Regular article
Addiction consultation services – Linking hospitalized patients to outpatient addiction treatment

https://doi.org/10.1016/j.jsat.2017.05.007Get rights and content

Highlights

  • Substance use disorders are common among hospitalized patients.

  • Hospitalization represents a “reachable moment” for substance use intervention.

  • Addiction care, even opioid agonists, can be started during acute medical care.

  • Inpatients started on addiction medications can be transitioned to on-going care.

Abstract

Background

Approximately 15% of hospitalized patients have an active substance use disorder (SUD). Starting treatment for SUD, including medications, during acute hospitalizations can engage patients in addiction care. In July 2015, the Boston Medical Center Addiction Consult Service (ACS), began providing inpatient diagnostic, management, and discharge linkage consultations. We describe this implementation.

Methods

The ACS staff recorded SUDs diagnoses and medication recommendations and tracked follow-up data for affiliated outpatient office-based addiction clinics and methadone maintenance programs. We assessed the number of consults, SUDs diagnoses, medications recommended and initiated, and outpatient addiction clinic follow-up.

Results

Over 26 weeks, the BMC ACS completed 337 consults: 78% had an opioid use disorder (UD), 37% an alcohol UD, 28% a cocaine UD, 9% a benzodiazepine UD, 3% a cannabinoid (including K2) UD, and < 1% a methamphetamine UD. Methadone was initiated in 70 inpatients and buprenorphine in 40 inpatients. Naltrexone was recommended 45 times (for opioid UD, alcohol UD, or both). Of the patients initiated on methadone, 76% linked to methadone clinic, with 54%, 39%, and 29% still retained at 30, 90, and 180 days, respectively. For buprenorphine, 49% linked to clinic, with 39%, 27%, and 18% retained at 30, 90, and 180 days, respectively. For naltrexone, 26% linked to clinic, all with alcohol UD alone.

Conclusions

A new inpatient addiction consultation service diagnosed and treated hospitalized patients with substance use disorders and linked them to outpatient addiction treatment care. Initiating addiction medications, particularly opioid agonists, was feasible in the inpatient setting. Optimal linkage and retention of hospitalized patients to post-discharge addiction care warrants further innovation and program development.

Keywords

Addiction consultation
Inpatient
Opioid agonists treatment
Linkage to care

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