Evaluating Opioid Agonist Therapy and Safer Supply Medications during Transitions of Care for Medical Inpatients with Opioid Use Disorder: A Retrospective Chart Review

Background: Hospital admissions for patients living with opioid use disorder (OUD) are increasing, and patient-centred interventions are required to maximize the impact of OUD treatment. It is important to continue pharmacotherapy for hospitalized patients with OUD to prevent withdrawal and self-directed discharge. Objectives: The primary objective was to identify the proportion of any OUD pharmacotherapy administered more than 24 hours after hospital presentation. Secondary objectives included determining the proportion of home OUD regimens ordered during transitions of care, the incidence of OUD pharmacotherapy initiation during hospitalization, and the incidence of deleterious events. Methods: A retrospective chart review was conducted for 100 adult medicine patients with OUD and existing OUD pharmacotherapy or newly initiated opioid agonist therapy seen in hospital between November 2023 and June 2024. Results: Of the 74 patients on prior OUD pharmacotherapy, 64 (86%) received a dose of any OUD pharmacotherapy within 24 hours of hospital presentation. In addition, 54 (73%) of these patients did not have their full home OUD regimens ordered on admission, and for 20 (37%) of these 54 patients, changes to home regimens lacked documented justification. Intentional changes to home regimens on admission were most often due to opioid toxicity events and altered level of consciousness. Deleterious outcomes were common and included self-directed discharge and code white events. Conclusions: Most patients with existing OUD pharmacotherapy received doses of any OUD pharmacotherapy within 24 hours of presentation to hospital. Gaps in care were identified in the continuation of home OUD pharmacotherapy regimens, especially among patients with multiagent regimens.