Medications for OUD Reduces Rates of Overdose and Endocarditis

Patients with opioid use disorder (OUD) who receive medications for OUD following endocarditis may experience improved health-related outcomes, according to study results published in Clinical Infectious Diseases.

According to previous research, endocarditis is an increasingly common complication of injected drug use with nonprescription opioids and contributes to high hospitalization rates. Medications for OUD including methadone and buprenorphine have been shown to reduce rates of opioid use, overdose, and death. However, receipt of these medications during hospitalization or upon discharge is uncommon.

Therefore researchers conducted a retrospective cohort study with the objective of determining whether rates of health outcomes, overdose, and rehospitalization differ between commercially insured patients with OUD hospitalized for endocarditis who receive medications for OUD during perihospitalization and those who do not.

Researchers used a nationally representative commercial insurance claims database to analyze data on 768 patients aged >18 years with OUD who were hospitalized for endocarditis between 2010 and 2016. Incidence rates were calculated for the primary outcomes, and Cox hazards models were developed to predict time from hospital discharge to each primary outcome as a function of receipt of medications for OUD. 

Approximately 6% of patients (n=44) received medications for OUD within 30 days following an index hospitalization for endocarditis. A total of 41 patients who did not receive medications experienced an overdose: a rate of 7.3 overdoses per 100-person years (95% CI, 7.1-7.5). The rate of overdoses per 100 person-years for patients who received OUD medications, conversely, was 5.8 (95% CI, 5.1-6.4).

The rate of 1-year rehospitalization for those who received medications for OUD was 162.0 per 100 person-years, which was lower than the 255.4 rate for those who did not (95% CI, 157.4-166.6 and 254.0-256.8, respectively). The 30-day rehospitalization rate per 100-person-30 days was 40.5 among patients who did not receive OUD medications, compared with 32.6 among those who did. Cox hazard models showed no significant risk reduction in overdose for patients who received medications for OUD vs those who did not (hazard ratio 1.18; 95% CI, 0.36-3.80).

Limitations to this study included lack of insurance information for methadone therapy, inability to determine whether medications for OUD were initiated in the hospital, and exclusion of patients who were uninsured or who had public insurance. In addition, researchers could not determine whether overdoses were fatal and were unable to explore polysubstance overdose due to a lack of toxicology in claims data.

The study authors concluded that the use of medications for OUD during perihospitalization for endocarditis in OUD may be key to comprehensive care and positive health outcomes, and may also improve retention in care and long-term recovery in this population.

Reference

Barocas JA, Morgan JR, Wang J, McLoone D, Wurcel A, Stein MD. Outcomes associated with medications for opioid use disorder among persons hospitalized for infective endocarditis [published online January 21, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa062