Opioid Use Disorder Outcomes Following Inpatient Opioid Withdrawal Management

Objectives: Medically assisted withdrawal (MAW) for opioid use disorders (OUD) remains common. NIDA’s CTN-0051 (X:BOT) trial compared two OUD medications initiated during an acute inpatient MAW admission and continued postdischarge at 8 US sites. This ancillary observational follow-on study explored treatment-as-usual outcomes at 5 X:BOT sites. Methods: Adults admitted for OUD were conveniently and consecutively recruited to an 8-week, prospective, observational, noninterventional study targeting up to 300 participants. Withdrawal protocols and medications for OUD (MOUD) followed site usual practices. Baseline and postdischarge weeks 1, 4, and 8 measures were OUD severity, length-of-stay (LOS), urine samples, self-reported MOUD, nonprescribed opioid use, and overdoses. Data analyses were descriptive. Results: A total of N = 211 enrolled participants were primarily white men (74%) with daily heroin (87.2%) and intravenous (64.0%) use. About 41.7% (n = 88) reported MOUD treatment at discharge: extended-release naltrexone (n = 39), sublingual buprenorphine-naloxone (n = 38), methadone (n = 8), and oral naltrexone (n = 3). Self-reported MOUD use at week 8 was 28.0%, when 52.6% reported no regular use (<7 consecutive days) and 25.6% reported nonprescribed opioid abstinence. Negative urine rates for nonprescribed opioids ranged from 26.1% to 31.3%. One overdose death and 17 nonfatal opioid-related overdose events occurred in 15 participants. Conclusions: Return to nonprescribed opioid use, frequent overdose events, one death, and a relative lack of MOUD treatment uptake characterized this usual care cohort following inpatient OUD admissions. Scientific Significance: These findings underscore the urgent need for individuals and providers to prioritize linkage to evidence-based MOUD treatments following acute inpatient OUD-related admissions, given high rates of return to opioid use and overdose events.