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Abstract

Background: Inpatient withdrawal management services (WMS) are important settings within the continuum of evidence-based substance use care. As such, this thesis aims to explore factors impacting access to, treatment in, and patient-initiated discharge (PID) events from inpatient WMS. Methods: An initial scoping review was conducted to identify factors impacting access to inpatient WMS among individuals who use substances or have a SUD in the United States and Canada. Following this, observational data from a cohort of individuals admitted to a hospital-based WMS facility in Vancouver, Canada, was utilized. More specifically, individuals with an opioid use disorder (OUD) who accessed this setting are characterized and factors associated with discharge from the facility on different opioid agonist therapy (OAT) medications as well as PID events are both independently analyzed. Results: Studies included in the scoping review identified factors impacting access to inpatient WMS, both negatively (e.g. unstable housing status, distance to facilities), as well as positively (e.g. timely service delivery). Among 140 individuals with OUD accessing a hospital-based WMS, the median age was 36 years, more than half identified as men (56%), White (54%), and two thirds (67%) of participants were unstably housed. Almost all study participants (96%) had an OAT prescription at the time of discharge; participants who were unstably housed (OR = 0.25; 95% CI: 0.09 – 0.75) were found to be less likely to be prescribed buprenorphine at the time of hospital discharge, while individuals with co-morbid stimulant use disorder were more likely to be prescribed buprenorphine (OR = 2.98; 95% CI: 1.07 – 8.29). Unstable housing was identified as a factor increasing the likelihood of a PID event among individuals with OUD accessing hospital-based WMS (OR = 6.75; 95% CI: 1.74 – 26.2), while longer length of admission decreased the odds of the same (OR 0.86; 95% CI: 0.76 – 0.98). Conclusion: This thesis showed the importance of inpatient WMS as sites of engagement with treatment for individuals with SUDs, and generated novel insights regarding ongoing unmet needs of individuals seeking access to these settings, factors associated with the type of OAT medication prescribed at discharge, and factors associated with PID events.