Browsing by Subject "Polysubstance Use"

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    Hospital treatment for patients with opioid and methamphetamine co-use
    (2024) Shearer, Riley
    The overdose crisis in the United States is increasingly characterized by the combined use of opioids and stimulants, with a sharp increase in the rate of deaths indicating both fentanyl and methamphetamine. Inpatient hospitalizations are a key opportunity to engage patients and initiate substance use disorder treatment. In response to rising rates of hospitalizations involving substance use, a variety of addiction services have been developed. However, it remains unclear whether these services remain effective for patients who use both opioids and methamphetamine compared to opioids alone. This dissertation uses a multi-method approach to describe hospital stays for patients who use both methamphetamine and opioids in order to inform the development and implementation of hospital-based addiction services tailored for this growing patient population. Using nationally representative data from the National Inpatient Sample we describe patient sociodemographic characteristics, health profiles, and stay outcomes associated with co-use. Next, we conducted semi-structured interviews with hospital providers to describe their experiences and perspectives caring for patients who use both opioids and stimulants. Finally, we use data from a large Midwest safety-net hospital to analyze whether the co-use of specific substances moderates the effect of being seen by an addiction consultation service on the receipt of medications for opioid use disorder. We found that patient sociodemographic and health characteristics differed for hospital stays indicating opioid use alone compared to opioid and methamphetamine co-use. A higher proportion of co-use related stays were for patients who were male and/or under 35 years old. Additionally, co-use-related stays had higher rates of co-morbid mental health (60.7%; 95% CI: 59.9-61.4%) and infectious diseases (41.5%; 95% CI: 40.8-42.2%), than opioid-related stays. Finally, we found that co-use related stays were more likely to end in patient directed discharge (10.7%; 95% CI: 10.4-11.0%) compared to opioid-related stays (8.1%; 95% CI: 7.9-8.3%). From qualitative interviews with 20 hospital-based providers we identified themes describing how opioid and stimulant co-use complicated treatment: 1) patients’ unstable circumstances impacting the treatment plan, 2) co-occurring withdrawals are difficult to identify and treat, 3) providers holding more stigmatizing views of patients with co-use, and 4) stimulant use is often “ignored” in the treatment plans. We also identified a range of potential opportunities to improve the treatment of patients with co-use in the hospital setting such as provider practice changes, healthcare system changes, and development and validation of clinical tools and stimulant use disorder treatment approaches. Finally, we found that an ACS may be an effective treatment model to support patients who use multiple substances. Among patients who were not seen by the ACS, a higher proportion of with opioid use alone (33.6%; 95% CI: 31.5-35.7) received MOUD during the hospital stay compared to those with any co-use (23.3%; 95% CI: 21.6-24.9). However, among patients seen by the ACS, the proportion that received MOUD did not vary between opioid use alone (56.2%; 95% CI: 52.2-60.2) and any co-use (57.8%; 95% CI: 55.5-60.1). We found this difference was most pronounced among patients who had opioid and methamphetamine co-use. Compared to patients without methamphetamine co-use, the increase in the proportion of admissions receiving MOUD after being seen by the ACS was 39.0 percentage points (95% CI: 31.8-39.8) higher for patients with methamphetamine co-use. Taken together these findings suggest that hospital services must account for the high rates of medical co-morbidities (e.g., infectious disease and psychiatric conditions) as well as unstable life circumstances (e.g., poverty, housing, and transportation instabilities) that may complicate treatment for patients with co-use. ACSs may help address some of the challenges treating patients with co-use such as identifying co-occurring intoxication and withdrawal symptoms and reducing stigmatizing views. Ongoing randomized trials should further test the impact of ACS on outcomes specifically among patients with co-use. In addition to hospital models to initiate treatment, transition strategies that support linkage to outpatient treatment must also account for the challenges associated with co-use. As these strategies continue to be refined and tested it is important that they also address barriers that patients with co-use face transitioning to community treatment.