NEW
YORK, July 29, 2024 /PRNewswire/ -- Previous
research has found that over 80 percent of people with opioid
use disorder (OUD) do not receive evidence-based lifesaving
medications. While access to these medications is better in
New York City than elsewhere in
the United States, numerous
structural and social barriers impede access to treatment, and more
than 100,000 people in the U.S. continue to die from drug overdoses
each year.
To help close this alarming treatment gap, researchers at NYU
Grossman School of Medicine partnered with the New York City public hospital system to
investigate if a program offering addictions care to patients with
substance use disorder while they are in the hospital could lead to
better uptake of OUD treatment after discharge.
The findings, published online July
29 in JAMA Internal Medicine, indicated this intervention,
known as the CATCH program (Consult for Addiction Treatment and
Care in Hospitals), was highly effective. In the first large
randomized controlled trial of hospital-based addiction consult
services for the treatment of opioid use disorder, the team of
researchers found that with the CATCH program, the odds of patients
initiating medication for opioid use disorder treatment
post-discharge were eight times higher, and the odds of continuing
treatment were nearly six times higher, in comparison to usual
care.
"Addiction consult programs like CATCH have tremendous potential
to reduce the negative consequences of untreated substance use
disorder," said Jennifer McNeely,
MD, principal investigator of the study and associate professor in
the Departments of Population Health and Medicine at NYU Langone.
"We have highly effective medications for treating opioid use
disorder and preventing overdose, but far too few patients are
receiving them. It is our hope that programs like CATCH will
be replicated, reimbursed, and rolled out at hospitals across the
country, to transform hospital care for patients with substance use
disorder."
People with untreated opioid use disorder have high rates of
hospital admissions, which can be an opportunity for starting
medications for OUD treatment and improving engagement with medical
and harm reduction services, said McNeely. Specialty consult
services are common in the hospital, but rare for addiction.
For example, if a patient is hospitalized after an asthma attack,
they would typically be seen by a pulmonary consult service, which
would have specialized providers to make a diagnosis, start
medications, and craft a discharge plan for ongoing
treatment. Unfortunately, in most hospitals, patients who are
hospitalized after an overdose, or with other complications of a
substance use disorder, there is no specialized care. Programs like
CATCH fill this gap.
How the Study was Conducted
Beginning in October 2017 and
running through January 2021, the
randomized trial was conducted in six of the 11 public hospitals
run by NYC Health + Hospitals (H+H). Using data from New York State Medicaid claims data and
electronic health records to identify patients with substance use
disorder, the investigators analyzed the impact of CATCH on 2,315
hospitalized patients.
CATCH consult teams consisted of a medical clinician, social
worker or addiction counselor, and peer counselor. The
investigators assessed whether patients who were not already in
treatment prior to hospitalization received medication for OUD in
the first 14 days post-hospital discharge, as well as continuation
with treatment 30 days after initiation. Initiation was defined as
having at least one outpatient treatment event such as a filled
prescription for buprenorphine or an encounter in an opioid
treatment program. Engagement in treatment was defined as having
two treatment events 30 days after starting medication for OUD.
The majority of identified patients were male (73 percent)
averaging 47 years old. Patients were racially and ethnically
diverse, with 31.5 percent Black and 32.5 percent Hispanic. Two
thirds of patients had three or more chronic medical conditions and
at least one diagnosis of serious mental illness. In the past three
years, half had three or more hospitalizations and 58 percent had
three or more visits to the emergency department, while less than
half had received any medications for OUD previously.
With the CATCH program, 11 percent of patients with eligible
admissions started OUD medications following discharge, compared to
less than 7 percent when hospitals were providing usual care. Out
of all eligible admissions, 7.5 percent of patients in CATCH
hospitals remained in treatment for at least 30 days, compared to
5.5 percent in usual care. Retention in treatment after six months
was low for both the CATCH (3.2 percent) and control patients (2.4
percent).
The six H + H hospitals participating in the study have
continued offering CATCH even after the study ended.
"NYC Health + Hospitals' Consult for Addiction Treatment and
Care in Hospital (CATCH) teams engage patients admitted into the
hospital who exhibit symptoms of substance use disorder. They offer
compassionate, wrap-around, cutting-edge addiction care," said NYC
Health + Hospitals Medical Director of Substance Use Disorder
Services Dan Schatz, MD, MS. "We
have begun thousands of patients on lifesaving buprenorphine
treatment through this program, and we are grateful to NYU for partnering with us on a study to show what
we have long witnessed every day. The impact of programs like CATCH
is indisputable, both in direct clinical outcomes and in catalyzing
culture change within hospitals to make them the gold standard of
care. These teams, located at six of our hospitals, are bringing
care directly to patients who need it the most, ensuring that
patients have the resources and treatment that they need."
Despite the success of CATCH, treatment for OUD following
hospitalization remains low, largely due to structural and social
barriers, reminds McNeely--highlighting the need for further
efforts to improve hospital and community-based services for
treatment.
Additional research is also needed to determine if addiction
consult services may be effective in boosting initiation to
treatment for patients with non-opioid substance use disorders
following discharge from hospital, the investigators said.
In addition to McNeely, other study investigators from NYU
Langone include Yasna Rostam-Abadi,
MD, MPH, Thadeus Tarpey, PhD,
Jasmine Fernando, MPharm,
Noa Appleton, MPH, Adetayo Fawole, MD, MPH, and Medha Mazumdar, MS. New York City Health +
Hospitals collaborators include senior author Carla King, MPH, Samira
Siddiqui, MPH, Charles
Barron, MD, Roopa Kalyanaraman
Marcello, DrPH, Johanna
Dolle, MPA, and Caroline
Cooke, MPH. Additional investigators include John Billings, JD and Scarlett Wang, MPH, MSW from NYU Robert F.
Wagner Graduate School of Public Service and Zoe M. Weinstein, MD, Department of Medicine,
Boston University Chobanian &
Avedesian School of Medicine, Boston Medical Center.
Funding for the study was provided by the National Institute on
Drug Abuse (NIDA), grant number R01DA045669. Funding for
initiation of the CATCH program was also provided under former
New York City Mayor Bill de Blasio's Healing NYC initiative.
Media Inquiries Before August
6
Shira Polan
212-404-4279
shira.polan@nyulangone.org
Media Inquiries on or After August
6
Sasha Walek
646-501-3873
Sasha.walek@nyulangone.org
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SOURCE NYU Grossman School of Medicine and NYU Langone
Health