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Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder

BACKGROUND: Patients with opioid use disorder (OUD) frequently leave the hospital as patient directed discharges (PDDs) because of untreated withdrawal and pain. Short-acting opioids can complement methadone, buprenorphine, and non-opioid adjuvants for withdrawal and pain, however little evidence ex...

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Autores principales: Thakrar, Ashish P., Uritsky, Tanya J., Christopher, Cara, Winston, Anna, Ronning, Kaitlin, Sigueza, Anna Lee, Caputo, Anne, McFadden, Rachel, Olenik, Jennifer M., Perrone, Jeanmarie, Delgado, M. Kit, Lowenstein, Margaret, Compton, Peggy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9951406/
https://www.ncbi.nlm.nih.gov/pubmed/36829242
http://dx.doi.org/10.1186/s13722-023-00368-z
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author Thakrar, Ashish P.
Uritsky, Tanya J.
Christopher, Cara
Winston, Anna
Ronning, Kaitlin
Sigueza, Anna Lee
Caputo, Anne
McFadden, Rachel
Olenik, Jennifer M.
Perrone, Jeanmarie
Delgado, M. Kit
Lowenstein, Margaret
Compton, Peggy
author_facet Thakrar, Ashish P.
Uritsky, Tanya J.
Christopher, Cara
Winston, Anna
Ronning, Kaitlin
Sigueza, Anna Lee
Caputo, Anne
McFadden, Rachel
Olenik, Jennifer M.
Perrone, Jeanmarie
Delgado, M. Kit
Lowenstein, Margaret
Compton, Peggy
author_sort Thakrar, Ashish P.
collection PubMed
description BACKGROUND: Patients with opioid use disorder (OUD) frequently leave the hospital as patient directed discharges (PDDs) because of untreated withdrawal and pain. Short-acting opioids can complement methadone, buprenorphine, and non-opioid adjuvants for withdrawal and pain, however little evidence exists for this approach. We described the safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with OUD at an academic hospital in Philadelphia, PA. METHODS: From August 2021 to March 2022, a pharmacist guided implementation of a pilot sOAT protocol consisting of escalating doses of oxycodone or oral hydromorphone scheduled every four hours, intravenous hydromorphone as needed, and non-opioid adjuvants for withdrawal and pain. All patients were encouraged to start methadone or buprenorphine treatment for OUD. We abstracted data from the electronic health record into a secure platform. The primary outcome was safety: administration of naloxone, over-sedation, or a fall. Secondary outcomes were PDDs and respective length of stay (LOS), discharges on methadone or buprenorphine, and discharges with naloxone. We compared secondary outcomes to hospitalizations in the 12 months prior to the index hospitalization among the same cohort. RESULTS: Of the 23 cases, 13 (56.5%) were female, 19 (82.6%) were 40 years or younger, and 22 (95.7%) identified as White. Twenty-one (91.3%) regularly injected opioids and four (17.3%) were enrolled in methadone or buprenorphine prior to hospitalization. sOAT was administered at median doses of 200–320 morphine milligram equivalents per 24-h period. Naloxone administration was documented once in the operating room, over-sedation was documented once after unsanctioned opioid use, and there were no falls. The PDD rate was 44% with median LOS 5 days (compared to PDD rate 69% with median LOS 3 days for prior admissions), 65% of sOAT cases were discharged on buprenorphine or methadone (compared to 33% for prior admissions), and 65% of sOAT cases were discharged with naloxone (compared to 19% for prior admissions). CONCLUSIONS: Pilot implementation of sOAT was safe. Compared to prior admissions in the same cohort, the PDD rate was lower, LOS for PDDs was longer, and more patients were discharged on buprenorphine or methadone and with naloxone, however efficacy for these secondary outcomes remains to be established. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00368-z.
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spelling pubmed-99514062023-02-25 Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder Thakrar, Ashish P. Uritsky, Tanya J. Christopher, Cara Winston, Anna Ronning, Kaitlin Sigueza, Anna Lee Caputo, Anne McFadden, Rachel Olenik, Jennifer M. Perrone, Jeanmarie Delgado, M. Kit Lowenstein, Margaret Compton, Peggy Addict Sci Clin Pract Case Study BACKGROUND: Patients with opioid use disorder (OUD) frequently leave the hospital as patient directed discharges (PDDs) because of untreated withdrawal and pain. Short-acting opioids can complement methadone, buprenorphine, and non-opioid adjuvants for withdrawal and pain, however little evidence exists for this approach. We described the safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with OUD at an academic hospital in Philadelphia, PA. METHODS: From August 2021 to March 2022, a pharmacist guided implementation of a pilot sOAT protocol consisting of escalating doses of oxycodone or oral hydromorphone scheduled every four hours, intravenous hydromorphone as needed, and non-opioid adjuvants for withdrawal and pain. All patients were encouraged to start methadone or buprenorphine treatment for OUD. We abstracted data from the electronic health record into a secure platform. The primary outcome was safety: administration of naloxone, over-sedation, or a fall. Secondary outcomes were PDDs and respective length of stay (LOS), discharges on methadone or buprenorphine, and discharges with naloxone. We compared secondary outcomes to hospitalizations in the 12 months prior to the index hospitalization among the same cohort. RESULTS: Of the 23 cases, 13 (56.5%) were female, 19 (82.6%) were 40 years or younger, and 22 (95.7%) identified as White. Twenty-one (91.3%) regularly injected opioids and four (17.3%) were enrolled in methadone or buprenorphine prior to hospitalization. sOAT was administered at median doses of 200–320 morphine milligram equivalents per 24-h period. Naloxone administration was documented once in the operating room, over-sedation was documented once after unsanctioned opioid use, and there were no falls. The PDD rate was 44% with median LOS 5 days (compared to PDD rate 69% with median LOS 3 days for prior admissions), 65% of sOAT cases were discharged on buprenorphine or methadone (compared to 33% for prior admissions), and 65% of sOAT cases were discharged with naloxone (compared to 19% for prior admissions). CONCLUSIONS: Pilot implementation of sOAT was safe. Compared to prior admissions in the same cohort, the PDD rate was lower, LOS for PDDs was longer, and more patients were discharged on buprenorphine or methadone and with naloxone, however efficacy for these secondary outcomes remains to be established. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00368-z. BioMed Central 2023-02-24 2023 /pmc/articles/PMC9951406/ /pubmed/36829242 http://dx.doi.org/10.1186/s13722-023-00368-z Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Study
Thakrar, Ashish P.
Uritsky, Tanya J.
Christopher, Cara
Winston, Anna
Ronning, Kaitlin
Sigueza, Anna Lee
Caputo, Anne
McFadden, Rachel
Olenik, Jennifer M.
Perrone, Jeanmarie
Delgado, M. Kit
Lowenstein, Margaret
Compton, Peggy
Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title_full Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title_fullStr Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title_full_unstemmed Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title_short Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder
title_sort safety and preliminary outcomes of short-acting opioid agonist treatment (soat) for hospitalized patients with opioid use disorder
topic Case Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9951406/
https://www.ncbi.nlm.nih.gov/pubmed/36829242
http://dx.doi.org/10.1186/s13722-023-00368-z
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