Most people treated for an overdose at a hospital continue to take opioids after they are discharged, and few begin medication-assisted treatment for opioid misuse, suggesting hospitals can do more to intervene at the point of care, according to a research letter in JAMA.
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For the study, researchers at the University of Pittsburgh assessed claims data for Medicaid beneficiaries in Pennsylvania ages 12 to 64 who experienced "an overdose event" between 2008 and 2013. Specifically, the researchers examined claims data for prescription opioids and medication-assisted treatment for substance misuse, such as buprenorphine, naltrexone, or methadone six months before and after the overdose.
According to the study, 13,670 Medicaid beneficiaries were treated for an overdose in that time frame; however, the study focused on the 6,013 beneficiaries who were continuously enrolled in the program for six months before and after the overdose event. Of those, 3,945 overdosed on opioids and 2,068 overdosed on heroin.
The researchers found that in the six months before and after the overdose event, the rate of filled opioid prescriptions declined by:
- About 10 percent among those who had overdosed on opioids, from 66.1 percent (2,609) prior to the overdose to 59.6 percent (2,350) after the overdose; and
- About 8 percent among those who had overdosed on heroin, from 43.2 percent (894) prior to the overdose to 39.7 percent (822) afterwards.
Further, the researchers found that in the six months before and after the overdose event, the percentage of beneficiaries with at least 90 days' worth of prescription opioids decreased by:
- 1.5 percentage points among those who had overdosed on heroin, from 10.5 percent to 9 percent; and
- 4.1 percentage points among those had overdosed on opioids, from 32.5 percent to 28.3 percent.
Meanwhile, the researchers found that in the six months before and after the overdose event, the rate of filled prescriptions for medication-assisted treatment drugs increased by:
- 3.6 percentage points among those had had overdosed on heroin, from 29.5 percent to 33 percent afterwards; and
- 1.6 percentage points among those who had overdosed on opioids, from 13.5 percent to 15.1 percent.
Julie Donohue, associate professor of health policy and management at the University of Pittsburgh and the senior author on the paper, said the study underscores the "need to rethink how we organize medical care for people with opioid addiction, especially for people who are treated for an overdose."
Not only does the health care system need to find ways to share comprehensive patient data with physicians who are prescribing the opioids, Donohue said, but hospitals should take stronger action while the patient is in care. "There is a strong evidence base to suggest that initiating additional treatment while people are still in the hospital is more effective than giving them a referral to another treatment facility," she said.
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For instance, Neil Capretto, medical director of Gateway Rehabilitation, cited the benefits of a "warm handoff"—when a patient is introduced to treatment options while in the hospital, such as medication-assisted treatment or a direct transfer to a treatment program, rather than simply referring the patient for further care.
Yngvild Olsen, medical director for the Institutes for Behavior Resources/REACH Health Services, agreed, saying that the research affirms the need for stronger hospital interventions than the "usual standard of care, which has been to hand people a phone number or pamphlet and say, 'Here. Good luck.'"
Olsen cited the success of more intensive strategies outlined in a 2015 study, which found that 78 percent of patients who misused opioids received buprenorphine while in the hospital were still in treatment 30 days later. In contrast, 45 percent of patients who misused opioids who received only a 10- to 15-minute interview and information about treatment options, and 37 percent of such patients who simply received a handout, were still in treatment 30 days later (Hsu, "Shots," NPR, 8/22; Sapatkin, Philly News, 8/22; Guza, Trib Live, 8/22; Vendel, Penn Live, 8/22).
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