The Substance Treatment and Recovery Team (START): Measuring the effectiveness and feasibility of an inpatient addiction consult service at an academic general hospital

Background: Addiction Consult Services (ACS) have become an emergent clinical intervention for persons with substance use disorders (SUD) requiring hospital-based care. However, there have been few recent evaluations of the evidence for the effectiveness of ACS on SUD outcomes.Objective: We aimed to assess the effectiveness of ACS for persons with SUD on a range of SUD-related outcomes.Methods: We systematically reviewed peer-reviewed scientific literature measuring ACS outcomes. We searched 5 electronic sources (PubMed, MEDLINE, CINAHL, Cochrane, and EMBASE) from database inception through April 2021 and hand-searched article bibliographies for additional records. In addition, we considered any interventional or observational study design presenting original data and appraised study quality with the Joanna Briggs Institute checklist. Assessed outcomes included pharmacotherapy initiation in-hospital and postdischarge, retention in addiction treatment, length of hospital stay, 30-day readmissions, deaths, and patientdirected discharges. Finally, we conducted a narrative synthesis due to study design and outcome measurement heterogeneity.Results: From the initial pool of 1057 records, 26 studies (n = 12,823 participants; 60% male; mean age: 41 y) met review inclusion criteria. Most ACS provided pharmacotherapy, usually medications for opioid use disorder; add-on services varied, with some also providing psychotherapy (69%), discharge planning services (23%), and infectious disease consultation and treatment (19%). Overall, 7 studies (27%) observed positive impacts of ACS compared with control interventions on postdischarge engagement in addiction treatment and reduced addiction severity. Four studies (15%) reported no significant impacts of ACS versus control interventions on postdischarge care utilization or injection drug use frequency. The remaining 15 studies (58%) described the uptake of ACS-delivered treatments by hospital-based samples of patients with SUD but did not compare against a control condition.

show abstract

“…The included studies were published across >2 decades, spanning 1994 through 2022 (Table 1). 23,27,40–63 …”

Section: Resultsmentioning

confidence: 99%

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Bahji

Brothers

Mauer-Vakil

et al. 2023

Canadian Journal of Addiction

Self Cite

View full text Add to dashboard Cite

show abstract

“…Treatment with OAT is the standard-of-care for opioid use disorder; it is associated with large reductions in risk of death [ 12 ] and may be associated with decreased risk of readmission [ 14 ] among patients with IDU-IE. Accumulating evidence suggests that hospitalization is a “reachable moment” to engage patients in addiction treatment, and that most hospitalized patients with untreated opioid use disorder are interested in initiating OAT [ 25 , 27 , 34 , 35 ]. A randomized controlled trial [ 36 ] and several cohort studies [ 15 , 16 ] show that in-hospital initiation of OAT is associated with improved engagement in treatment after hospital discharge, compared to outpatient referrals.…”

Section: Discussionmentioning

confidence: 99%

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

View full text Add to dashboard Cite

Background Addiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs. Methods Retrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months. Results We identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients’ own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients’ own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice. Conclusions Patients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

show abstract

“…Integrated, multidisciplinary treatment for comorbid addiction and psychiatric disorders is consistently superior to treating individual conditions with separate treatment plans. 11,13 Integrated concurrent disorder treatment programs include distinct stages (engagement, persuasion, active treatment, and relapse prevention), with each having specific goals. There is evidence that concurrent disorder models are beneficial when considering the medical complications of SUDs, such as infective endocarditis in the setting of injection drug use.…”

Section: Commentarymentioning

confidence: 99%

“…Psychiatrists leading these teams are critical to ensure meaningful integration of psychotherapy for concurrent disorders (eg, seeking safety, trauma-focused therapy, and Cognitive and Dialectical Behavioural Therapies) and practical assessment and management of concurrent addiction and psychiatric disorders. Integrated, multidisciplinary treatment for comorbid addiction and psychiatric disorders is consistently superior to treating individual conditions with separate treatment plans 11,13 . Integrated concurrent disorder treatment programs include distinct stages (engagement, persuasion, active treatment, and relapse prevention), with each having specific goals.…”

Section: Commentarymentioning

confidence: 99%

Concurrent Disorders Management in Psychiatric Care: Opportunities and Challenges

Danilewitz

Bahji

Lamba

et al. 2021

Canadian Journal of Addiction

Self Cite

View full text Add to dashboard Cite

Despite increased awareness of the prevalence and burden of substance use disorders, there is limited access to addiction treatment services in Canada, including in psychiatric settings. While substance use disorders are highly comorbid and confer a poorer prognosis on psychiatric illnesses, psychiatric services are often ill-equipped in managing comorbid addictions. While there has slowly been an increase in recognition of this deficit in psychiatric training, there continues to be a deficit in concurrent disorder services in psychiatric care. A potential strategy to address this gap in clinical services is a concurrent disorder consult model. Herein, we outline a model for improved access to addiction treatment in psychiatric care and outline considerations for developing concurrent disorder consult services.

show abstract

The Substance Treatment and Recovery Team (START): Measuring the effectiveness and feasibility of an inpatient addiction consult service at an academic general hospital

Cited by 12 publications

References 10 publications

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Concurrent Disorders Management in Psychiatric Care: Opportunities and Challenges

Contact Info

Product

Resources

About