SHM Converge Scientific Abstract ePoster Gallery-Association of First 72-Hour Moud Dose and Timing With Patient Directed Discharge

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This study examined whether the timing and dose of medications for opioid use disorder (MOUD) in the first 72 hours of hospitalization were associated with patient-directed discharge (PDD), which is common among hospitalized patients with OUD and is linked to worse outcomes.<br /><br />Researchers reviewed 4,134 hospital encounters at Johns Hopkins Hospital from July 2019 to June 2022 involving adults with an OUD-related diagnosis. They excluded patients who left within 72 hours of emergency department presentation. Data were extracted from the electronic medical record, including Clinical Opiate Withdrawal Scale (COWS) scores and dosing/timing of oral or sublingual methadone and buprenorphine.<br /><br />Overall, 283 encounters (6.8%) ended in PDD. Methadone and buprenorphine were used at similar rates. However, higher MOUD dosing in the first 72 hours was associated with lower risk of PDD. Specifically, methadone doses were significantly higher in the non-PDD group at 24, 48, and 72 hours, and buprenorphine dose at 72 hours was also higher in the non-PDD group. Patients who left early had worse withdrawal control: they were more likely to have COWS documented and had a much higher median COWS score before discharge (12 vs 2).<br /><br />The findings support the idea that undertreated opioid withdrawal may contribute to early PDD. The authors conclude that increasing MOUD doses during the first 72 hours may help reduce PDD, but more research is needed to determine safe, effective dosing strategies and the potential role of adjunctive medications or short-acting opioids.

Asset Subtitle

Rebecca Meredith

Meta Tag

Author List Megan Buresh, Rebecca Meredith, William M. Garneau

Category Research

Concept Medication for Opioid Use Disorder

Concept Opioid Use Disorder

Concept Patient-Directed Discharge

Concept Opioid Withdrawal

Concept Methadone

Distinguished Non-Finalist

Presenter Organization Johns Hopkins Hospital/Johns Hopkins University School of Medicine

Presenting Author Rebecca Meredith

Track Outcomes Research

Keywords

opioid use disorder

medications for opioid use disorder

patient-directed discharge

hospitalization

methadone

buprenorphine

withdrawal management

Clinical Opiate Withdrawal Scale

early dosing

hospital outcomes

Medication for Opioid Use Disorder

Opioid Use Disorder

Patient-Directed Discharge

Opioid Withdrawal

Methadone