Establishing MOUD services for hospitalized patients

A quick guide to adding or expanding hospital-based addiction treatment and consultation services

Innovative Strategy

  • People with substance use disorders (SUDs) have higher hospitalization rates, more comorbidities, greater insurance costs, and increased use of medical services compared to those without SUDs.1
  • Nearly one-quarter of hospitalized patients have an SUD, and the risk of overdose death is ten times more likely for patients in the first month after hospital discharge.
  • Overextended hospital and acute care providers are ill-equipped to screen for, diagnose, and treat SUDs.
  • A hospital-based addiction consultation service (ACS) is an evidence-based practice that can help overcome these barriers by providing inpatient diagnoses and management of SUDs, and linkage consultations at discharge.
  • ACS may vary considerably in terms of clinical staffing, patient recruitment strategies, and interventions offered.

Potential Benefits to Community

  • Starting medications for the treatment of SUD in acute care settings has been associated with a reduction in substance use, improvement in treatment retention, and a decrease in hospital readmission rates.
  • ACSs can provide clinical staff support, effective role modeling, and education about SUD interventions, which, in turn, may improve preparedness among health care providers in managing SUDs, reducing stigma associated with the condition, and ultimately improving clinical practice.
  • Methadone and buprenorphine treatment manage distressing withdrawal symptoms and can facilitate the effective treatment of acute illnesses, which can be a life-saving clinical decision in the hospital setting.
  • MOUD can serve as a bridge to recovery by encouraging the establishment of a plan for long-term management of opioid use disorder after discharge.

Estimated Time from Planning to Implementation

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4-5 months

Operational Considerations

  • Team will need to be led by a provider-champion with knowledge of OUD treatment and empowered to prescribe MOUD and medications to control withdrawal symptoms.
  • There are a range of existing practice models including consult team composition and strategies for patient identification. Roles to consider:
    • A physician or advanced practice provider to manage pharmacotherapy
    • Nurse for clinical assessment
    • Resource specialist, social workers or other role to help with psychosocial support and community transition
    • Peer or recovery workforce involvement or staffing
    • Universal screening versus referral from treatment team
  • Often involves working with hospital pharmacy, hospital information technology, and other stakeholders to ensure methadone and buprenorphine are available and accessible.
  • Implementation of program could be expedited if aligned internal candidate(s) identified among staff.
    • Consider building on an existing framework or workflow for inpatient consult-liaison services.
    • Establish a network of partner organizations, including methadone and buprenorphine clinics, to receive referred patients, and continuously cultivate these relationships.

Evaluation Metrics

  • Track the following information to help measure success of the program:
    • Number of patients who receive ACS consultation during hospital stay.
    • Number of referrals made to outpatient addiction treatment.
    • Observed insights from clinical staff regarding efficiency of workflow.

Estimated Cost to Implement

  • $120,000-$500,0000

    • Varies considerably based on staffing model and existing infrastructure.
    • Staff should be able to bill for services.

Available Training and Technical Assistance (TTA)

Footnotes:

1 Englander H, Priest KC, Snyder H, Martin M, Calcaterra S, Gregg J. A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder. Journal of Hospital Medicine. 2020 Mar;15(3):184-187. doi: 10.12788/jhm.3311.

Acknowledgments

We wish to express our thanks to all community partners who have implemented these programs during the HEALing Communities Study. Key insights from these partners were crucial in the development of these resources that will be important tools for programs looking to build on the successes of these strategies to reduce fatal overdoses.