National trends and characteristics of inpatient detoxification for drug use disorders in the United States

He Zhu,Li-Tzy Wu

doi:10.1186/s12889-018-5982-8

Abstract

BackgroundPrior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed. This study examined national trends and characteristics of inpatient detoxification for DUDs and explored factors associated with receiving DUD treatment (i.e., inpatient drug detoxification plus rehabilitation) and discharges against medical advice (DAMA).MethodsWe analyzed inpatient hospitalization data involving the drug detoxification procedure for patients aged≥12 years (n = 271,403) in the 2003–2011 Nationwide Inpatient Samples. We compared the estimated rate and characteristics of inpatient drug-detoxification hospitalizations between 2003 and 2011 and determined demographic and clinical correlates of inpatient drug detoxification plus rehabilitation (versus detoxification-only) and DAMA (versus transfer to further treatment).ResultsThere was no significant yearly change in the population rate of inpatient drug-detoxification hospitalizations during 2003–2011. The majority of inpatient drug detoxification were patients aged 35–64 years, males, and those on Medicaid. Among inpatient drug-detoxification hospitalizations, only 13% received detoxification plus rehabilitation during inpatient care, and up to 14% were DAMA; the most commonly identified diagnoses were opioid use disorder (OUD; 75%) and non-addiction mental health disorders (48%). Being on Medicaid (vs. having private insurance) and having OUD (vs. no OUD) were associated with decreased odds of receiving detoxification plus rehabilitation, as well as increased odds of DAMA.ConclusionsThese findings suggest the presence of a potentially large detoxification-treatment gap for inpatient detoxification patients. They highlight the need for implementing DUD services to improve engagement in receiving further DUD treatment in order to improve recovery and health outcomes.

Highlights

Prior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed
Among inpatient drug-detoxification hospitalizations for patients aged≥12 years, 61% were aged 35–64 years, 65% were males, 45% were non-Hispanic whites, 36% were residents in the area with lowest household income, 40% reported Medicaid as the primary payer, 44% resided in the northeast region, and 93% were treated in urban hospitals
Trends in clinical characteristics of inpatient drugdetoxification hospitalizations (Table 2) Among inpatient drug-detoxification hospitalizations for patients aged≥12 years, 71, 12 and 11% were admitted to hospitalization primarily for any DUD diagnosis, alcohol use disorder (AUD) diagnosis and any non-addiction mental health disorder (MHD) diagnosis, respectively

Summary

Introduction

Prior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed. This study examined national trends and characteristics of inpatient detoxification for DUDs and explored factors associated with receiving DUD treatment (i.e., inpatient drug detoxification plus rehabilitation) and discharges against medical advice (DAMA). According to the Treatment Episode Data Set, about 18% of treatment admissions for problem drug users aged≥12 years received detoxification (excluding medication-assisted opioid therapy) in the United States in 2014 [3]. This study seeks to examine trends and characteristics of inpatient detoxification for DUD and related treatment utilization to inform efforts aimed at improving DUD treatment engagement and health outcomes for problem drug users. The earlier data from a convenience sample of a hospital-based alcohol/drug detoxification unit showed that the common primary substances identified among patients were alcohol, cocaine, and opiates [18]. The analysis of pooled alcohol and drug detoxification data can obscure the difference in treatment gaps between problem alcohol users and problem drug users

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Discussion

Conclusion