Nearly half a million individuals with opioid use disorders are hospitalized each year in the United States. While they are in the hospital, medical providers often treat complications of this disorder, such as bloodstream infections, but rarely directly address their addiction. That’s like pumping up a flat tire without ever looking for the nail that caused the problem.
Our national failure to treat opioid addiction in the hospital setting is costing lives and wasting valuable resources.
Hospitalization is a “reachable moment” for many people with opioid use disorders — they are in a safe space removed from environments that may promote drug use and, with an acute medical issue, they may be reflecting on the consequences of their addiction and open to solutions to help them enter recovery. We need to do a better job building systems and training health care professionals to adequately treat opioid use disorder in the hospital and to connect patients with ongoing outpatient treatment and support.
At the vast majority of the 6,000 acute care hospitals in the U.S., patients with opioid use disorder are typically offered little more than detoxification. In one large academic hospital, for example, fewer than 10% of patients with heart infections from intravenous drug use were provided access to drug treatment programs.
This approach isn’t effective. About 80% of people who use heroin who are provided only detox in the hospital will return to using the drug within a month of discharge. And up to 30% of hospitalized patients with a substance use disorder discharge themselves early against medical advice before completing critical medical treatment.
Patients who are offered medications to treat opioid use disorder do much better. Buprenorphine, an FDA-approved medication for opioid use disorder, reduces opioid withdrawal symptoms and decreases cravings. When started in the hospital, buprenorphine increases participation in outpatient treatment and reduces hospital readmission for opioid-related reasons. This prevents avoidable deaths and reduces the overall costs of care.
Unfortunately, buprenorphine is rarely used in the hospital setting. Prescribers describe lacking experience or formal education in treating addiction and using recovery-centered language. Many hospital-based clinicians and administrators feel that treating addiction is something that should be left to psychiatrists in the outpatient setting. While ensuring ongoing outpatient treatment is essential, ignoring this problem in the hospital is a missed opportunity to intervene.
Several institutions are working to remove these barriers. The California Bridge program and programs at Rush University, Oregon Health and Science University, University of Colorado Denver, Boston Medical Center, and Icahn School of Medicine at Mount Sinai are proof that treating opioid addiction in the hospital setting is an appropriate, necessary, and lifesaving practice.
Dell Seton Medical Center, where we work, is the only hospital in the state of Texas offering a formal program to treat opioid addiction during inpatient hospitalization. The B-Team, operated jointly by the medical center and Dell Medical School at The University of Texas at Austin, has worked with over 75 patients in less than six months, offering them the opportunity to begin medication-assisted therapy with buprenorphine. This team includes internists, psychiatrists, social workers, pharmacists, nurses, and chaplains.
It works like this: A patient with an existing opioid use disorder who is admitted to an inpatient medical floor for treatment of a medical condition is evaluated by the inpatient care team, which then consults the B-Team for assessment and treatment.
Interdisciplinary collaboration is essential to the team’s success. The social worker arranges appropriate outpatient appointments, the chaplain address the patients’ spiritual needs, and pharmacists secure access to buprenorphine.
The B-Team has helped people like Stephanie McCurry, a 33-year-old Air Force veteran who had been addicted to heroin for about four years. She was admitted to Dell Seton with bacterial pneumonia and endocarditis, a heart and bloodstream infection that often results from intravenous drug use. In addition to being given antibiotics to treat the infections, she was seen by the B-Team and started on buprenorphine therapy. She says it was the only thing that has worked to keep her off heroin. “It just seems like nothing was working for me, as far as treatment, until when I got really sick and ended up at Dell Seton,” she said. “I started seeing a difference in the way I was thinking. It was like I was becoming myself again.”
As the nation continues to define meaningful strategies for dealing with the opioid crisis, we must engage inpatient hospital programs and offer hospitals a seat at the table in the national conversation. Hospitals treat patients with type 1 diabetes by providing them with insulin. Likewise, they should treat people with opioid use disorders with an effective and evidence-based medication.
Starting buprenorphine therapy during hospitalization saves lives and must become the standard of care at every U.S. hospital starting today.
Richard Bottner is a certified physician assistant and Christopher Moriates is a physician at Dell Seton Medical Center, part of the Ascension health system. Both are faculty members at Dell Medical School at The University of Texas at Austin.
Almost 3 years ago a very close my family member almost died from an opioid addiction. They spent 20 minutes trying to revive her at the hospital. She has some short term memory loss today. After 3 years she continues to carry on about her stomach pain, which is what started the opioid addiction. Recently she drove herself to the same hospital that revived her, where she was in a coma for 4-5 days, they gave her opiods for her stomach pain! HOSPITALS are the top contributor to the opiod addiction today. They do not want to take on any responsibility or obviously care to! This opiod crisis starts with the physician, then moves onto the so called pain management program, then onto the hospital, and continues where she went to receive after care treatment, and they sent her home after 2 weeks, saying they have more patients in higher need than her. Still, today, fighting addiction whether she believes she is or not.
First, we need doctors interested in helping people with pain. Not all doctors are interested. Next, we need transitional spaces that have the trained hospital personnel that are interested in recognizing the problems with the hospitals …. https://www.beckershospitalreview.com/opioids/hospitals-blind-spots-are-fueling-the-opioid-crisis-here-are-specific-ways-leaders-can-address-them.html
Also, until we start mandating insurances to cover multi-disciplinary treatments, the hospitals, in general, will continue with their blind spots.
AWESOME piece! You need exposure! I am in Washington, DC! Please reach out!
Buprenorphine is an OPIOID. POINT BLANK. PERIOD. Rebranded. And disguised. SUBoxone. SUBstitution. Lord help ’em. Help ’em all…
Its good to see addicts have something to be treated with but I wish they would be more clear with what the real issues are. What we have in this country is an ‘illegal and illicit drug use epidemic’, not an ‘opioid epidemic’ as far as I am concerned. Pain patients are always being blamed along with addicts for this tragedy when only a very small percentage of them (1-2%) are in any way responsible for it, and many thousands of genuine patients in need of opioids are paying a terrible price with unnecessary pain or death. Is our government ever going to wake up and be honest about the injustice that they keep going?
Over three years and counting…
Thank you for this very timely article. Had a discussion regarding starting the treatment of opioid addiction in the hospital just a couple of weeks ago with an associate. His concerns regarded the economic justification for resources used to provide the treatment if it is not reimbursable…. glad to see it is reducing unexpected readmissions……… Shared your article with my associate. Thanks so much.
I am a Chaplain what role did they play in the recovery of the patient?
Thanks John , all we can do is vote these sorry , ignorant fools OUT of office & get some more fools who’ll probably keep it status quo to keep them in office, WE HAVE TO LET THEM KNOW !!!!
Right! Take care Will, everybody,
Damn will! Thought I had it bad?? Hit by car..drunk driver speeding, hit in nose with speeding baseball,(vietnam vet medic reset nose on ground could not breathe).. bit tongue almost all way off, piece of metal rip into my eyeball, had brains beat with bat..street fights pounded hard in head 100+ times!!..ruptured disks at least 10 times..bone cutting into nerves! Horrendous..you know!! Then to have some fools like this kolodny guy or former ag sessions say to take some aspirin and shit?? Unreal, fools!! This is kinda stuff those idiots need to hear folks, like Will here…I KNOW ALOT OF PEOPLE EVEN HAVE IT WORSE THAN US!! None of you poor suffering people should be treated like SHIT from this damned government!!
I’m NOT addicted to Oxymorphone ( I think dependent is a better word ) , but I am addicted to NOT BEING IN DEBELITATING PAIN !!! As I have previously stated , all of the surgeries & car wrecks ,motocross life & wrecks & wins , fights , uncountable falls cuts , facial reconstruction ( from totaling my sister’s car hitting a pine tree with a lap belt on & being whipped into the steering wheel & nearly bleeding out ), punches thrown at brick walls & people’s face & bodies & being punched in numerous fights , jumping off houses , having my head pushed through a wall while being held by my two much bigger friends horizontally, being zipped up in a mummy sleeping bag while my older cousins & older brother took running shots at me ( I’d say 7 or 8 ) till I started to cry, jamming my left knee into 4&1/2 feet of water running full speed off a pier trying to catch a football ( right leg bent but the left took the full force ) & the pain was so intense that I screamed underwater & nearly drowned because the idiot 20 somethings I was playing with were oblivious to my plight & all the other stupid & fun stuff I did when I was 13 till I started having surgeries to repair some of the damage & still have a minimum of 3 left to go , my right ankle , left knee & my neck , & my brother think I actually ENJOY this shit !!! He has NEVER been under the knife & I wish I didn’t have to , but facts are facts , just like the fact that the bi-lateral steroid injections ( which are now 3 weeks overdue ) & the 40mgER of Oxymorphone keep me going , & NOT completely out of pain but manageable , & the way they have cut my meds is akin to taking someone who is bi-polar off there meds or cutting them in half , it’s LUNACY !!!! I’ve tried herbal supplements that didn’t work ( the wild lettuce ) & the CBD oil is SNAKEOIL to me anyway just like all of the anti-inflamatories (sp) are , except Vioxx , but of course they took that off the market . I’m starting to head down the hole that Seth was digging awhile back & I truly don’t see a way out unless I get back to where I was , & that’s NOT GOING TO HAPPEN !!!! Again , there are thousands of people who are WAY worse off than I am & I’m aware of that & my heart goes out to them , but not the STUPID people who OD’d on this just because they wanted to get high & that includes my cousin who I loved like a brother , you could write a funny as hell book or screenplay about his life & tragic death , & I guarantee it would be a hit , but that does nothing to extricate me from the totally worthless person I will become the first of next month when they cut me down to 100mg or 90mg of this stuff as I’m only worthwhile about eight hours a day that the Percocet works & that will be gone & then some next month , & that just might be the final straw , I just can’t imagine not being able to get out of bed because of the shear pain , I just can’t wrap my head around it.
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