Researchers at the Perelman School of Medicine have observed a worrying increase in patients with opioid use disorder (OUD) leaving the hospital before completing their treatment. They advocate for improved addiction withdrawal treatment options for doctors to employ.
Ashish Thakrar, MD at Penn Medicine, expresses his concern about this trend. "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," he said. Thakrar further added, "By 2020, one in six were leaving early." He emphasized the gravity of the situation by noting that "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."
In a study conducted at the University of Pennsylvania, researchers compared early departures from hospital between OUD patients and those admitted for other reasons. The data revealed that between 2016 and 2020, there was an increase from 9.3% to 17% in OUD patients who left before medical advice deemed it appropriate. In contrast, early discharges among non-opioid hospitalizations only rose from 1.1% to 1.5%. The researchers also investigated correlations between early departures and days one through three of opioid withdrawal—the most severe period. From 2016 to 2020, premature departures increased from 42.6% to 48%, according to a news release from Penn Medicine News.
Thakrar highlighted fentanyl as a significant contributor to opioid-related deaths: "These data didn’t allow us to discern which type of opioid that individuals were using when admitted for OUD, but we know that fentanyl—an opioid 25 to 50 times more potent than heroin—has spread in unregulated drug supplies and is now involved in 88% of opioid overdoses in the US. Withdrawal symptoms from fentanyl are more difficult to manage than from other opioids like heroin and oxycodone. This study illustrates why we need more research on how to manage individuals withdrawing from fentanyl and other substances in the unregulated drug supply."
Kit Delgado, MD, MS, associate professor of Emergency Medicine and Epidemiology, and director of the Penn Medicine Nudge Unit, recommends better treatment options to help patients navigate the most challenging days of opioid withdrawals. "The drugs that individuals are using have changed over the past decade, and how we treat them should change, too. Health systems can expand the use of interventions that are already proven to treat withdrawal and reduce but not widely used, such as medications like buprenorphine and methadone." The researchers also suggest implementing strategies shown to decrease premature departures, such as addiction consult services.
