.99]) had decreased odds of OAT receipt. Large-sized (AOR = 2.0; 95% CI [1.39, 3.00]) and medium-sized (AOR = 1.9; 95% CI [1.33, 2.70]) hospitals were more likely to provide OAT.Conclusions In a sample of VHA inpatient medical admissions, OAT delivery was infrequent, varied across the health system, and was associated with specific patient and hospital characteristics. Policy and educational interventions should promote hospital-based OAT delivery.
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Few hospital patients receive SUD treatment services.
“yet few hospital patients receive SUD treatment services.4,21,22”
From Assessment of Annual Cost of Substance Use Disorder in US Hospitals (2021) · cites this paper as [22]
The Discussion reports that only 15% of hospitalized VHA patients with OUD received opioid agonist therapy during admission. This supports low receipt of one SUD treatment in that group, but the claim extends to SUD treatment services generally and to hospital patients beyond the studied population. (LLM, conf=0.87)
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Assessment of Annual Cost of Substance Use Disorder in US Hospitals
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- Authors
- Priest, K. C., Lovejoy, T. I., Englander, H., Shull, S., & McCarty, D.
- Affiliations
- Portland State University (US)
- Oregon Health & Science University (US)
- Portland VA Medical Center (US)
- Corresponding author
- Priest, Kelsey C.
- Venue
- Journal of General Internal Medicine
- Published
- 2020-04-14
- Volume
- 35
- Issue
- 8
- Pages
- 2365-2374
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC7403377
- OpenAlex
- W3015890779
- Cited by
- 72
- References
- 30
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 25 · 2023: 9 · 2022: 10 · 2021: 13 · 2020: 3
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PDXScholar (Portland State University) (submittedVersion)
- Funders
- National Institute on Drug Abuse (F30 DA044700UG, R33 DA035640, UG1 DA015815)
- Greenlick Family Scholarship Fund
- U.S. Department of Veterans Affairs (IK2HX001516)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid substitution therapy, opioid use disorder, methadone, buprenorphine, hospitalization, Veterans Health Administration, opioid withdrawal management, linkage to care, hospital size, opioid prescribing, veterans, surgical procedures, gender differences, hospital-level variation, substance use disorder treatment access
- MeSH terms
- Adolescent, Analgesics, Opioid, Hospitalization, Humans, Male, Opioid-Related Disorders, Retrospective Studies, Cohort Studies, Veterans Health, Opiate Substitution Treatment
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