A Comparison of Medication for Opioid Use Disorder Treatment Strategies for Persons Who Inject Drugs With Invasive Bacterial and Fungal Infections. (2nd September 2020)

• Record Type: Journal Article
• Authors: Marks, Laura R; Munigala, Satish; Warren, David K; Liss, David B; Liang, Stephen Y; Schwarz, Evan S; Durkin, Michael J
• Is Part Of: Journal of infectious diseases. Volume 222(2020)Supplement 5
• Page Start: S513
• Page End: S520
• Publication Date: 2020-09-02
• Subjects: injection drug use -- medications for opioid use disorder -- opioids -- opioid use disorder -- people who inject drugs (PWID); Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiz516
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Patients with opioid use disorder (OUD) are frequently admitted for invasive infections. Medications for OUD (MOUD) may improve outcomes in hospitalized patients. Methods: In this retrospective cohort of 220 admissions to a tertiary care center for invasive infections due to OUD, we compared 4 MOUD treatment strategies: methadone, buprenorphine, methadone taper for detoxification, and no medication to determine whether there were differences in parenteral antibiotic completion and readmission rates. Results: The MOUDs were associated with increased completion of parenteral antimicrobial therapy (64.08% vs 46.15%; odds ratio [OR] = 2.08; 95% CI, 1.23–3.61). On multivariate analysis, use of MOUD maintenance with either buprenorphine (OR = 0.38; 95% CI, .17–.85) or methadone maintenance (OR = 0.43; 95% CI, .20–.94) and continuation of MOUD on discharge (OR = 0.35; 95% CI, .18–.67) was associated with lower 90-day readmissions. In contrast, use of methadone for detoxification followed by tapering of the medication without continuation on discharge was not associated with decreased readmissions (OR = 1.87; 95% CI, .62–5.10). Conclusions: Long-term MOUDs, regardless of selection, are an integral component of care in patients hospitalized with OUD-related infections. Patients with OUD should have arrangements made for MOUDs to be continued after discharge, and MOUDs should not be discontinued before discharge.