Preliminary Results From a Randomized Controlled Trial of an Integrated Care Model of Infectious Disease Management and Long-Acting Injectable Buprenorphine for Patients Hospitalized With Infections and Opioid Use Disorder

Author: Sandra Springer Nikhil Seval Cynthia Frank Michelle Strong Prerana Roth Jonathan Nunez Meredith Schade Alain Litwin Kathleen Brady Frances Levin Edward Nunes Kathleen

Theme: Clinical Research Year: 2022

Hospitalization with co-occurring opioid use disorder (OUD) and infections presents a critical time to
intervene to improve outcomes for these intertwined epidemics. Infectious Disease (ID) specialists
manage these infections and are a logical resource to engage patients in medication treatment for
OUD (MOUD). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential
advantage for initiating MOUD while admitted and bridging to outpatient treatment. An ongoing NIHfunded randomized multi-site trial tests a new model of care (ID/LAB) in which OUD and infections are
managed by ID specialists using LAB coupled with community referrals for long-term MOUD.

Adults with infections and DSM-5 moderate to severe OUD admitted to 3 U.S. hospitals were randomly
assigned 1:1 to ID/LAB or treatment as usual (TAU). Preliminary findings of the characteristics of the
cohort as well as the acceptability, feasibility, and safety of initiating LAB in this cohort are reported.
Early implementation findings will also be reported including successful strategies of low dose
buprenorphine transitions from methadone to LAB and the optimally timing of LAB dosing in the
setting of ongoing infections.

Characteristics of the initial 77 adults enrolled are as follows: 47% female, 10% Black, 18.5%
Hispanic, mean age 39 years, 32% unhoused, 40% uninsured, & 47% stimulant use disorder.
Participants reported using heroin (75%), fentanyl (26%), prescription opioids (7.9%), cocaine
(28.6%) and methamphetamine (40.8%) in the 30 days prior to hospitalization. The most common
infectious diseases included: bacteremia (52%), active HCV (49%), endocarditis (36%), abscess
(24.6%), and COVID19 (7.2%). 80% have retained in the study at 12 weeks (end of intervention
period). No related serious adverse events were identified related to the intervention arm.

These early study findings show that initiating LAB in patients hospitalized with infectious diseases
can be safely done and may improve OUD and ID outcomes.

Disclosure of Interest Statement:

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