Medication treatment lacking in cirrhotic veterans with active opioid use disorder

Majority of veterans with active opioid use disorder (OUD) and cirrhosis do not receive medication treatment, while those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were the least likely to receive such therapies despite their proven effectiveness, a US study has found.

The authors developed a cohort of veterans with cirrhosis and active OUD within the Veterans Health Administration Corporate Data Warehouse using two outpatient and one inpatient International Classification of Diseases, ninth revision (ICD-9) codes from 2011 to 2015 to define each condition. They assessed initiation of medication treatment for OUD (MOUD) with methadone or buprenorphine over 180 days following the first OUD ICD-9 code in the study period.

Multivariable regression models were fitted to examine the relationship of sociodemographic and clinical factors with receiving MOUD and the associations between MOUD and subsequent clinical outcomes, including new hepatic decompensation and mortality.

A total of 5,600 veterans met the criteria for active OUD and cirrhosis, of whom only 722 (13 percent) were prescribed MOUD over 180 days of follow-up.

In multivariable analysis, MOUD significantly correlated with age (adjusted odds ratio [AOR] per year, 1.04, 95 percent confidence interval [CI], 1.01–1.07), hepatitis C virus (AOR, 2.15, 95 percent CI, 1.37–3.35), and other substance use disorders (AOR, 1.47, 95 percent CI, 1.05–2.04). In addition, MOUD negatively correlated with alcohol use disorder (AOR, 0.70, 95 percent CI, 0.52–0.95), opioid prescription (AOR, 0.51, 95 percent CI, 0.38–0.70), and schizophrenia (AOR, 0.59, 95 percent CI, 0.37–0.95).

In contrast, MOUD did not correlate significantly with mortality (adjusted hazards ratio, 1.20, 95 percent CI, 0.95–1.52) or new hepatic decompensation (OR, 0.57, 95 percent CI, 0.30–1.09).