A Qualitative Analysis of Hospitalist Perceptions of Self-Directed Discharge Among Inpatients with Opioid Use Disorder

Reed, Megan; Sarpoulaki, Nazanin; Murali, Vignesh; Weinstein, Lara Carson; Zavodnick, Jillian; Bowles, Jeanette M.; Rising, Kristin L

doi:10.1080/10826084.2023.2191698

Cited by 5 publications

(1 citation statement)

References 27 publications

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“…10,14 Clinicians report that the use of methadone and buprenorphine reduces opioid withdrawal symptoms and facilitates meaningful interactions with patients, leading to greater job satisfaction. 10,15,16 When patients request methadone continuation after hospital discharge, navigating the hospital to OTP linkage can be challenging for patients and for clinicians who are responsible for ensuring safe care transitions. Hospital to OTP linkage barriers include uncontrolled opioid withdrawal and pain, lack of transportation, identification, or housing, and unstable medical or mental illness.…”

Section: Introductionmentioning

confidence: 99%

Unintended consequences of methadone regulation for opioid use disorder treatment among hospitalized patients

Calcaterra,

Dafoe,

Tietbohl

et al. 2024

Journal of Hospital Medicine

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BackgroundIn the United States, there are no federal restrictions on the use of methadone to manage opioid withdrawal symptoms when patients are hospitalized with a medical or surgical condition other than addiction. In contrast, in an outpatient setting, methadone for opioid use disorder (OUD) is highly regulated by federal and state governments and can only be dispensed from an opioid treatment program (OTP). Discrepancies in regulatory requirements across these settings may lead to barriers in care for patients with OUD.ObjectiveIdentify how methadone regulation impacts the care of patients with OUD during hospitalization, care transitions, and in the OTP setting.MethodsWe completed 26 interviews with clinicians and social workers working on hospital‐based addiction consultation services across the United States. Study findings are the result of a secondary content analysis of interviews to identifying the word “methadone” and construct themes resulting from the data.ResultsWe identified three major themes related to “methadone” for OUD treatment, all of which impacted patient care: (1) limited OTP hours leads to tenuous or delayed hospital discharges; (2) inadequate information‐sharing between hospitals and OTPs leads to delays in care; and (3) methadone regulations create treatment barriers for the most vulnerable patients.ConclusionStrict methadone regulations have resulted in unintended consequences for patients with OUD in the hospital setting, during care transitions, and in the OTP setting. Recent and ongoing federal efforts to reform methadone provision may improve some of the reported challenges, but significant hurdles remain in providing safe, equitable care to hospitalized patients with OUD.

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