Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals

Mariah M Kalmin; David Goodman-Meza; Erik Anderson; Ariana Abid; Melissa Speener; Hannah Snyder; Arianna Campbell; Aimee Moulin; Steve Shoptaw; Andrew A Herring

doi:10.1016/j.drugalcdep.2021.108673

Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals

Drug Alcohol Depend. 2021 May 1:222:108673. doi: 10.1016/j.drugalcdep.2021.108673. Epub 2021 Mar 18.

Authors

Affiliations

¹ Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States. Electronic address: mkalmin@mednet.ucla.edu.
² Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States; Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, United States.
³ Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA, United States.
⁴ Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
⁵ California Bridge Program, Public Health Institute, Oakland, CA, United States.
⁶ California Bridge Program, Public Health Institute, Oakland, CA, United States; Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States.
⁷ California Bridge Program, Public Health Institute, Oakland, CA, United States; Department of Emergency Medicine, Marshall Medical Center, Placerville, CA, United States.
⁸ California Bridge Program, Public Health Institute, Oakland, CA, United States; Department of Emergency Medicine, University of California, Davis, Sacramento, CA, United States.
⁹ Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA, United States; California Bridge Program, Public Health Institute, Oakland, CA, United States.

Abstract

Background: Medication for opioid use disorder (MOUD) using buprenorphine in primary or specialty care settings is accessed primarily by persons with private health insurance, stable housing, and no polysubstance use. This paper applies Social Cognitive Theory to frame links between social factors and treatment outcomes among patients with social and economic disadvantages who are seeking MOUD at California Bridge Program (CA Bridge) hospitals.

Methods: Electronic medical records for patients identified with OUD between January-April, 2020 receiving care at CA Bridge hospitals defined outcomes: hospital-administered buprenorphine; provision of buprenorphine prescription at discharge. Multi-level models assessed whether social factors-housing status, insurance type, and co-methamphetamine use-predicted outcomes while accounting for group-level effects of treating hospital and controlling for age, race/ethnicity, and gender.

Results: 15 CA Bridge hospitals yielded 845 patient records. Most patients received hospital-administered buprenorphine (58 %) and/or a buprenorphine prescription (55 %); 26 % received neither treatment. Patients with unstable housing had greater odds of hospital-administered buprenorphine compared to patients with stable housing. Patients with Medicaid had greater odds of receiving a buprenorphine prescription compared to patients with other insurance. Co-methamphetamine use was not associated with outcomes.

Conclusions: Patients with OUD are successful in accessing same-day MOUD in CA Bridge hospital settings over a significant period. Importantly, access to MOUD in these settings was facilitated for patients traditionally not treated using buprenorphine, i.e., those with housing instability, Medicaid insurance, and co-methamphetamine use. Findings suggest barriers to MOUD for patients with social and economic disadvantages can be lowered by changing treatment delivery.

Keywords: Buprenorphine-administration and dosage; Emergency services; Opiate substitution treatment; Opioid-related disorders.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Buprenorphine* / therapeutic use
California / epidemiology
Hospitals
Humans
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Social Factors
United States

Substances

Buprenorphine

Abstract

Publication types

MeSH terms

Substances

Grants and funding