Predictors of Linkage to an Opioid Treatment Program and Methadone Treatment Retention following Hospital Discharge in a Safety-Net Setting

Abstract

Background: Methadone is increasingly initiated during hospitalization for the treatment of opioid use disorder (OUD). However, little is known about which factors are associated with linkage to opioid treatment programs (OTP) and retention in methadone maintenance therapy (MMT) following hospital discharge. Materials & Methods: This is a retrospective study of adults with OUD hospitalized in an urban, safety-net hospital referred by inpatient clinicians to an onsite OTP for post-discharge MMT follow-up from October 2017 to July 2019. We used multivariable modified Poisson regression models to generate adjusted risk ratios (aRR) for associations of sociodemographic factors, mental health disorders, alcohol use, stimulant use, and prior care engagement with post-discharge OTP enrollment and MMT retention at 30 and 90-days. Results: Of the 125 patients referred, 40% enrolled in the OTP post-discharge. Among enrollees, 74% were retained at 30-days and 52% were retained at 90-days. Patients with co-occurring stimulant use were less likely to enroll in the OTP post-discharge compared to those without stimulant use (aRR 0.65, 95% CI 0.44–0.97). We found no associations with 30-day MMT retention, but patients who reported stable housing were more likely to be retained in MMT at 90-days compared to those without stable housing (aRR 1.66, 95% CI 1.03–2.66). Conclusion: Our findings suggest that hospitalized patients with co-occurring stimulant use may need additional support to optimize post-discharge OTP linkage. Stable housing may improve retention in MMT. Additional research is needed to identify trends in MMT engagement among those referred from the acute hospital setting.

Keywords:

• Opioid use disorder
• methadone
• hospitalization
• care transitions
• linkage
• retention

Acknowledgments

We thank Ashley Moss and the San Francisco General Hospital Ward 93 team for their care of patients and the opportunity to highlight their work.

Authors’ contributions

All authors contributed the original concept and design of the study. SWT and SS were involved in data collection. SWT and HRT performed data analysis. All authors interpreted the data. HRT and SWT drafted the manuscript. MM is responsible for project supervision. All authors have critically revised this article and approved the final version to be published.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

Written participant consent for sharing individual level data publicly was not obtained, so due to the sensitive nature of the data, supporting data are not available at an individual level without additional permissions.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.