Medication for addiction treatment and acute care utilization in HIV-positive adults with substance use disorders

ABSTRACT

Medication for addiction treatment (MAT) could reduce acute care utilization in HIV-positive individuals with substance use disorders. The study objective was to determine if HIV-positive people with substance use disorders treated with MAT report less acute care utilization than those not receiving MAT. We assessed the association between MAT and acute care utilization among HIV-positive individuals with alcohol or opioid use disorder. Acute care utilization 6 months later was defined as any past 3-month self-reported (1) emergency department (ED) visit and (2) hospitalization. Of 153 participants, 88% had alcohol use disorder, 41% had opioid use disorder, and 48 (31%) were treated with MAT. Fifty-five (36%) participants had an ED visit and 38 (25%) participants had a hospitalization. MAT was not associated with an ED visit (AOR 1.12, 95% CI 0.46–2.75) or hospitalization (AOR 1.09, 95% CI 0.39–3.04). MAT was not associated with acute care utilization. These results highlight the need to increase MAT prescribing in HIV-positive individuals with substance use disorders, and to address the many factors that influence acute care utilization.

KEYWORDS:

• HIV infections
• substance-related disorders
• health services
• social determinants of health

Acknowledgements

Conceived and designed the study: KT, AW, MD, MS, RS. Analyzed the data: MW, TH. Wrote the paper: KT, AW, MW, TH, AV, MD, MS, RS. Dr Saitz reports non-financial support from Alkermes, personal fees from American Society of Addiction Medicine, personal fees from UpToDate, personal fees from Massachusetts Medical Society, outside the submitted work; and Support from NIDA and NIAAA (NIH) and PCORI to study alcohol and other drug use disorder, and to train trainees in addiction. Travel supported by BMJ, American Society of Addiction Medicine (ASAM), American Medical Association (AMA), Wolters Kluwer, National Council on Behavioral Healthcare, the International Network on Brief Intervention for Alcohol and other drugs (INEBRIA) and Sytembolaget. Salary support for training doctoral students from Burroughs Wellcome Fund. Consulting as an editor and author for BMJ, AMA, ASAM, NIDA, the Massachusetts Medical Society and UpToDate. Consulting for speaking or as a research expert for Kaiser Permanente, in medical malpractice cases, for RAND, the Institute for Research and Training in the Addictions, the National Council on Behavioral Healthcare, Charles University (Czech Republic), National Committee on Quality Assurance and University of Oregon. The authors would like to acknowledge the study participants for providing their time.

Disclosure statement

R. Saitz is and has been principal investigator of grants awarded to Boston Medical Center and Boston University from the National Institutes of Health (including NIAAA and NIDA, and the Substance Abuse and Mental Health Services Administration) to study the management of unhealthy substance use, including to test the accuracy of screening and the efficacy of screening, brief intervention and referral to treatment and the effectiveness of integrated care. He has been paid to speak or had travel reimbursed to speak or to consult for/at numerous professional and scientific organizations, all non-profit organizations for over a decade, such as the American Society of Addiction Medicine (ASAM), RAND, the Research Society on Alcoholism, The BMJ, the American Medical Association, the Institute for Research and Training in the Addictions, the National Council on Behavioral Healthcare, the International Conference on Treatment of Addictive Behaviors, and the International Network on Brief Intervention for Alcohol and other drugs (INEBRIA), Leed Management Consulting, Inc. (for a Harvard University Opioid Use Disorder Education Program supported by NIDA), Kaiser Permanente Washington Health Research Institute, IRETA, Kaiser Permanente Division of Research, Kaiser Permanente Center for Health Research Portland and numerous universities and hospitals. He is an author and editor for Springer, UpToDate, the American Society of Addiction Medicine, JAMA, the BMJ and the Massachusetts Medical Society (royalties and/or honoraria). Wolters Kluwer has supported conference travel to an editors meeting. Systembolaget, a Swedish government agency that aims to minimize alcohol-related problems, supported transportation and lodging for a presentation on brief intervention at an INEBRIA thematic meeting in 2016. Alkermes provided medication for an NIH-funded trial of alcohol disorder treatment effectiveness. He has been paid to serve as an expert witness in malpractice cases related to the management of alcohol and other drug disorders. In 2009 he consulted for Inflexxion and Medical Directions, in 2008 and 2004 for Saatchi and Saatchi healthcare, in 2006 for Fusion Medical Education, in 2004 for the Lewin Group, in 2002 for Axis-Shield ASA and Forest Pharmaceuticals. Has has also consulted regarding research for Yale University, Brandeis University, Group Health Inc, Beth Israel-Deaconess Hospital, and other universities. He spoke at a National Press Foundation event on the terminology of addiction and received no compensation but the meeting was funded by ASAM, Open Society Foundations, Pew Charitable Trusts, Shatterproof, Hazelden Betty Ford Foundation and the Addiction Technology Transfer Center Network. He is employed by Boston University School of Public Health. The other authors have no other conflicts of interest.

Additional information

Funding

This study was funded by the National Institute on Alcohol Abuse and Alcoholism [grant numbers U01AA020784, U24AA020778, U24AA020779]. Additional funding included NIH [grant numbers T32 A1052074-1, UL1TR001430]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.