Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.8586 Dr. Allison J. Ober et al.
Points
- A randomized clinical trial evaluated the effectiveness of the Substance Use Treatment and Recovery Team (START) in improving opioid use disorder (OUD) treatment initiation and follow-up care during hospitalization and post-discharge.
- The trial involved 325 adults with OUD at three hospitals. It showed that START participants were significantly more likely to initiate medications for opioid use disorder (MOUD) during hospitalization compared to usual care participants.
- START participants were also more successful in linking to OUD treatment after discharge, with 72.0% linking to care, compared to 48.1% in the usual care group, demonstrating better post-discharge continuity.
- The study suggests that the START intervention addresses critical gaps in inpatient care, improving MOUD initiation and linkage to treatment, which may help reduce long-term mortality and overdose risks for individuals with OUD.
- The findings highlight the potential benefits of integrating hospital-based addiction services like START into inpatient care to enhance treatment engagement and improve outcomes for people with opioid use disorder.
Summary
In a randomized clinical trial, researchers evaluated the effectiveness of the Substance Use Treatment and Recovery Team (START), a hospital-based addiction consultation service, in improving opioid use disorder (OUD) treatment initiation during hospitalization and follow-up care post-discharge. The trial, conducted between November 2021 and September 2023, involved 325 adults with OUD at three hospitals in Los Angeles, Albuquerque, and Springfield. Participants were randomly assigned to the START intervention group (n=164) or the usual care group (n=161). The primary outcomes were the initiation of medications for opioid use disorder (MOUD) during hospitalization and successful linkage to OUD care within 30 days post-discharge.
Results showed that START participants were significantly more likely to initiate MOUD during hospitalization than those receiving usual care. Specifically, 57.3% (94/164) of START participants initiated MOUD versus 26.7% (43/161) of usual care participants (adjusted risk ratio [aRR], 2.10; 97.5% CI, 1.51–2.91). Additionally, START participants were more successful in linking to OUD treatment after discharge, with 72.0% (90/125) linking to care versus 48.1% (50/104) in the usual care group (aRR, 1.49; 97.5% CI, 1.15–1.93). These findings highlight the potential of hospital-based addiction services to significantly improve treatment engagement and continuity of care for individuals with OUD.
The study suggests that the START intervention addresses critical gaps in inpatient care for people with OUD, leading to higher rates of MOUD initiation and linkage to treatment following discharge. This intervention may be key in reducing long-term mortality and overdose risks by improving access to evidence-based treatments during hospitalization and beyond. The findings underscore the importance of integrating addiction-focused services within hospital settings to enhance treatment outcomes for people with OUD.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832101
References Ober, A. J., Murray-Krezan, C., Page, K., Friedmann, P. D., Anderson, J., Osilla, K. C., Ryzewicz, S., Huerta, S., Mazer, M. W., Hoskinson, R. A., Garvey, R., Peltz, A., Watkins, K. E., Nuckols, T., IsHak, W. W., Mariano, L. T., & Danovitch, I. (2025). Hospital addiction consultation service and opioid use disorder treatment: The start randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.8586
