Initiating Substance Use Disorder Treatment for Hospitalized Opioid Use Disorder Patients.

Patients with opioid use disorder (OUD) frequently utilize hospitals due to soft tissue
infections and other conditions that require inpatient level of care. Prior studies have
indicated that OUD patients are often amenable to te initiating buprenorphine treatment and
can be successfully linked to outpatient treatment. However, hospitalized OUD patients
initiated on buprenorphine have much lower treatment retention rates at 6-months compared to
OUD patients initiating treatment in the outpatient setting. As such, there is a great need
to identify strategies to improve treatment retention in this patient population. There is a
growing body of evidence for the benefits of recovery coaches, who provide peer-delivered
support services in the community. Tracing their origin to mutual support groups to
supplement traditional clinical services, recovery coaches are individuals with lived
experience of recovery. Studies of recovery coaches have demonstrated greater treatment
retention, reduced substance use, and reduced inpatient utilization. However, no prior
studies have examined the impact of recovery coaches in improving buprenorphine treatment
retention. As such, the aim of this 24-week study is to evaluate the impact of recovery coach
intervention on rates of treatment retention, illicit opioid use, and readmission among
hospitalized patients newly initiated on buprenorphine compared to the control intervention.
Patients who are successfully initiated on buprenorphine will be eligible to enroll. .
Assessments will be conducted at baseline, 4 weeks, 12 weeks, and 24 weeks.

Inclusion Criteria:

- English speaking, adults aged 18-75

- DSM-5 opioid use disorder, severe, actively using illicit opioids until the time of
hospitalization

- Suitable for initiation of buprenorphine during the admission

- Desire for buprenorphine maintenance after discharge

- Have a working telephone

- Can identify at least 2 individuals who can act as points of contact following
discharge from the hospital

- Eligible for BWH/BWFH-affiliated buprenorphine programs

- Not engaged in SUD treatment

Exclusion Criteria:

- Planning to leave the Greater Boston area during study period

- Likely to require opioids for pain relief after initiation of buprenorphine

- Liver function test >3x upper normal limit

- Pregnant

- Psychotic disorder, active suicidality or homicidality

- Condition likely to be terminal in 24 weeks such as cancer

- Unable to perform consent due to mental status