Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial.

Importance: Medications for opioid use disorder (MOUD) are effective, but hospitalized people with opioid use disorder (OUD) seldom receive MOUD while in the hospital or link with treatment after. Objective: To test whether an addiction-focused consultation service, the Substance Use Treatment and Recovery Team (START), increases MOUD initiation during hospitalization and linkage to follow-up care after discharge. Design, Setting, and Participants: This 1:1 randomized clinical trial grouped participants into the START intervention or usual care. The study was conducted between November 2021 and September 2023 at 3 hospitals in the following cities: Los Angeles, California; Albuquerque, New Mexico; and Springfield, Massachusetts. The last follow-up was in December 2023. Eligible individuals were 18 years and older and met criteria for OUD. Intervention: START consists of an addiction medicine specialist and a care manager delivering a motivational and addiction-focused discharge planning intervention and follow-up calls. Main Outcomes and Measures: Primary outcomes were the proportions of patients (1) initiating MOUD (naltrexone, buprenorphine, or methadone) during hospitalization (per electronic medical record data) and (2) successfully linking to OUD treatment within 30 days after discharge (per patient self-report). Results: A total of 325 were consented and randomized to START (n = 164) or usual care (n = 161). Median (IQR) age was 41.0 (32.0-50.0) years. A total of 213 participants (65.5%) were male at birth, 28 (8.6%) were American Indian or Alaska Native, 21 (6.5%) were Black, 156 (48.0%) were Hispanic, and 125 (38.5%) were White. More than half, 175 (53.8%), were unhoused in the past year, and 163 (50.2%) were unemployed. START participants were more likely than usual care participants to initiate MOUD during hospitalization (94/164 [57.3%] vs 43/161 [26.7%], respectively; adjusted risk ratio [aRR], 2.10 [97.5% CI, 1.51-2.91]) and to link to OUD care after discharge (90/125 [72.0%] vs 50/104 [48.1%], respectively; aRR, 1.49 [97.5% CI, 1.15-1.93]). Conclusions and Relevance: By addressing gaps in inpatient care, the hospital-based addiction-focused consultation service presented in this randomized clinical trial improved receipt of evidence-based treatment for people with OUD in the hospital and linkage to treatment after discharge. Trial registration: ClinicalTrials.gov Identifier: NCT05086796.