Interventions for hospitalized medical and surgical patients with opioid use disorder: A systematic review

Abstract

Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.

Keywords:

• Opioid treatment
• hospitalization
• interventions
• addiction

Acknowledgment

The authors would like to thank Richard James, a biomedical librarian at the University of Pennsylvania School of Nursing, for his expertise in conducting the literature search for this review.

Disclosure statement

None of the authors have any disclosures to report. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional information

Funding

Dr. French’s predoctoral fellowship was supported by the National Institute of Nursing Research under Grant [T32NR007104]. Dr. Aronowitz is supported the National Clinician Scholars Program. Dr. Brooks Carthon is supported by the National Institute of Minority Health & Health Disparities under Grant [R01MD011518]. Dr. Schmidt is supported by the National Institute on Drug Abuse under Grants [R01DA037897] and [R21DA045792]. Dr. Compton is supported by the National Institute of Nursing Research under Grant [R21NR019047]; and by the National Institute on Drug Abuse under Grant [R21DA046346].