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The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder.
Addict Sci Clin Pract. 2022 07 28; 17(1):39.AS

Abstract

BACKGROUND

People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use.

METHODS

This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records.

DISCUSSION

The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www.

CLINICALTRIALS

gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist = .

Links

PMC Free PDF

Authors+Show Affiliations

Ober AJ
RAND Corporation, 1776 Main St, Santa Monica, CA, 90407-2138, USA. ober@rand.org.
Murray-Krezan C
University Pittsburgh, Pittsburgh, PA, USA.
Page K
University of New Mexico Hospital, Albuquerque, NM, USA.
Friedmann PD
University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA.
Chan Osilla K
Stanford University, Palo Alto, CA, USA.
Ryzewicz S
University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA.
Huerta S
University Pittsburgh, Pittsburgh, PA, USA.
Mazer MW
Cedars Sinai Medical Center, Los Angeles, CA, USA.
Leamon I
RAND Corporation, 1776 Main St, Santa Monica, CA, 90407-2138, USA.
Messineo G
Cedars Sinai Medical Center, Los Angeles, CA, USA.
Watkins KE
RAND Corporation, 1776 Main St, Santa Monica, CA, 90407-2138, USA.
Nuckols T
Cedars Sinai Medical Center, Los Angeles, CA, USA.
Danovitch I
Cedars Sinai Medical Center, Los Angeles, CA, USA.

MeSH

AftercareBuprenorphineHumansMethadoneOpiate Substitution TreatmentOpioid-Related DisordersPatient DischargeRandomized Controlled Trials as Topic

Pub Type(s)

Clinical Trial Protocol
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35902888

Clinical Trial Links

Clinical trial which this article describes

Citation

Ober, Allison J., et al. "The Substance Use Treatment and Recovery Team (START) Study: Protocol for a Multi-site Randomized Controlled Trial Evaluating an Intervention to Improve Initiation of Medication and Linkage to Post-discharge Care for Hospitalized Patients With Opioid Use Disorder." Addiction Science & Clinical Practice, vol. 17, no. 1, 2022, p. 39.
Ober AJ, Murray-Krezan C, Page K, et al. The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder. Addict Sci Clin Pract. 2022;17(1):39.
Ober, A. J., Murray-Krezan, C., Page, K., Friedmann, P. D., Chan Osilla, K., Ryzewicz, S., Huerta, S., Mazer, M. W., Leamon, I., Messineo, G., Watkins, K. E., Nuckols, T., & Danovitch, I. (2022). The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder. Addiction Science & Clinical Practice, 17(1), 39. https://doi.org/10.1186/s13722-022-00320-7
Ober AJ, et al. The Substance Use Treatment and Recovery Team (START) Study: Protocol for a Multi-site Randomized Controlled Trial Evaluating an Intervention to Improve Initiation of Medication and Linkage to Post-discharge Care for Hospitalized Patients With Opioid Use Disorder. Addict Sci Clin Pract. 2022 07 28;17(1):39. PubMed PMID: 35902888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder. AU - Ober,Allison J, AU - Murray-Krezan,Cristina, AU - Page,Kimberly, AU - Friedmann,Peter D, AU - Chan Osilla,Karen, AU - Ryzewicz,Stephen, AU - Huerta,Sergio, AU - Mazer,Mia W, AU - Leamon,Isabel, AU - Messineo,Gabrielle, AU - Watkins,Katherine E, AU - Nuckols,Teryl, AU - Danovitch,Itai, Y1 - 2022/07/28/ PY - 2022/04/08/received PY - 2022/07/01/accepted PY - 2022/7/28/entrez PY - 2022/7/29/pubmed PY - 2022/8/2/medline KW - Addiction consult team KW - Collaborative care KW - Inpatient KW - Linkage to follow-up KW - Medications for opioid use disorder (MOUD) KW - Opioid use disorder (OUD) SP - 39 EP - 39 JF - Addiction science & clinical practice JO - Addict Sci Clin Pract VL - 17 IS - 1 N2 - BACKGROUND: People with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use. METHODS: This study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records. DISCUSSION: The START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions. TRIAL REGISTRATION: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021. https://www. CLINICALTRIALS: gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist = . SN - 1940-0640 UR - https://www.unboundmedicine.com/medline/citation/35902888/The_Substance_Use_Treatment_and_Recovery_Team__START__study:_protocol_for_a_multi_site_randomized_controlled_trial_evaluating_an_intervention_to_improve_initiation_of_medication_and_linkage_to_post_discharge_care_for_hospitalized_patients_with_opioid_use_disorder_ DB - PRIME DP - Unbound Medicine ER -