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Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder?

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Abstract

Introduction

Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Data are needed to inform whether the choice of medication during hospitalization influences probability of retention in outpatient OUD treatment.

Methods

This was a retrospective cohort analysis of patients who received a medical toxicology consult for OUD. Medical records were reviewed to determine if patients received MOUD and were referred to Engaging Patients in Care Coordination (EPICC), a service that connects hospitalized patients with OUD to outpatient care. Patients were stratified by the last form of MOUD they received in the hospital (methadone verses buprenorphine); retention in outpatient treatment was measured at 2 weeks, 30 days, and 12 weeks. The log-rank test was used to determine the difference in probabilities of retention in the methadone and buprenorphine groups. An event was defined as drop-out from outpatient treatment.

Results

Of 267 total patients with medical toxicology consults for OUD, 155 received MOUD and referral to EPICC. One hundred six patients received buprenorphine and 46 received methadone. Three additional patients were excluded. The rate of retention in outpatient treatment for patients who received buprenorphine was 37%, 26%, and 13% and for patients who received methadone was 43%, 39%, and 35% at 2 weeks, 30 days, and 12 weeks, respectively. Methadone was associated with a statistically significant increased probability of retention in outpatient treatment as compared to buprenorphine (P < 0.01).

Conclusion

Despite the limitations of this retrospective study, in hospitalized patients who received MOUD, the probability of retention in outpatient treatment was higher in patients receiving methadone compared to buprenorphine.

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Abbreviations

OUD:

Opioid use disorder

MOUD:

Medication for opioid use disorder

ED:

Emergency department

OTP:

Opioid treatment program

EPICC:

Engaging Patients in Care Coordination

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Acknowledgements

We thank the Barnes-Jewish Hospital Foundation for providing funding (grant #4479) to support treatment for opioid use disorder. We also thank the Behavioral Health Network of St. Louis for collaborating and sharing data acquired through their EPICC (Engaging Patients in Care Coordination) program. We also thank Jyoti Arora for her statistical analysis consultation.

Funding

Washington University School of Medicine Summer Research Program and the Office of Medical Student Research.

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Authors and Affiliations

  1. Washington University in St. Louis School of Medicine, St. Louis, USA

    Skyler H. Kessler

  2. Division of Toxicology, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave. Campus, Box 8072, St. Louis, MO, 63110, USA

    Evan S. Schwarz & David B. Liss

Authors
  1. Skyler H. Kessler
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Contributions

All authors contributed to study design. SHK and DBL collected and analyzed the data. SHK drafted the manuscript, and all authors edited and approved the final manuscript.

Corresponding author

Correspondence to David B. Liss.

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None.

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Supervising Editor: Leslie R. Dye, MD.

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Previous Presentations of Data

Preliminary data from this study were presented at the 2020 American College of Medical Toxicology (ACMT) Annual Scientific Meeting, March 13–15, 2020.

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Kessler, S.H., Schwarz, E.S. & Liss, D.B. Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder?. J. Med. Toxicol. 18, 11–18 (2022). https://doi.org/10.1007/s13181-021-00858-z

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