Shari Rogal1,2,3,4,5,6,7,8,9,10,11, Ada Youk1,4, Olufunso Agbalajobi5, Hongwei Zhang1, Walid Gellad1,6,7, Michael J Fine1,6, Pamela Belperio8, Timothy Morgan9,10, Chester B Good1,6,11, Kevin Kraemer1,5. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 2. Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 3. Department of Surgery, Division of Transplant Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 4. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 5. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 6. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 7. Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 8. Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA. 9. Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, USA. 10. Division of Gastroenterology, Department of Medicine, University of California, Irvine, California, USA. 11. Centers for Value Based Pharmacy Initiatives and High Value Health Care, UPMC Health Plan Insurance Division, Pittsburgh, Pennsylvania, USA.
Abstract
INTRODUCTION: Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. We aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. METHODS: Within the Veterans Health Administration Corporate Data Warehouse, we developed a cohort of Veterans with cirrhosis and active OUD, using 2 outpatient or 1 inpatient International Classification of Diseases, ninth revision codes from 2011 to 2015 to define each condition. We assessed MOUD initiation with methadone or buprenorphine over the 180 days following the first OUD International Classification of Diseases, ninth revision code in the study period. We fit multivariable regression models to assess the association of sociodemographic and clinical factors with receiving MOUD and the associations between MOUD and subsequent clinical outcomes, including new hepatic decompensation and mortality. RESULTS: Among 5,600 Veterans meeting criteria for active OUD and cirrhosis, 722 (13%) were prescribed MOUD over 180 days of follow-up. In multivariable modeling, MOUD was significantly, positively associated with age (adjusted odds ratio [AOR] per year: 1.04, 95% confidence interval (CI): 1.01-1.07), hepatitis C virus (AOR = 2.15, 95% CI = 1.37-3.35), and other substance use disorders (AOR = 1.47, 95% CI = 1.05-2.04) negatively associated with alcohol use disorder (AOR = 0.70, 95% CI = 0.52-0.95), opioid prescription (AOR = 0.51, 95% CI = 0.38-0.70), and schizophrenia (AOR = 0.59, 95% CI = 0.37-0.95). MOUD was not significantly associated with mortality (adjusted hazards ratio = 1.20, 95% CI = 0.95-1.52) or new hepatic decompensation (OR = 0.57, CI = 0.30-1.09). DISCUSSION: Few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
INTRODUCTION: Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. We aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. METHODS: Within the Veterans Health Administration Corporate Data Warehouse, we developed a cohort of Veterans with cirrhosis and active OUD, using 2 outpatient or 1 inpatient International Classification of Diseases, ninth revision codes from 2011 to 2015 to define each condition. We assessed MOUD initiation with methadone or buprenorphine over the 180 days following the first OUD International Classification of Diseases, ninth revision code in the study period. We fit multivariable regression models to assess the association of sociodemographic and clinical factors with receiving MOUD and the associations between MOUD and subsequent clinical outcomes, including new hepatic decompensation and mortality. RESULTS: Among 5,600 Veterans meeting criteria for active OUD and cirrhosis, 722 (13%) were prescribed MOUD over 180 days of follow-up. In multivariable modeling, MOUD was significantly, positively associated with age (adjusted odds ratio [AOR] per year: 1.04, 95% confidence interval (CI): 1.01-1.07), hepatitis C virus (AOR = 2.15, 95% CI = 1.37-3.35), and other substance use disorders (AOR = 1.47, 95% CI = 1.05-2.04) negatively associated with alcohol use disorder (AOR = 0.70, 95% CI = 0.52-0.95), opioid prescription (AOR = 0.51, 95% CI = 0.38-0.70), and schizophrenia (AOR = 0.59, 95% CI = 0.37-0.95). MOUD was not significantly associated with mortality (adjusted hazards ratio = 1.20, 95% CI = 0.95-1.52) or new hepatic decompensation (OR = 0.57, CI = 0.30-1.09). DISCUSSION: Few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
Authors: James N Fleming; Jennifer C Lai; Helen S Te; Adnan Said; Erin K Spengler; Shari S Rogal Journal: Clin Transplant Date: 2017-11-27 Impact factor: 2.863
Authors: Victor I Reus; Laura J Fochtmann; Oscar Bukstein; A Evan Eyler; Donald M Hilty; Marcela Horvitz-Lennon; Jane Mahoney; Jagoda Pasic; Michael Weaver; Cheryl D Wills; Jack McIntyre; Jeremy Kidd; Joel Yager; Seung-Hee Hong Journal: Focus (Am Psychiatr Publ) Date: 2019-04-10
Authors: Shari S Rogal; Rory McCarthy; Andrea Reid; Keri L Rodriguez; Linda Calgaro; Krupa Patel; Molly Daley; Naudia L Jonassaint; Susan L Zickmund Journal: Dig Dis Sci Date: 2017-05-18 Impact factor: 3.199
Authors: Alex H S Harris; Laura Ellerbe; Tyler E Phelps; John W Finney; Thomas Bowe; Shalini Gupta; Steven M Asch; Keith Humphreys; Jodie Trafton Journal: J Subst Abuse Treat Date: 2015-01-15
Authors: Shari S Rogal; Klaus Bielefeldt; Ajay D Wasan; Francis E Lotrich; Susan Zickmund; Eva Szigethy; Andrea F DiMartini Journal: Clin Gastroenterol Hepatol Date: 2014-11-05 Impact factor: 11.382
Authors: Suneet Kaur; Karen M Stechuchak; Cynthia J Coffman; Kelli D Allen; Lori A Bastian Journal: J Gen Intern Med Date: 2007-02 Impact factor: 5.128