The number of patients admitted with opioid use disorder (OUD) and injection-related infections who left the hospital before completing treatment increased significantly between 2016 and 2020, according to analysis from researchers at the Perelman School of Medicine. One in six of these patients now leave the hospital before their care team deems them safe to do so.
The findings, published in JAMA also reveal that the rate at which patients with any opioid-related issues (patients presenting with other issues but who also exhibit a dependance on opioids) left the hospital before completing treatment increased more than 50%. In both of these groups, nearly half of before medically advised (BMA) discharges occurred before the third day, when withdrawal symptoms are most severe. Now that fentanyl has become the dominant opioid causing overdoses, the findings illustrate the need for patient-centered care that adequately manages pain and withdrawal symptoms so that patients can complete treatment.
Approximately 500,000 patients are discharged against medical advice in the United States annually, and those circumstances are associated with increased likelihood of death and hospital readmission. Previous research shows that patients with addiction cite withdrawal and pain as their reason for BMA discharge.
“The rapid increase in early discharges is alarming; in 2016, less than one in ten patients admitted for OUD and injection-related infections left the hospital before their care team considered it safe. By 2020, one in six were leaving early,” says lead author Ashish Thakrar, an assistant professor of medicine in the division of Internal Medicine. “What’s more, since the study period ended, the COVID-19 pandemic caused the opioid crisis to escalate, underscoring just how urgent it is to understand how we might be able to reverse this trend and get patients the treatment they need.”
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