Expanding Treatment Opportunities for Hospitalized Patients with Opioid Use Disorders

Abstract

The prevalence of opioid use disorders (OUDs) is rising across the United States. Patients with OUDs are often hospitalized for medical conditions other than addiction, such as infection, injury, or pregnancy. These hospital admissions provide an opportunity for healthcare providers to initiate opioid agonist therapy with methadone or buprenorphine. Randomized trials have demonstrated the superior effectiveness of this treatment strategy, but its adoption by hospital providers has been slow. A number of barriers have impeded its implementation, including misperceptions about the regulation of opioid prescribing, limited resources for the transition to community- based treatment, and a lack of familiarity among clinicians about the appropriate initiation and dose adjustment of these opioid agonists for maintenance therapy. We discuss changes in policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.

Managing Opioid Withdrawal in the Emergency Department With Buprenorphine

“…However, admitted patients with opioid use disorder may receive buprenorphine or methadone indefinitely to permit the ongoing treatment of a concomitant medical issue. 38 Buprenorphine diversion may occur, but its abuse potential and risk profile remain substantially better than that of full-agonist opioids. State prescription drug monitoring programs typically collect buprenorphine dispensing data and specifically omit data on opioid treatment program dispensing of methadone (by law).…”

Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis

“…Though there are decades of evidence showing the effectiveness of medication for opioid (11) and alcohol use disorders (12), most hospitals lack expertise and systems to treat SUD and do not effectively connect people to treatment after discharge (13). Barriers include lack of addiction medicine expertise, regulatory concerns, stigma, and silos between hospital and community SUD treatment settings (8,14).…”

A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder

“…For opioid use disorder, hospitalists should treat withdrawal and offer treatment initiation with opioid agonist therapy (ie, methadone, buprenorphine), which reduces mortality by over half. Commonly, hospitalized patients are subjected to harmful, nonevidence-based treatments, such as mandated rapid methadone tapers, 25 which Abbreviations: AUD, alcohol use disorder; ECHO, extensions for community healthcare outcomes; IMPACT: inpatient addiction medicine consult service; OUD, opioid use disorder; SUD, substance use disorder; UCSF, University of California, San Francisco.…”