E-consultation for medications to treat opioid use disorders: a pilot study

Abstract

Background and objectives

An electronic consultation to provide expert guidance on medications to treat opioid use disorders [MOUD] was piloted.

Methods

Medical record review of the first 100 unique patients receiving consultation with 6-month follow-up. Descriptive statistics, chi-square, and Fisher’s exact tests of significance were calculated as appropriate.

Results

Most consultation requests originated from inpatient psychiatry (66%). Patients (67%) and consultants (33%) preferred buprenorphine/naloxone most often (p < 0.0001). Half of the patients received MOUD prior to discharge. Three quarters of the half who kept their first outpatient appointments received the recommended treatment (p < 0.0001). At 6 months, four patients died and four others overdosed only. Type of MOUD was not associated with either overdose or death, but those who overdosed used cannabis, sedative-hypnotics, or stimulants (all, p < 0 .05).

Discussion and conclusions

Guidance for MOUD offered via e-consultation may have increased outpatient treatment engagement following inpatient treatment.

Keywords:

• Medications
• opioid use disorders
• e-consultation

Acknowledgments

The authors wish to acknowledge the Addiction Psychiatry Fellows and attendings from the Boston University School of Medicine/VA Boston Healthcare System Fellowship program. Drs DC Park, Esteban Toledo Carrion, and G. Iru Fernando were the pioneering Fellows. Dr Chang presented an earlier version of these findings at the Annual Meeting of the American Psychiatric Association in 2019.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 Table 2A.

2 Table 2B and C.

3 Table 2D.

4 Table 2E.

5 Table 2F and G.