START
Trial question
What is the effect of hospital-based addiction-focused consultation service in hospitalized patients with opioid use disorder?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 325
325 patients (112 female, 213 male).
Inclusion criteria: hospitalized adults with opioid use disorder.
Key exclusion criteria: receipt of FDA-approved medication treatment for opioid use disorder; < 6 months life expectancy; age < 18 years.
Interventions
N=164 substance use treatment and recovery team (addiction medicine specialist and care manager delivered motivational and addiction-focused discharge planning and follow-up calls).
N=161 usual care (each hospital's respective practices for managing opioid use disorder).
Primary outcome
Proportion of patients successfully initiating medications for opioid use disorder during hospitalization
57.3%
26.7%
57.3 %
43.0 %
28.6 %
14.3 %
0.0 %
Substance use treatment and recovery
team
Usual
care
Significant
increase ▲
NNT = 3
Significant increase in the proportion of patients successfully initiating medications for opioid use disorder during hospitalization (57.3% vs. 26.7%; RR 2.1, 97.5% CI 1.51 to 2.91).
Secondary outcomes
Significant increase in the proportion of patients successfully linking to opioid use disorder treatment within 30 days after discharge (72% vs. 48.1%; RR 1.49, 97.5% CI 1.15 to 1.93).
Significant increase in opioid use disorder-focused discharge plan in the medical record (49.4% vs. 27.3%; RR 1.8, 95% CI 1.36 to 2.41).
Significant increase in initiation or continuation of medications for opioid use disorder after hospital discharge (52.4% vs. 30.8%; RR 1.71, 95% CI 1.23 to 2.39).
Conclusion
In hospitalized adults with opioid use disorder, substance use treatment and recovery team were superior to usual care with respect to proportion of patients successfully initiating medications for opioid use disorder during hospitalization.
Reference
Allison J Ober, Cristina Murray-Krezan, Kimberly Page et al. Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial. JAMA Intern Med. 2025 Apr 7:e248586. Online ahead of print.
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