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Initiating Injectable Buprenorphine in People Hospitalized With Infections: A Randomized Clinical Trial
Journal article   Open access   Peer reviewed

Initiating Injectable Buprenorphine in People Hospitalized With Infections: A Randomized Clinical Trial

Nikhil Seval, Prerana Roth, Cynthia A Frank, Angela Di Paola, Alain H Litwin, Brent Vander Wyk, Victor Neirinckx, Esther Schlossberg, Patrick Lawson, Michelle Strong, …
JAMA network open, v 8(5), e2513000
01 May 2025
DOI: https://doi.org/10.1001/jamanetworkopen.2025.13000
PMID: 40445619
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1001/jamanetworkopen.2025.13000View
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Abstract

Adult Buprenorphine - administration & dosage Connecticut Female Hospitalization - statistics & numerical data Humans Male Middle Aged Narcotic Antagonists - administration & dosage Opiate Substitution Treatment - methods Opioid-Related Disorders - complications Opioid-Related Disorders - drug therapy
Hospitalizations are increasing in the US due to infections related to opioid use disorder (OUD); however, few patients have treatment with medications for OUD (MOUD) initiated. Injectable long-acting buprenorphine (LAB) could help improve MOUD receipt and infection treatment completion. To compare initiation of LAB combined with infectious disease (ID) management (ID-LAB) with treatment as usual (TAU) during inpatient medical hospitalization periods for improving receipt of MOUD at 12 weeks. The Coordinating Opioid Use Treatment Through Medical Management With Infection Treatment (COMMIT) trial was a multisite randomized clinical trial with enrollment from August 19, 2020, through October 31, 2023, at 3 US hospital systems in Connecticut, Pennsylvania, and South Carolina. Eligible participants were individuals hospitalized with a diagnosis of moderate to severe OUD according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) and concurrent infection. Intent-to-treat outcomes were assessed at the end of the 12-week intervention period. Participants were randomized 1:1 to receive ID-LAB or TAU during treatment for infection in a hospital setting or early after discharge. All participants received a nurse care medical management intervention. The primary outcome was the proportion of patients who received any form of MOUD at 12 weeks after randomization. Models were adjusted by site, prescription of MOUD in the 30 days prior to hospitalization, and the baseline value of each outcome when assessable. Of the 171 participants who were enrolled, 86 were randomized to the ID-LAB arm and 85 to the TAU arm. A total of 88 participants (51.5%) were men, and median age was 39 (IQR, 33-47) years. At 12 weeks, there was no statistically significant difference in receipt of MOUD between the ID-LAB and TAU groups, with 51 patients (59.3%) and 46 (54.1%), respectively, receiving MOUD (adjusted rate ratio, 1.01; 95% CI, 0.78-1.30). In this randomized clinical trial comparing initiation of LAB for OUD with ID management in the hospital setting compared with TAU, there was no difference between arms in the receipt of MOUD at 12 weeks. The TAU arm had higher retention than anticipated. These findings suggest that hospitalization with an infection related to drug use may present an opportunity to identify OUD and initiate MOUD that may include injectable LAB. The nurse case management services provided to all participants should be evaluated in future studies. ClinicalTrials.gov Identifier: NCT04180020.

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Collaboration types
Domestic collaboration
Web of Science research areas
Psychiatry
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