The Impact of Addiction Consultation and Medication for Opioid or Alcohol Use Disorder on Hospital Readmission

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Abstract
Background Patients with substance use disorder (SUD) are frequently hospitalized and readmitted. Hospitalization is an opportunity for treatment initiation, including medications for alcohol (MAUD) and opioid use disorder (MOUD). Addiction consult teams are one model for increasing hospital-based SUD treatment. Methods Retrospective analysis examining adult hospitalizations from 2019 to 2023 at an academic medical center with a robust addiction consult team. We assessed the association of addiction consultation with MOUD or MAUD receipt during admission, and the association of addiction consultation, MOUD or MAUD discharge prescription, or MOUD or MAUD new initiation with 30-day readmission rates in generalized linear models. Results There were 19,697 admissions for patients with SUD among 10,453 unique patients. Addiction consultation was associated with higher rates of medication receipt during admission (MOUD, 84% vs. 49%, p < 0.001; MAUD, 33.4% vs. 6.0%, p < 0.001) For patients with OUD, MOUD discharge prescription rates doubled among those seen by the consult team (RR, 2.29; 95% CI, (2.02–2.60). For those with AUD, MAUD discharge prescription rates increased several-fold among those seen by the consult team (RR, 9.48; 95% CI, 8.05–11.16). Addiction consultation was associated with reduced risk of readmission (aRR, 0.82; 95% CI, 0.75–0.89). For AUD, discharge MAUD was associated with reduced risk of readmission (aRR, 0.84; 95% CI, 0.72–0.99) as was new MAUD initiation (aRR, 0.78; 95% CI, 0.629–0.977). For OUD, addiction consultation was associated with a reduced risk of readmission (aRR, 0.77; 95% CI, 0.68–0.87) as was newly initiating MOUD and prescribing it at discharge (aRR, 0.46; 95% CI, 0.33–0.46). Conclusion Addiction consultation is associated with increased MAUD and MOUD receipt and decreased risk of 30-day readmission. MOUD initiation and MAUD initiation are associated with reduced risk of readmission.

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