University of Minnesota School of Public Health, 420 Delaware St SE, Mayo Building B681, Minneapolis, MN 55455, USA; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, USA.
Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, 900 S 8(th) St, Minneapolis, MN 55415, USA.
J Subst Use Addict Treat. 2024 Dec;167:209505. doi: 10.1016/j.josat.2024.209505. Epub 2024 Sep 5.
Despite effective medications for opioid use disorder (MOUD), treatment engagement remains low. As the overdose crisis is increasingly characterized by opioids co-used with other substances, it is important to understand whether existing models effectively support treatment for patients who use multiple substances. Hospital-based addiction consultation services (ACS) have shown promise at increasing MOUD initiation and treatment engagement, but the effectiveness for patients with specific co-use patterns remains unknown.
Using 2016-2023 admissions data from a large safety net hospital, we estimated a random-effects logistic regression model to determine whether specific co-use (methamphetamine, cocaine, alcohol, sedative, and other) moderated the effect of being seen by ACS on the receipt of MOUD. Adjusting for patient sociodemographic, health, and admission characteristics we estimated the proportion of patients who received MOUD across specific co-use groups.
Of 7679 total admissions indicating opioid use, of which 5266 (68.6 %) indicated co-use of one or more substances and 2387 (31.1 %) were seen by the ACS. Among admissions not seen by the ACS, a smaller proportion of admissions with any co-use received MOUD (23.5 %; 95 % CI: 21.9-25.1) compared to admissions with opioid use alone (34.0 %; 95 % CI: 31.9-36.1). However, among admissions seen by the ACS a similar proportion of admissions with any co-use received MOUD (57.8 %; 95 % CI: 55.5-60.1) as admissions with opioid use alone (56.2 %; 95 % CI: 52.2-60.2). The increase in proportion of admissions receiving MOUD associated with being seen by the ACS was larger for admissions with methamphetamine (38.6 percentage points; 95 % CI: 34.6-42.6) or cannabis co-use (39.0 percentage points; 95 % CI: 32.9-45.1) compared to admissions without methamphetamine (25.7 percentage points; 95 % CI: 22.2-29.2) or cannabis co-use (29.1 percentage points; 95 % CI: 26.1-32.1).
The ACS is an effective hospital-based treatment model for increasing the proportion of admissions which receive MOUD. This study shows that ACSs are also able to support increased receipt of MOUD for patients who use other substances in addition to opioids. Future research is needed to further understand what transition strategies best support treatment linkage for patients who use multiple substances.
尽管有治疗阿片类药物使用障碍（MOUD）的有效药物，但治疗参与度仍然很低。由于阿片类药物过量危机越来越多地表现为与其他物质共同使用，因此了解现有的模型是否能有效地为同时使用多种物质的患者提供治疗支持非常重要。基于医院的成瘾咨询服务（ACS）已显示出在增加 MOUD 起始和治疗参与度方面的潜力，但对于具有特定共同使用模式的患者，其有效性仍不清楚。
我们使用来自一家大型医疗保障医院的 2016-2023 年入院数据，估计了一个随机效应逻辑回归模型，以确定特定的共同使用（冰毒、可卡因、酒精、镇静剂和其他物质）是否会影响 ACS 对 MOUD 接受率的影响。我们调整了患者的社会人口统计学、健康和入院特征，估计了在特定共同使用组中接受 MOUD 的患者比例。
在 7679 例总入院病例中，有 5266 例（68.6%）表明存在一种或多种物质的共同使用，其中 2387 例（31.1%）接受了 ACS 的治疗。在未接受 ACS 治疗的入院病例中，与单独使用阿片类药物的入院病例相比（34.0%；95%CI：31.9-36.1），有任何共同使用的入院病例接受 MOUD 的比例较小（23.5%；95%CI：21.9-25.1）。然而，在接受 ACS 治疗的入院病例中，与单独使用阿片类药物的入院病例相比（56.2%；95%CI：52.2-60.2），有任何共同使用的入院病例接受 MOUD 的比例相似（57.8%；95%CI：55.5-60.1）。与未接受 ACS 治疗的入院病例相比，与接受 ACS 治疗的入院病例相比，接受 MOUD 的入院病例比例增加幅度更大，这与使用冰毒（38.6 个百分点；95%CI：34.6-42.6）或大麻共同使用（39.0 个百分点；95%CI：32.9-45.1）有关，而不是与不使用冰毒（25.7 个百分点；95%CI：22.2-29.2）或大麻共同使用（29.1 个百分点；95%CI：26.1-32.1）有关。
ACS 是一种有效的基于医院的治疗模式，可增加接受 MOUD 的入院病例比例。本研究表明，ACS 还能够为除阿片类药物以外还使用其他物质的患者提供更多的 MOUD 接受机会。需要进一步研究以了解哪些过渡策略最能支持同时使用多种物质的患者的治疗联系。
