Patients with cirrhosis who have active opioid use disorder (OUD) are not often prescribed medication treatments for OUD (MOUD), and likelihood of receiving MOUD is less likely for patients with previous opioid prescriptions, schizophrenia, and alcohol use disorder, according to study findings published in The American Journal of Gastroenterology.
Although MOUD is evidence-based and performs better than abstinence-based nondrug treatments in the general population, there is a lack of data about MOUD treatments in patients with cirrhosis. To address these knowledge gaps, a team of investigators conducted a retrospective cohort study using data from the Veterans Health Administration to determine the factors associated with the use of MOUD and whether MOUD is linked to hepatic decompensation or death in patients with cirrhosis and active OUD.
Of the 5600 veterans (mean age, 56.8 years; 98% men) who were diagnosed with cirrhosis, 722 (13%) were prescribed MOUD throughout the 180 days of follow-up. The majority of patients had cirrhosis due to hepatitis C virus (HCV; 83%), although only 2% received HCV treatment. In addition, 52% of patients were prescribed opioids in the year prior to their OUD diagnosis.
Among the 722 patients treated with MOUD, 70% were treated with methadone and 30% were treated with buprenorphine. According to results of a univariate analysis, patients who were treated with MOUD were significantly older and more likely to have HCV and other substance use disorders compared with patients who were not treated.
Multivariate analysis confirmed that treatment with MOUD was positively associated with age (adjusted odds ratio [aOR] per year, 1.04), HCV (aOR, 2.25), and other substance use disorders (aOR, 1.47); however, MOUD was negatively associated with alcohol use disorder (aOR, 0.70), opioid prescription (aOR, 0.51), and schizophrenia (aOR, 0.59).
Throughout the 5-year study period, there were 1736 deaths (excluding mortality in the first 6 months of the analysis); 36% and 30% of patients receiving and not receiving MOUD, respectively, died throughout follow-up. Adjusted models suggested that MOUD was not independently associated with survival time (adjusted hazard ratio, 1.20; P =.117).
“These findings suggest that providers should screen for and treat OUD in patients with cirrhosis. Subsets of patients at risk of nontreatment may require more targeted approaches to increase MOUD adoption,” investigators stated.
“Future research should focus on barriers to MOUD uptake and further assessment of the safest and most efficacious way to implement OUD treatment in patients with cirrhosis,” the investigators concluded.
Rogal S, Youk A, Agbalajobi O, et al. Medication treatment of active opioid use disorder in veterans with cirrhosis. Am J Gastroenterol. 2021;116(7):1406-1413. doi:10.14309/ajg.0000000000001228