(180) Assessing C-L Psychiatrists' Recommendations for Naloxone and Opioid-Agonist Medications for Medically Hospitalized Patients with Opioid Use Disorder

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Background: Medical hospitalizations of patients with opioid use disorder (OUD) represent important ‎opportunities for initiating opioid-agonist therapies and prescribing naloxone kits, evidence-based treatments for ‎improving outcomes post-discharge (Herscher, 2020). Consultation-liaison (CL) psychiatrists often evaluate patients ‎with OUD, creating critical opportunities to provide life-saving interventions at point of care. The goal of this study was ‎to determine if CL psychiatrists within our health system are recommending medications for OUD (MOUD) and ‎naloxone to patients with active opioid use, and to identify barriers and strategies to improve these practices.‎

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Methods: We completed a retrospective analysis of patient records at seven medical hospitals that had ‎access to psychiatry consults without access to specialized addiction medicine services. We manually collected and ‎analyzed all initial consult notes written by CL psychiatrists in 2020 on patients with documented OUD. This study was ‎approved by our institution's Quality Review Committee.‎

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Results: We identified 179 distinct patients with OUD out of 5395 consultations. 129 patients (72.1%) had ‎active opioid use at time of consultation. Those with active use were 49.6% female, with average age 40.9 years and ‎average length of stay 8.8 days. Psychiatric notes contained recommendations for naloxone for 11 patients (8.5%) with ‎active opioid use. There were 114 patients with active opioid use who were not currently prescribed MOUDs, of whom ‎‎55.3% received recommendations for initiating a MOUD. A sub-analysis of those with active opioid use not on MOUDs ‎found that those who received recommendations had a significantly longer average time to consultation (2.42 versus ‎‎0.80 days, p = .0045) and non-significantly longer average length of stay (11.53 days vs 7.41 days, p = .11).‎

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Discussion: Our analysis reveals that our multi-hospital CL service has very low rates of recommending ‎naloxone to those with active opioid use and opportunity for improvement in recommending MOUDs. The results in ‎our system reflect broader issues with underutilization of MOUDs, as demonstrated in other large health systems ‎‎(Wyse, 2018). Our results also suggest that earlier consultation is associated with lower rates of MOUD ‎recommendations, perhaps due to fewer observed opioid withdrawal symptoms or higher co-morbid medical acuity at ‎time of consultation.‎

‎Conclusion/Implications: The initial results of our study demonstrate a need for educational or process ‎interventions related to MOUDs and take-home naloxone for medically hospitalized patients with OUD. We are ‎currently in the process of holding semi-structured individual interviews with C-L psychiatrists at these hospitals to ‎collect both quantitative and qualitative information about barriers to recommending these medications.‎

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References: ‎
‎1. Herscher M, Fine M, Navalurkar R, Hirt L, Wang L. Diagnosis and Management of Opioid Use Disorder in Hospitalized ‎Patients. Med Clin North Am. 2020 Jul;104(4):695-708.‎
‎2. Wyse JJ, Gordon AJ, Dobscha SK, Morasco BJ, Tiffany E, Drexler K, Sandbrink F, Lovejoy TI. Medications for opioid ‎use disorder in the Department of Veterans Affairs (VA) health care system: Historical perspective, lessons learned, ‎and next steps. Substance Abuse. 2018;39(2):139-144.‎