(256) Impact of Medications for Opioid Use Disorder on Infectious Disease Management

Background: : Opioid use disorder significantly impacts overall health, leading to increased morbidity with the exacerbation of other severe health conditions. For instance, injection drug use has been linked to the spread of infectious diseases (ID) yet there is a lack of data on the effects of medications for opioid use disorder (MOUD) utilization on ID outcomes.

Objective: : This study compared the effect of MOUD on acute ID incidence and ID-specific healthcare resource utilization (HCRU) across two buprenorphine-based treatment cohorts.

Methods: : This retrospective observational cohort study utilized the Veradigm outpatient electronic health records linked to a claims database between July 2018–Dec 2023 to identify patients treated with either transmucosal buprenorphine (TM-BUP) or extended-release buprenorphine (XR-BUP) for ≥90 consecutive days. Both unweighted analyses and analyses adjusted using inverse probability of treatment weighting (IPTW) were conducted to assess the impact of TM-BUP compared to XR-BUP on acute ID incidence rates and ID-specific HCRU 6 months following treatment initiation, employing a Difference-in-Difference approach.

Results: : Among 467 XR-BUP and 118,112 TM-BUP patients, those receiving XR-BUP had a 37% lower incidence (95% confidence interval: 12%–55%) of acute skin infections (e.g., cellulitis) during the 6-months following treatment initiation compared to TM-BUP in unweighted analyses.

In IPTW-weighted acute ID incidence analyses, bacteremia incidence was found to be 62% (26%–81%) lower in the XR-BUP cohort 6-months following treatment initiation compared to the TM-BUP cohort.

Unweighted ID-related HCRU analyses revealed XR-BUP patients had significant reductions in inpatient (81%; 18%–96%) and outpatient (55%; 24%–74%) skin infection visits. Outpatient visits for the treatment of hepatitis B/C (63%; 11%–138%) and bone/joint infections (823%; 17%–7192%) were higher for XR-BUP patients possibly suggesting improved chronic care treatment. After adjusting for IPTW, there was a significant reduction in sexually transmitted infection (STI) outpatient visits (77%; 43%–91%) among XR-BUP versus TM-BUP patients.

Conclusions: : XR-BUP treatment was associated with larger reductions in acute skin infections and bacteremia incidence as well as STI-related outpatient visits compared to TM-BUP, suggesting a potential benefit for XR-BUP in mitigating acute ID complications. Increased hepatitis B/C and bone-joint infection outpatient visits among XR-BUP patients may reflect improved chronic ID management through regular clinical follow-ups.

Sponsorship:: Indivior