Buprenorphine Team Increases Inpatient Treatment and Outpatient Follow-up for MOUD

Introduction :
Despite evidence that the use of medications for patients with opioid use disorder (OUD) leads to reduced mortality and improved engagement in outpatient addiction treatment, these life-saving medications are underutilized in the hospital setting. This study reports the outcomes of a hospitalist-led interprofessional inpatient program, known as the B-Team (buprenorphine team), to guide the initiation of buprenorphine and transition to outpatient treatment following discharge.

Methods
A protocol for inpatient screening and initiation of buprenorphine was developed based on a literature review and expert opinion. If eligible, the B-Team provider initiates therapy in concert with the primary team. If eligible for continued outpatient MAT, the B-Team coordinates with an outpatient MAT clinic to ensure the patient receives an appointment prior to discharge. A B-Team provider prescribes a sufficient supply of buprenorphine to bridge until the outpatient appointment. Process measures and patient demographics are entered into REDCap, and received IRB approval.

Eligibility criteria for inpatient induction was created in collaboration with the outpatient MAT clinic, which included: 1. Admission to hospital with anticipated length of stay amenable to induction of buprenorphine, 2. Diagnosis of OUD, 3. Not on other MAT, 4. No concomitant medical or psychiatric diagnoses limiting ability to attend outpatient MAT clinic appointments, and 5. Patient desires buprenorphine treatment.

Results
During the first two years, the B-Team began inpatient buprenorphine therapy for 132 patients; 113 (86%) were bridged to an outpatient program. Eighty-four patients (74%) were seen at their first outpatient appointment within 14 days; 72 (64%) remained engaged at 1-month; 63 (56%) at 3 months; and 57 (50%) at 6 months.

Conclusion
A hospital based buprenorphine program (the B-Team) increased inpatient treatment and outpatient follow-up for treatment of opioid use disorder. This model is potentially replicable at other hospitals because it does not require dedicated addiction medicine expertise.

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