Examining Impact of Addiction Medicine Consult Service on MOUD Initiation | ACCP 2024

The availability of addiction medicine consult services (AMCS) could help increase medication for opioid use disorder (MOUD) initiation in hospitalized patients with a history of opioid use disorder (OUD), according to research presented at the American College of Clinical Pharmacy 2024 Annual Meeting, held October 12 to 15 in Phoenix, Arizona.¹

Examining Impact of Addiction Medicine Consult Service on MOUD Initiation / Eric Hood - stock.adobe.com

From 2002 to 2021, the rate of drug overdose deaths increased from 8.2 per 100000 to 32.6 in the United States.² Drug overdoses now represent one of the leading causes of injury death in the country, with synthetic opioids like fentanyl playing a major role in recent years. Although overdose deaths decreased in 2023 for the first time since 2018, the issue remains a significant threat to public health.³

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MOUD, which includes medications such as methadone, buprenorphine and naltrexone, is the standard treatment for patients with OUD. Research has shown that MOUD has better efficacy compared to nonpharmacologic treatments and improves mortality, treatment retention and remission.⁴ However, MOUD uptake remains low and many parts of the country lack access to certain MOUD medications.

Investigators from the University of Pittsburgh Medical Center St. Margaret conducted a study to examine if access to an AMCS would increase MOUD initiation in inpatients with untreated OUD. Data for the retrospective, quantitative, cohort study was gathered from 2 sites: 1 that developed an AMCS in 2021 and 1 that did not have an AMCS.

At baseline, before the first site developed an AMCS, data was collected on MOUD initiation and demographics. Additional data was also gathered from the first site after it developed its AMCS. For the study, investigators compared the change in MOUD initiation rates between the periods at both sites. The main study objective was to assess how an AMCS influences MOUD initiation in patients with untreated OUD.

The study cohort included 504 adult patients with ICD-10 codes that were related to OUD who were not currently receiving treatment. Patients were excluded from the study if they had an active cancer diagnosis. To estimate and test the difference in rates of MOUD within each site, researchers used Z-Test for proportions.

At baseline, the rate of MOUD initiation at site 1 was 8%, compared to 5% at site 2. After site 1 implemented its AMCS, the rate of MOUD initiation was 21% versus 6% at site 2. The authors of the study concluded that the availability of an AMCS could increase MOUD initiation in patients with a history of OUD.

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References

1. Dillen M, Baumgartner M, D’Amico F, et al. Impact of an Addiction Medicine Consult Service on Medications for Opioid Use Disorder Initiation in Hospitalized Patients. Presented at: American College of Clinical Pharmacy 2024 Annual Meeting; October 12-15, 2024; Phoenix, AZ; Poster 108.

2. Spencer MR, Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135849

3. U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. News Release. CDC. May 15, 2024. Accessed October 14, 2024. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm

4. Wakeman SE, Larochelle MR, Ameli O, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open. 2020;3(2):e1920622. doi:10.1001/jamanetworkopen.2019.20622