Thursday, June 2, 2016

Patients Treated for Opioid Dependence May Not Be Receiving Proper Treatment After Discharge

As the number of hospitalizations for opioid misuse continues to grow, so too have questions of whether patients have access to medications approved to treat opioid dependence following inpatient treatment. A study published yesterday in Psychiatric Services in Advance suggests that the majority of patients discharged following a hospitalization for opioid misuse are not getting appropriate treatment.

Methadone, naltrexone, and buprenorphine—approved by the FDA for the treatment of opioid dependence—are known to significantly augment treatment retention, decrease illicit opioid use, reduce the burden of opioid craving, and, in some cases, provide relief from opioid-withdrawal symptoms.

To identify patterns of postdischarge prescription fills following a hospitalization for opioid misuse, Sarah Naeger, Ph.D., M.P.H., of the Substance Abuse and Mental Health Services Administration and colleagues analyzed data on individuals hospitalized for opioid abuse, dependence, or overdose contained in the 2010-2014 MarketScan Commercial Claims and Encounters database. Use of FDA-approved medication for the treatment of opioid dependence was defined as a prescription fill for buprenorphine or naltrexone or a paid claim for methadone; the authors also examined prescription fills for antidepressants, antipsychotics, benzodiazepines, and opioid pain medications, such as oxycodone, methadone, morphine, fentanyl, hydrocodone, and tramadol.

Within the database, the authors identified 36,719 patients with an inpatient admission for opioid abuse, dependence, or overdose. Less than a quarter (16.7%) of these patients received any FDA-approved medication for opioid use disorder in the 30 days following discharge. The most commonly filled prescriptions were for antidepressants, received by 40.3% of patients in the sample, followed by opioid pain medication at 22.4%, antipsychotics at 15.6%, and benzodiazepines at 13.9%. Thirty-five percent of the sample did not have any prescription fills in the 30-day postdischarge window.

The low rate of opioid dependence medication and postdischarge use of opioid pain medications and benzodiazepines observed in the study are concerning, the authors wrote: “The finding that 13.9% of patients filled a benzodiazepine prescription, 22.4% filled an opioid prescription, and 7% filled both after an opioid-related hospitalization suggests that targeted outreach to physicians and patients about recommended prescribing practices and the risks associated with the combined use of benzodiazepine and opioid use may be warranted.”

They concluded, “More research is needed to understand the policy, structural, and financial barriers facing patients with an opioid use disorder in trying to access outpatient services that include opioid dependence medication.”

For related information, see the Psychiatric News article “AMA Survey Indicates M.D. Support for Measures to Address Opioid Epidemic.”

(Image: iStock/MJFelt)


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