Research: Increasing trend of opioid withdrawal and leaving against medical advice among hospitalized patients

Trend could have negative impact on hospital’s critical role in engaging opioid-dependent patients.

Investigators from ChristianaCare recently published their research findings on increasing trends of opioid withdrawal and leaving against medical advice among hospitalized patients. The Delaware Clinical and Translational Research (DE-CTR) ACCEL Program’s Biostatistics, Epidemiology and Research Design (BERD) Core helped in the design, analysis, and publication of the study.

“We expect this study will promote more research to investigate causality including the role of fentanyl and determine if established practices such as buprenorphine induction should be modified,” explained Keshab Subedi, biostatistician at ChristianaCare Health Service’s Institute for Research on Equity and Community Health (iREACH).

The paper, “Escalation of Opioid Withdrawal Frequency and Subsequent AMA Rates in Hospitalized Patients from 2017 to 2020,” was published online in the Journal of Addiction Medicine in June.

The research team and paper’s authors included:

  • Terry Horton, MD, Head of the Department of Patient Insights and Advocacy Head at Indivior
  • Keshab Subedi, MS, MSc, Biostatistician at ChristianaCare Health Services, Inc., iREACH, DE-CTR ACCEL Program BERD Core
  • Ram A. Sharma, MD, Psychiatrist, Department of Psychiatry, ChristianaCare Health Services, Inc.
  • Beverly Wilson, MS, Senior Program Manager of Addiction Medicine at ChristianaCare Health Services, Inc.
  • Gbadebo M. Bayo, MBA, Senior Business/Data Analyst at the ChristianaCare Health Services, Inc., iREACH, DE-CTR ACCEL Program BERD Core
  • Claudine Jurkovitz, MD, MPH, Director of Clinical Research at ChristianaCare Health Services, Inc., iREACH; DE-CTR ACCEL Program BERD Core Lead; and Director of the Centralized Research Support Network (CRSN) with DE-INBRE

“The increasing rates of leaving AMA both from inpatient and the [emergency department] is a serious concern and could lead to negative health outcomes,” Subedi said. “Vulnerable patient populations, including patients with substance use disorder, are at risk of leaving AMA.

The study reported a 15%, 21% and 34% year-to-year increment in the number of hospitalizations with opioid withdrawal in 2018, 2019 and 2020, respectively. The analysis showed a statistically significant upward trend in the monthly number of patients hospitalized with opioid withdrawal after January 2019. The study also reported a significantly higher and escalating trend of AMA among the patients admitted with opioid withdrawal than among all other admitted patients.

The investigators suggest the increasing rate of AMA among patients with opioid withdrawal could have a negative impact on the critical role hospitals perform in engaging opioid-dependent patients in life-sustaining treatment.

Currently, the investigators are pursuing other studies looking at the trend of fentanyl exposure over time and its potential association with increasing AMA rates among the OW patients.

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