More than 75% of U.S. overdose deaths involve opioids. Yet, medications for opioid use disorder (MOUD), including buprenorphine and methadone, are severely underused. 

Integrating MOUD into follow-up care for patients hospitalized with serious injection-related infections could increase access to these lifesaving medications, according to a study published in JAMA Network Open. 

Serious injection-related infections (SIRIs) have more than doubled in the past twenty years, associated with drastic spikes in opioid use. Hospitalizations related to these infections can be an opportunity to start patients on MOUDs. Still, only 41% of patients hospitalized with a SIRI received MOUD in the following year.

“The findings of this study underscore the national public health emergency directly related to the coalescing substance use and infectious disease epidemics related to fentanyl, leading to increasing overdose deaths and fueling new infectious disease epidemics,” Dr. Sandra Springer, professor of medicine at Yale School of Medicine, wrote in a commentary about the study.

Researchers analyzed publicly available data of almost 9,000 Massachusetts residents between the ages of 18 and 64 with an opioid use disorder (OUD) diagnosis and an SIRI hospitalization claim to determine rates of MOUD treatment after hospitalization.

The study revealed that patients who received MOUD six months before their hospitalization were more likely to receive it in the following year. People who had received methadone had the highest chance of receiving MOUDs later on, followed by those who had previously received buprenorphine and extended-release naltrexone.

The study also uncovered substantial inequities in MOUD treatment across different demographics.

Non-Hispanic Black people and older people between ages 50 and 64 were less likely to receive treatment than younger white people. Those discharged to a skilled nursing facility, rehab, or home services were also less likely to receive MOUDs.

“Stigma, ageism, and racism related to OUD exist across many health care settings, which impedes access to lifesaving MOUD,” Springer wrote. “Adopting universal screening and diagnosis of OUD can lead to immediate initiation of MOUD, including in hospitals, and could reduce potential practitioners’ bias in deciding who receives assessment and treatment.”

SIRIs have a significant risk of morbidity and mortality, but receiving MOUD treatment after a SIRI hospitalization can decrease rates of rehospitalization and mortality.

“The period after SIRI hospitalization may be a critical opportunity to deliver substance use treatment, as one-year mortality was 11.1%,” the study’s authors wrote. “Low MOUD treatment rates after SIRI hospitalization is likely a failure to initiate and link to MOUD treatment during hospitalizations.”

Patients may also be more motivated to start MOUD after a SIRI hospitalization, making it an ideal time to connect them with care.

To increase MOUD use, the researchers recommend improved clinician efforts to start and retain patients on treatment after SIRI hospitalization and the creation of addiction consultant programs. These consultants can work to connect hospitalized people who inject drugs to MOUD treatment and are “critically needed.”