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35th AM (2025) - Poster Session
Quality of Life and Psychiatric Characteristics am ...
Quality of Life and Psychiatric Characteristics among Hospitalized Adults with OUD and Serious Injection-Related...
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This study examines hospitalized adults with opioid use disorder (OUD) and serious injection-related infections (SIRI), such as endocarditis, focusing on their quality of life, psychiatric comorbidities, and challenges in medical treatment continuity. Conducted as a randomized clinical trial (NCT04677114), the research evaluates the effectiveness of a trauma-informed integrated outpatient model—Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT)—compared to usual inpatient care for patients receiving buprenorphine and intravenous antibiotics via PICC lines.<br /><br />Seventy-one participants, mostly white (94%), averaging 41 years old, with complex comorbidities including 77.5% having stimulant use disorder, were randomized to either B-OPAT or treatment as usual (TAU). Psychiatric assessments revealed moderate anxiety and depression symptoms, with some diagnosed with PTSD and histories of suicide attempts, often linked to the pain of OUD. Lifetime trauma, especially life-threatening illnesses, was common.<br /><br />Over 24 weeks, results demonstrated improved health-related quality of life (HRQoL) in both groups, with some indications of superior outcomes in the integrated B-OPAT model. Addiction severity scores related to drug use decreased significantly in the B-OPAT group. However, challenges emerged with involuntary loss of prescribed medical treatments, particularly medication for OUD (MOUD), in settings such as jails, court-ordered treatment facilities, and skilled nursing facilities. Six participants (8.5%) experienced nine such instances, with only two resolved through clinician advocacy emphasizing MOUD's status as a disability-protected treatment under the Americans with Disabilities Act (ADA).<br /><br />The study highlights the importance of trauma-informed care approaches and clinician knowledge of legal protections to improve retention in MOUD and continuity of care. Despite systemic barriers, integrated infectious disease and OUD treatment models like B-OPAT show promise in enhancing HRQoL and psychiatric outcomes in this high-risk population. The authors advocate for improved hospital discharge planning and transitional care strategies that address these complexities to prevent treatment disruptions and support recovery.
Keywords
opioid use disorder
serious injection-related infections
endocarditis
buprenorphine
outpatient parenteral antimicrobial therapy
randomized clinical trial
psychiatric comorbidities
trauma-informed care
medication for opioid use disorder
health-related quality of life
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