Medication for Opioid Use Disorder After Serious Injection-Related Infections in Massachusetts
Authors: Kimmel Simeon D. , Walley Alexander Y. , White Laura F. , Yan Shapei , Grella Christine , Majeski Adam , Stein Michael D. , Bettano Amy , Bernson Dana , Drainoni Mari-Lynn , Samet Jeffrey H. , Larochelle Marc R. 
Published: July 2024

Importance

Serious injection-related infections (SIRIs) cause significant morbidity and mortality. Medication for opioid use disorder (MOUD) improves outcomes but is underused. Understanding MOUD treatment after SIRIs could inform interventions to close this gap.

Objectives

To examine rehospitalization, death rates, and MOUD receipt for individuals with SIRIs and to assess characteristics associated with MOUD receipt.

Design, Setting, and Participants

This retrospective cohort study used the Massachusetts Public Health Data Warehouse, which included all individuals with a claim in the All-Payer Claims Database and is linked to individual-level data from multiple government agencies, to assess individuals aged 18 to 64 years with opioid use disorder and hospitalization for endocarditis, osteomyelitis, epidural abscess, septic arthritis, or bloodstream infection (ie, SIRI) between July 1, 2014, and December 31, 2019. Data analysis was performed from November 2021 to May 2023.

Exposure

Demographic and clinical factors potentially associated with posthospitalization MOUD receipt.

Main Outcomes and Measures

The main outcome was MOUD receipt measured weekly in the 12 months after hospitalization. We used zero-inflated negative binomial regression to examine characteristics associated with any MOUD receipt and rates of treatment in the 12 months after hospitalization. Secondary outcomes were receipt of any buprenorphine formulation, methadone, and extended-release naltrexone examined individually.

Results

Among 9757 individuals (mean [SD] age, 43.3 [12.1] years; 5701 [58.4%] male) who survived a SIRI hospitalization, 4652 (47.7%) received MOUD, 6518 (66.8%) were rehospitalized, and 1068 (10.9%) died within 12 months. Of those treated with MOUD in the 12 months after hospitalization, the mean (SD) number of MOUD initiations during follow-up was 3.0 (1.8), with 985 of 4652 individuals (21.2%) receiving treatment at least 80% of the time. MOUD treatment after SIRI hospitalization was significantly associated with MOUD in the prior 6 months (buprenorphine: adjusted odds ratio [AOR], 16.63; 95% CI, 14.04-19.71; methadone: AOR, 28.61; 95% CI, 22.80-35.90; or naltrexone: AOR, 2.05; 95% CI, 1.58-2.66). Prior buprenorphine (incident rate ratio [IRR], 1.16; 95% CI, 1.09-1.22) or methadone (IRR, 1.90; 95% CI, 1.79-2.02) use was associated with higher treatment rates after hospitalization, and prior naltrexone use (IRR, 0.85; 95% CI, 0.77-0.95) was associated with lower rates.

Conclusions and Relevance

This study found that in the year after a SIRI hospitalization in Massachusetts, mortality and rehospitalization were common, and only half of patients received MOUD. Treatment with MOUD before a SIRI was associated with posthospitalization MOUD initiation and time receiving MOUD. Efforts are needed to initiate MOUD treatment during SIRI hospitalizations and subsequently retain patients in treatment.