Providing Opioid Addiction Treatment to Hospitalized Patients May Reduce Illicit Drug Use

Opioid-addicted patients who receive buprenorphine in the emergency department plus a referral to primary care for ongoing treatment may have better odds of reducing their illicit drug use.

This research finding could help support a recent proposal from the US Department of Health and Human Services to allow physicians to prescribe buprenorphine for twice as many opioid-addicted patients as they do now.

In the study, researchers from Yale University observed more than 300 opioid-addicted patients who were treated at an urban hospital’s emergency department between April 2009 and June 2012 in order to test the efficacy of 3 interventions for opioid dependence.

Of the patients studied, 104 were randomized to a referral group where they were screened and referred to addiction treatment services, 111 were randomized to a brief intervention group, and 114 were randomized to take buprenorphine/naloxone at the hospital and continue that treatment while receiving a referral to primary care for a 10-week follow-up.

Thirty days after this randomization, 78% of the buprenorphine group was engaged in addiction treatment, compared with 37% in the referral group and 45% in the brief intervention group. The number of days of illicit opioid use per week also decreased from 5.4 days to less than 1 day in the buprenorphine group, compared with a reduction from 5.4 days to 2.3 days in the referral group, and 5.6 days to 2.4 days in the brief intervention group.

“The patients who received ED [emergency department]-initiated medication and referral for ongoing treatment in primary care were twice as likely than the others to be engaged in treatment 30 days later,” concluded first author Gail D’Onofrio, MD, MS, chair of emergency medicine at Yale School of Medicine, in a press release.

Urine samples testing negative for opioids didn’t vary widely across the 3 treatment groups: 53.8% in the referral group, 42.9% in the brief intervention group, and 57.6% in the buprenorphine group.

Finally, only 11% of patients in the buprenorphine group used inpatient addiction treatment services, while more than one-third of those in the brief intervention and referral groups used those services (37% and 35%, respectively).

Although this single study supports treatment strategies initiated in the emergency department, the researchers noted that their results must be replicated across other centers and sites before these strategies can be widely adopted.

“Effectively linking ED [emergency department]-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care,” said study co author Patrick O’Connor MD, MPH, in a press release.

The study findings were published in JAMA.