(77) Patient Factors Associated with Hospital Discharge on Buprenorphine Versus Methadone

Background & Introduction: Opioid use disorder (OUD) hospitalizations in the United States have increased by over 60% since 2005. In 2024, only 25% of patients with OUD received medications for opioid use disorder (MOUD). When discharged prematurely without MOUD, patients with OUD suffer consequences such as readmission, return to opioid use, and death due to overdose. The University of Illinois Hospital & Health Sciences System (UI Health) implemented a pharmacist-integrated, interprofessional inpatient OUD medication-assisted recovery (MAR) consultation service to address this gap through comprehensive OUD medication management and linkage to ongoing treatment upon discharge. The purpose of this study is to determine which patient factors are associated with treatment selection of methadone or buprenorphine to improve clinician and patient’s shared decision-making to initiate or continue a specific MOUD beyond hospital admission. This data could be incorporated into internal clinical protocols and in-services to bolster clinical decision making, ultimately increasing the number of people who are appropriately given MOUD, decreasing drug use, overdose, and fatalities.

Methods: This single-center retrospective cohort study was conducted via chart review for patients who were admitted to UI Health or had emergency department visits between July 1, 2022 and June 30, 2024, had a completed OUD MAR consult, and were discharged on MOUD. Completed consults for pain management support were excluded. The following data was collected: age; gender; race; insurance coverage; past MOUD use; admitting diagnosis; housing status; prolonged QTc on admission (≥460 for males and ≥450 for females); presence of comorbid pain, respiratory disorders, and psychiatric conditions; history of intravenous drug use; history of overdose; concurrent use of benzodiazepines; and length of stay. The primary outcome was the association between these patient factors and the selection of buprenorphine or methadone for treatment of OUD. Secondary outcomes include the strength of the association of patient factors on buprenorphine or methadone. Statistical analysis comprised descriptive, bivariate (Chi-Square and t-tests), and multivariate (Binary Logistic Regression) analyses (p < 0.05) in SPSS 29.0 to determine the association of patient factors on the selection of buprenorphine or methadone. Methadone was chosen for the “0” category and buprenorphine was chosen as the “1” category.

Results: Over three quarters (75.5%, n=324) of patients were discharged on methadone compared to 24.5% (n=105) of patients discharged on buprenorphine or buprenorphine/naloxone. Bivariate analysis revealed significant differences between patients discharged on methadone versus buprenorphine and past MOUD use of only buprenorphine (8.3% vs. 19.0%, p< 0.002), presence of comorbid psychiatric conditions (13.7% vs. 24.8%, p< 0.009), and MOUD at presentation (53.7% vs. 3.8% on methadone, 1.5% vs. 43.8% on buprenorphine, 44.7% vs. 52.4% not on MOUD). There was no significant difference in age between groups (mean 52.3 [SD 12.6] years in methadone group versus 52.3 [SD 13.2] years in buprenorphine group; mean difference: 0.03, 95% CI -2.79-2.84, p=0.986). Three factors were associated with being discharged on buprenorphine including taking buprenorphine at presentation (OR 8,121.77, 95% CI 726.02-90,855.69, p< 0.001), not taking any MOUD at presentation (OR 174.80, 95% CI 26.47-1,154.19, p< 0.001), and past use of only buprenorphine (OR 5.10, 95% CI 1.43-18.16, p=0.012). Prolonged QTc (OR 1.18, 95% CI 0.47-2.96, p= 0.719), presence of respiratory comorbidities such as asthma, chronic obstructive pulmonary disease, and pulmonary hypertension (OR 0.98, 95% CI 0.31-3.06, p=0.966), and housing instability (OR 2.47, 95% CI 0.50-12.12, p=0.265) were not associated with specific MOUD choice.

Conclusion & Discussion: There were significant associations with specific patient factors and the selection of methadone or buprenorphine including history of MOUD and current MOUD. Other factors including patient demographics, presence of respiratory comorbidities, having a prolonged QTc interval, and housing instability were not significantly associated with either MOUD option. These results align with our real-life clinical experiences with patients often expressing discontent with logistical restrictions of opioid treatment programs and reporting past precipitated withdrawal with buprenorphine. Interprofessional teams can use these results to focus their patient conversations on medication counseling and medication experiences. Results can also be used as a starting point to identify other patient factors (e.g. concurrent cocaine use, education level, attitudes towards the healthcare system) that may contribute to the selection of MOUD while hospitalized.

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