Medication Treatment of Active Opioid Use Disorder in Veterans With Cirrhosis

Abstract

INTRODUCTION: 

Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. We aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD.

METHODS: 

Within the Veterans Health Administration Corporate Data Warehouse, we developed a cohort of Veterans with cirrhosis and active OUD, using 2 outpatient or 1 inpatient International Classification of Diseases, ninth revision codes from 2011 to 2015 to define each condition. We assessed MOUD initiation with methadone or buprenorphine over the 180 days following the first OUD International Classification of Diseases, ninth revision code in the study period. We fit multivariable regression models to assess the association of sociodemographic and clinical factors with receiving MOUD and the associations between MOUD and subsequent clinical outcomes, including new hepatic decompensation and mortality.

RESULTS: 

Among 5,600 Veterans meeting criteria for active OUD and cirrhosis, 722 (13%) were prescribed MOUD over 180 days of follow-up. In multivariable modeling, MOUD was significantly, positively associated with age (adjusted odds ratio [AOR] per year: 1.04, 95% confidence interval (CI): 1.01–1.07), hepatitis C virus (AOR = 2.15, 95% CI = 1.37–3.35), and other substance use disorders (AOR = 1.47, 95% CI = 1.05–2.04) negatively associated with alcohol use disorder (AOR = 0.70, 95% CI = 0.52–0.95), opioid prescription (AOR = 0.51, 95% CI = 0.38–0.70), and schizophrenia (AOR = 0.59, 95% CI = 0.37–0.95). MOUD was not significantly associated with mortality (adjusted hazards ratio = 1.20, 95% CI = 0.95–1.52) or new hepatic decompensation (OR = 0.57, CI = 0.30–1.09).

DISCUSSION: 

Few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.