There are several examples of institutions that are laying the groundwork for this important work. The University of California, San Francisco; Oregon Health and Science University, Portland; the University of Colorado at Denver, Aurora; Rush Medical College, Boston; Boston Medical Center; the Icahn School of Medicine at Mount Sinai, New York; and the University of Texas at Austin – to name a few. Offering OUD treatment in the hospital setting must be our new and only acceptable standard of care.
What is next? We can start by screening patients for OUD at the time of admission. This can be accomplished by asking two questions: Does the patient misuse prescription or nonprescription opioids? And if so, does the patient become sick if they abruptly stop? If the patient says yes to both, steps should be taken to provide direct and purposeful care related to OUD. Hospitalists should become familiar with buprenorphine therapy and work to reduce stigma by using people-first language with patients, staff, and in medical documentation.
As a society, we should balance our past focus on optimizing opioid prescribing with current efforts to bolster treatment. To that end, a group of SHM members applied to establish a Substance Use Disorder Special Interest Group, which was recently approved by the SHM board of directors. Details on its rollout will be announced shortly. The intention is that this group will serve as a resource to SHM membership and leadership
As practitioners of hospital medicine, we may not have anticipated playing a direct role in treating patients’ underlying addiction. By empowering hospitalists and wisely using medical hospitalization as a time to treat OUD, we can all have an incredible impact on our patients. Let’s get to work.
Mr. Bottner is a hospitalist at Dell Seton Medical Center, Austin, Texas, and clinical assistant professor at the University of Texas at Austin.
1. Katz J. You draw it: Just how bad is the drug overdose epidemic? New York Times. https://www.nytimes.com/interactive/2017/04/14/upshot/drug-overdose-epidemic-you-draw-it.html. Published Oct 26, 2017.
2. National Institute on Drug Abuse. Ohio – Opioid summaries by state. 2018. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/ohio_2018.pdf.
3. Peterson C et al. U.S. hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011-2015. J Subst Abuse Treat. 2018;92:35-39. doi: 10.1016/j.jsat.2018.06.008.
4. Guy GP. Vital Signs: Changes in opioid prescribing in the United States, 2006-2015. Morb Mortal Wkly Rep. 2017;66. doi: 10.15585/mmwr.mm6626a4.
5. Chen Q et al. Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2018.7621.
6. Liebschutz J et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: A randomized clinical trial. JAMA Intern Med. 2014;174(8):1369-76.
7. Moreno JL et al. Predictors for 30-day and 90-day hospital readmission among patients with opioid use disorder. J Addict Med. 2019. doi: 10.1097/ADM.0000000000000499.
8. Larochelle MR et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Ann Intern Med. June 2018. doi: 10.7326/M17-3107.
9. Raleigh MF. Buprenorphine maintenance vs. placebo for opioid dependence. Am Fam Physician. 2017;95(5). https://www.aafp.org/afp/2017/0301/od1.html. Accessed May 12, 2019.
10. Ti L et al. Leaving the hospital against medical advice among people who use illicit drugs: A systematic review. Am J Public Health. 2015;105(12):2587. doi: 10.2105/AJPH.2015.302885a.
11. Springer SAM et al. Integrating treatment at the intersection of opioid use disorder and infectious disease epidemics in medical settings: A call for action after a National Academies of Sciences, Engineering, and Medicine workshop. Ann Intern Med. 2018;169(5):335-6. doi: 10.7326/M18-1203.