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.

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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.

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  • The reasons chronic pain patients are being demonized is because the government cannot make any real progress addressing the illeagal street drugs that are easily obtainable, and aside from being highly addictable, they are often deadly. People who are addicted to these drugs will do anything to ease their addictions. There are drug dealers on every corner, more than happy to offer heroin and fentanyl, often with deadly consequences. There are always more dealers out there to take the place of anybody actually arrested. There are no big news reports of what happens on the streets. Law enforcers know it is a dangerous situation. The tragedy of it all is since illegal drugs run rampant, often deadly, there will never be a real improvement for genforcement can etting drugs off the streets. Those getting rich selling heroin anf fentanyl know they really do not have to worry. There are more of them catering to addicts, than law enforcement can control. It has become a war against illegal drug marketing, and sadly relief for chronic pain patients. Law abiding people are becoming increasingly demonized, and drug lords love to see this. It means more people in debilitating pain are increasingly forced to find relief from anywhere they can. This, of course, means more addiction, and more death. More and more pain patients are turning to alcohol, and illegal substances, because theyare already labled as addicts by society. More rehabs are opening all the time, and plenty of people are making a lot of money, even though it has been proven that rehabs are often a temporary solution. Chronic, and acute pain should not be ignored, labeling those depending on prescribed medications as addicted, and addicts. The money-makers (rehabs) are making a fortune as more people suffering in retractable pain end up in these centers, and that is where politics come in. Nobody should have to get so desperate they have to turn to ilegal drugs, and also legal drugs like alcohol. Isn’t it ironic that these so-called drug enforcers plot against legal medical treatments, causing the public to be misinformed about who the real victims are, and what they are doing about it. They look like heroes, misinforming the public about what needs to be done to stop ‘opioid abuse. As Andrew Kolodny admitted,this was never meant to hurt pain patients. Unfortunately that is exactly what continues to happen, increasingly every day. We have a right not to suffer in pain. How did politics start enforcing laws depriving pain patients of much needed treatments, based on the false information being reported daily? As usual it is about money. We do not allow animals to suffer in pain, but modern day politics now dictate that a little pain doesn’t hurt anybody. Who are they to base their opinions on things they know nothing about. What goes around, comes around. How will they feel when someone they care about must suffer, in debilitating pain, and are told “Sorry the law dictates what the doctors can do to help”? Then again, these heartless policymakers will probably be able to get around the law, so why should they care. We need to hear from elected officials who will not allow these crimes against humanity continue to happen, and get them to speak out against these moneymakers whose real agendas are to lie to the public, and terrorize people in pain. The publicneeds to read between the lines, and let doctors do their jobs. Just because somebody takes pain medication, does not mean they are not productive members of society. Thoee that are barely able to function, many with conditions that will not improve also need their pain medications. Do not wait until it happens to you, or your loved ones. We need the real heroes ot political positions to stand up and end these crimes against humanity. Do not fall prey to the fast-talking, so called experts to dictate how pain should be addressed. Do not let them break civil right laws, mainly because they have the funds to publicly trick the public into believing pain patients, and doctors are criminals. Billions of people have fought, and died, for our rights. America stands on loyalty, protection, and freedom. This is a very dangerous political game being played against the medical community,to convince us they are working hard to end the opiod epidemic. How much do we hear about their real agenda–The illegal street drugs killing more people than ever. The money spent on rehab facilities should be addressed properly. There are human beings that need help, but let’s not throw innocent pain patients, that are not addicted, but dependent on rx medications to function, and the medical community serving them into one category. Addiction and dependence are two different things. Both deserve empathy, but treating pain patients like criminals is not the answer. I pray it does not happen to you.

    • Hi Dar, yeh, it seems all we can do is pray at times like this. It looks like the consensus on the street amoung young people is growing towards ‘don’t mess with abusing opiates and opioids, they can kill you’. The only way this epidemic is really gonna end is with all the people stopping their abuse and addiction to these medicines, and tragically, the deaths of so many, just scaring the hell out of potential abusers.. And hopefully, leaving these drugs were they properly belong….used by pain sufferers and patients.

  • Well-written post! It is exciting to see a move towards treating patients with addiction as PEOPLE first, not just “addicts.” To supplement the concern that providers “lack formal education in recovery-centered language,” the Institute for Healthcare Improvement Open School launched the Recover Hope Campaign to give providers resources around person-first and recovery-centered language. These resources can be found at:

    http://www.ihi.org/education/IHIOpenSchool/Recover-Hope-Campaign

  • Since when is addiction not a disease? It is, and ought to be treated as such. Medical education should include buprenorphine treatments, and hospitals (if they really care about patient’s well-being and not just act as quick fixer-uppers) ought to have services associated that promote flow of addicted patients to targeted help with stopping their addiction.
    The medical world (and politicians) also need to differentiate : not all opioid users are addicts, and denying opioid-level pain relief is tantamount to torture for some in serious pain. Hospitals and emergency rooms should not regress to lose compassion, it is part of the care and repair of human bodies.

  • You’ve completely overlooked the innocent victims in all of this, chronic pain patients. Currently, many chronic pain patients are not able to get life restoring opioid pain medicine because some people have chosen to abuse opioids. Not to mention the problem is, and has always been, primarily illicit or illicitly obtained opioids, not legitimate pain rx’s written for those with long term pain conditions.

    Unfortunately, in the US, only DATA 2000 doctors, mostly psychiatrists, are pretty much exempt from DEA scrutiny and interference. And these doctors can ONLY prescribe opioids to OPIOID ADDICTS! NOT CHRONIC PAIN PATIENTS! The ONLY way this problem will be solved is by decriminalizing drugs for personal use, regulating, and insuring all people only take pharmaceutical grade medications.

    This isn’t new or ticket science. Portugal decriminalized all drugs in 2001, after an exhaustive study. In 2017 they had only SEVEN overdose deaths. Prior to decriminalizing Portugal had a serious drug problem, now they don’t. However this takes a knowledgeable and progressive govt which the US doesn’t have.

    After WWI soldiers returned from way addicted to heroin. What did they do? They were prescribed a daily dose of prescription heroin and lived their lives normally – holding down jobs and raising families. These days the VA has completely cut off ALL veterans from ANY opioids no matter what their injuries. This has resulted in a spike in suicides, as it has other chronic pain patients.

    Until our govt gets its head out of its collective asses, the problems will continue.

    The leading authority on drugs and addicts… Dr Carl Hart.
    http://www.drcarlhart.com

  • This is about inpatient hospital visits….
    TERRIFYING!
    Not E.R. visits…which, btw, are ALSO a minefield to navigate for pain patients…
    Even hospitals are not safe spaces for chronic pain sufferers.
    This was hospital sanctioned patient abuse.
    It has become the norm, due to narcophobic policies, even for cancer patients!
    My absolutely unnecessary example of opioid-sparing was inflicted post-surgery.
    It was four years ago….just before the CDC Guidelines were released.
    I had a chest tube inserted (as a “prophylactic” procedure), on top of rib-removal, nerve scar debriding, removal of neck muscles, & cervical foraminotomy….It hurt to breathe!….
    My only transgression was that I was under long-term opioid therapy prior to my surgery.
    I had NO IDEA I would be profiled&judged. I then became a de-facto addict in the expert opinion of the surgeon.
    P.S. as a result, my surgery was a total failure because I wasn’t able to endure a single therapy session because of my increased pain which was completely undermanaged.

    • Just for me to think of all the hurt and suffering that drug abusers and addicts have caused for chronic pain patients is maddening. They show no sympathy or remorse AND expect to be treated like poor, innocent victims in this opioid epidemic that they have caused! Makes me livid!

    • Great post Cate – thank you! My own wife had an experience very similar to yours. What happened to her (and you) is absolutely unconscionable!

  • Great job linking to your sources, but I do have a question about one of them: ‘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’. What’s the percentage? How recent are those numbers?
    In the example of the 10% of patients with intravenous drug use and heart infections the data is from 2004 to 2014. Overdose deaths could have moved more hospitals to create substance use disorder teams and overdose deaths didn’t drop kick the door in until around 2010-2013.

  • Every pain-sufferer who is currently receiving pain management medication(“opioids” of any type) should be aware of this plan!
    They will be profiled and diagnosed as having opioid use disorder once their PDMP is reviewed.
    They will be treated as an addict by the entire staff and referred to the special “Pain Management Team” who will refuse them any REAL pain medications!
    I know because it happened to me during a surgery four years ago.
    After an involved surgery (thoracic outlet decompression) I was offered a combination of : Marinol(synthetic THC)/gabapentin/Tylenol/Tizanidine (anti-seizure med). When those failed to do ANYthing for the pain –
    I was offered methadone. The reason they gave was my current use of narcotics for pain relief. They decided this made me an addict.
    Be VERY careful before being admitted to the hospital if you are currently prescribed ANY pain medicine.

  • A person suffering from chronic/acute pain and who is not a “drug addict” ( does not take fentanyl, heroin, cocaine), and is not in a drug-induced coma, cannot get any help from a hospital. Legitimate chronic pain patients have no rights. Their human rights have been taken away. Hospitals, healthcare providers, inpatient and outpatient pharmacists, and the health insurance companies have abandoned these people, as have the FDA, CDC, DEA, federal and state governments. Due to horrific pain, physical and mental, and no longer having access to adequate pain treatment, chronic pain patients, including Veterans, living in the USA are committing suicide daily. Doctors do not understand pain, and hospitals don’t care to find out about pain. Chronic pain patients have been labeled “addicted to”opioids. The unfortunate people who are on illicit drugs do not really get help either. They, along with legitimate chronic pain patients, are victimized. The Veteran population gets no assistance with their physical pain either. Veterans have fought for the lives of people in the USA. Hospitals should be at the forefront of research, development, and education of good medical practices in the treatment of chronic pain patients.

  • Addicts get help. Chronic, intractable pain patients get demonized, get expensive ($1900./per) UA’s, get stabilized meds cut by 50%. Can we FINALLY start calling this a HEROIN/FENTANYL epidemic?

    • I think you hit the nail on the head. I am an empathizer. That being said, welcome to the “demonized” club. Your an Addict. Don’t demonize yourself. Get help. Or wait, that’s what you were trying to do before you were demonized. So you may be forced or feel compelled to “self medicate” , just to endure living. When the most effective treatment is suddenly taken away from an already painful existence. Going from having a scientifically valid “reason” for being on the treatment, to de-legitimized and judged for wanting to live a life. That’s addiction’s perspective from the inside out. And yes BTW, your correct, people have just begun to drop like flies. It’s beyond incredibly sad.

    • Also, why don’t more folks distinguish between pharmaceutical (physician prescribed) fentanyl and COUNTERFEIT pills which are manufactured using mail-order fentanyl and pill presses? These pills are bought off the street, look identical to ACTUAL pharmacy acquired pills and are lethal!
      These pills are what addicts are buying and using.
      It is NOT pharmaceutical-grade opioids/Xanax/barbiturates that are blamed.
      Millions of fentanyl tainted pills have flooded the market and people are DYING!!

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