One in six inpatients with opioid use disorder (OUD) leave the hospital before completing treatment, possibly due to untreated withdrawal symptoms, a new study shows.
Investigators found that between 2016 and 2020, the number of before medically advised (BMA) discharges nearly doubled. In addition, BMA discharges in patients with OUD and an injection site-related infection, a cohort more likely to have severe OUD and fentanyl use, increased 82%. The increase in BMAs with any opioid-related use increased by 50%.
Furthermore, nearly half of BMA discharges occurred before the third day of hospitalization, leading investigators to speculate that untreated withdrawal may be one reason patients check out early.
“The rapid increase in early discharges is alarming: in 2016, less than 1 in 10 patients admitted for OUD and injection-related infections left the hospital before their care team considered it safe. By 2020, one in six were leaving early,” lead investigator Ashish Thakrar, MD, an assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, said in a press release.
The findings were published online December 4 in a research letter in the Journal of the American Medical Association.
Increased Mortality Risk
Research suggests BMA discharges are associated with a significant increase in all-cause mortality and hospital readmission within 30 days. But current data on BMA discharge trends were lacking.
The investigators used the Nationwide Readmissions Database, which aggregates and weights information from more than 30 states to produce nationally representative data.
They identified patients with ICD-10 codes related to opioid use, dependence, abuse, or overdose, adding comorbid injection site-related infection to capture more severe OUD cases. They then compared annual changes in the BMA discharge rates for OUD patients to those for non-opioid admissions.
From 2016-2020, the annual BMA rate for patients with OUD and an injection site-related infection increased from 9.3% to 17%, an annual growth rate of 1.8% (P
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