Factors for leaving against medical advice from inpatient substance use detoxification treatment during the COVID-19 pandemic

BACKGROUND: Patients who are in detoxification units for substance use who leave against medical advice (AMA) present novel challenges to treatment program providers. We wanted to study variables associated with patients leaving AMA during the COVID-19 pandemic. METHODS: Cross-sectional survey completed by 374 respondents who either left AMA or did not leave AMA from an inpatient substance use detoxification center. Variables were analyzed from a multitude of factors of demographics, psychiatric history, substance use, social variables, attitudes, and satisfaction. RESULTS: Leaving the detoxification unit due to a fear of contracting COVID (OR:1.34, 95% CI: 1.03, 1.73, P=0.03), Other race/ethnicity (OR:2.67, 95% CI:1.19, 5.95, P=0.02), and current alcohol use detoxification (OR:2.97, 95% CI 1.11, 7.99, P=0.03) were each significantly associated with greater odds for leaving AMA. CONCLUSIONS: Facilities may benefit by taking additional measures involving mandatory masking, improving measures of sanitation, and increasing social distancing to ensure patients feel protected from COVID-19 during their substance use detoxification treatment. Patients from Other race/ethnicity and those who use alcohol as their preferred substance choice may require additional resources or staff attention to prevent treatment non-completion and leaving AMA.