Medications for opioid use disorder receipt in intensive care patients with opioid use disorder-A statewide cohort study.

DESIGN: Retrospective observational study. SETTING: Seven intensive care units (ICUs) across the MaineHealth system. PATIENTS: Adults with opioid use disorder (OUD) admitted to the ICU between November 2023 and June 2025. INTERVENTION: None. MEASURES: Receipt of medications for OUD (M-OUD) assessed preadmission, during hospitalization (ICU and general ward), and at discharge, stratified by prior treatment status and hospital rurality. RESULTS: Among 1,113 patients, 15.6 percent were on M-OUD preadmission. M-OUD exposure increased during ICU care, with no significant difference between urban and rural patients (44 percent vs 39 percent, p = 0.134). On the general ward, M-OUD exposure decreased: 29.8 percent of previously untreated patients received M-OUD, while 57.2 percent of those on preadmission M-OUD did not receive therapy (p < 0.001). At discharge, M-OUD prescribing was significantly lower in rural versus urban patients (8 percent vs 22 percent, p < 0.001). CONCLUSION: M-OUD remains underutilized across the ICU care continuum, with loss of treatment continuity at discharge for rural and urban patients.