Association of Early Opioid Withdrawal Treatment Strategy and Patient-Directed Discharge Among Hospitalized Patients with Opioid Use Disorder

Alrawashdeh, Mohammad; Rhee, Chanu; Larochelle, Marc R.; Poland, Russell E.; Guy, Jeffrey S.; Kimmel, Simeon D

doi:10.1007/s11606-023-08059-w

Cited by 7 publications

(13 citation statements)

References 99 publications

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“…Hospitalists also avoid methadone due to lack of addiction training and stigma toward patients with addiction 2,3 . These reasons for avoiding methadone compound and result in hospitalists ignoring addiction, viewing it as outside the scope of hospital medicine, or leaving it to specialists to address resulting in low overall rates of treatment during hospitalization 3–7 …”

Section: Why Hospitalists Avoid Offering Methadone For Opioid Withdrawalmentioning

confidence: 99%

“…Methadone is a life‐saving medication that reduces overdose and all‐cause mortality 9,10 . It is associated with decreased acute care utilization and, by treating opioid withdrawal, a lower risk of self‐discharges 7,10 . Methadone should be offered for withdrawal management regardless of a patient's desire or ability to continue it after hospitalization 11 .…”

Section: Why Hospitalists Should Offer Methadone For Opioid Withdrawalmentioning

confidence: 99%

“…2,3 These reasons for avoiding methadone compound and result in hospitalists ignoring addiction, viewing it as outside the scope of hospital medicine, or leaving it to specialists to address resulting in low overall rates of treatment during hospitalization. [3][4][5][6][7]…”

Section: Why Hospitalists Avoid Offering Methadone For Opioid Withdrawalmentioning

confidence: 99%

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Things We Do for No Reason™: Avoiding methadone for opioid withdrawal

Martin

Englander

Calcaterra

2023

Journal of Hospital Medicine

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Section: Why Hospitalists Avoid Offering Methadone For Opioid Withdrawalmentioning

confidence: 99%

Section: Why Hospitalists Should Offer Methadone For Opioid Withdrawalmentioning

confidence: 99%

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Things We Do for No Reason™: Avoiding methadone for opioid withdrawal

Martin

Englander

Calcaterra

2023

Journal of Hospital Medicine

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“…Patient-directed discharge (’against-medical-advice’) is an under-emphasized indicator of quality hospital care that is patient-centered and especially relevant to patients with SUDs (prevalence 6–30%) [49,50 ▪ ]. In a nationally representative sample of hospitalizations, the top two conditions associated with patient-directed discharges in 2002–2011 were alcohol- and substance-related disorders − combined, these two diagnostic categories heavily overshadowed all other conditions associated with patient-directed discharge [51].…”

Section: Call To Action: Sud Treatment Begins In the Icumentioning

confidence: 99%

Critical care for patients with substance use disorders

Steel,

Bhatraju,

Hills-Dunlap

2023

Current Opinion in Critical Care

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Purpose of review To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences. Recent findings Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant. Available data demonstrate SUDs are major risk factors for the development and severity of critical illness and are associated with poor outcomes. ICU patients with SUDs experience mutually reinforcing effects of substance withdrawal and pain, which amplify risks and consequences of delirium, and complicate management of comorbid conditions. Hospital-based addiction treatment can dramatically improve the health outcomes of hospitalized patients with SUDs and should begin in the ICU. Summary SUDs have a significant impact on critical illness and post-ICU outcomes. High-quality cohort and treatment studies designed specifically for ICU patients with SUDs are needed to define best practices and improve health outcomes in this vulnerable population.

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“…Patients who use drugs cite untreated withdrawal and pain as primary reasons for BMA discharge . Methadone and buprenorphine treat opioid withdrawal, reduce BMA discharges, and are effective for OUD but are rarely started during hospitalization . Fentanyl, a potent opioid, has spread in unregulated drug supplies since 2014.…”

mentioning

confidence: 99%