Hospital addiction consultation service boosts treatment initiation for opioid use disorder

Download PDF Copy

Reviewed

RAND CorporationApr 7 2025

Specialized hospital services that aid people with opioid use disorder regardless of why they are admitted can boost the number of patients who begin treatment with FDA-approved medication for opioid use disorder and increase the likelihood they remain engaged in that care once discharged, according to a new study.

Reporting results from the first parallel assignment randomized clinical trial of a hospital-based addiction consultation service for people with opioid use disorder, researchers found that people who received treatment from a specialized addiction consultation service were about twice as likely to begin medication treatment for opioid use disorder as patients who received the normal course of care.

In addition, those who received care from the special program were significantly more likely to link to care for opioid use disorder once they were discharged.

Researchers say the study contributes to growing evidence that an inpatient addiction consultation service can have a positive effect on treatment initiation and linkage to post-discharge care. The findings are published in the journal JAMA Internal Medicine.

This work clearly demonstrates there is value in having specialized hospital staff that aid patients who show evidence of an opioid use disorder, even if they are admitted for other medical problems. Patients can begin treatment for their addiction at the same time their other illnesses are being addressed."

Allison Ober, study's lead author and senior policy researcher at RAND

The U.S. overdose epidemic continues to be an urgent public health crisis, with 79,358 opioid overdose deaths in 2023. Despite the availability of effective medications for opioid use disorder, few hospitalized individuals initiate treatment while hospitalized or are linked to post-discharge services.

"Hospital admissions offer a crucial opportunity to engage patients in evidence-based treatments for opioid use disorder," said Dr. Itai Danovitch, co-lead of the study and chair of psychiatry at Cedars Sinai in Los Angeles, one of three hospitals that conducted the study. "Patients may be more receptive to care during hospitalization, particularly when their admission relates to medical consequences of opioid misuse."

The opportunity is particularly important for patients who face barriers to accessing medications for opioid use disorder in the health care system and other community access points because of unstable housing, costs and other social determinants of health.

A range of addiction consultation service models have been used by hospitals. The most common roles are a physician to medically manage substance use disorders, and a care manager to deliver brief therapy interventions and coordinate linkage to aftercare.

The project, led by RAND and Cedars Sinai researchers, along with investigators from University of New Mexico (UNM) Hospital and Baystate Medical Center, tested a hospital-based addiction consultation service called the Substance Use Treatment and Recovery Team (START) against usual care in a clinical trial conducted at three academic medical centers.

The START model, which consisted of an addiction medicine specialist and a care manager, provides diagnostic assessments, makes clinical recommendations, establishes discharge plans focused on patients' opioid use disorder, facilitates linkage to treatment after discharge, and provides follow-up telephone calls for one month after discharge. START delivered a specialized intervention aimed at improving patients' motivation to engage in treatment and connecting them directly with care.

The trial was conducted from November 2021 to December 2023 at Cedars Sinai Medical Center in Los Angeles, the University of New Mexico Hospital in Albuquerque, New Mexico, and Baystate Medical Center in Springfield, Massachusetts.

The project identified patients who might be appropriate for the trial by examining electronic medical records and by receiving referrals from patients' doctors. Most of the enrollees were low income and half had been unhoused at some point over the previous year. In addition, about 80% previously had received a medication for opioid use disorder.

The 325 patients enrolled in the clinical trial were randomly assigned to either care from the START, or to receive the usual care, which can be a less-intensive, less-coordinated effort to offer care for opioid use disorder, if the care occurs at all.

The study found that 57% of patients who were in the START group started medication treatment for their opioid use disorder, compared to 27% of those receiving usual care. In addition, 72% of those in the START group linked with treatment following discharge, compared to 40% of those receiving usual care.

Ober said that while the project focused on opioids, researchers believe it may be useful for other types of substance use disorders. They are making plans for a trial of the START protocol for patients with unhealthy alcohol use.

Support for the study was provided by the National Center for Advancing Translational Sciences and National Institute on Drug Abuse, both parts of the National Institutes of Health, under grant award number U01TR002756-01A1. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Other authors of the publication are Mia W. Mazer, Teryl Nuckols, and Waguih William IsHak, all of Cedars Sinai; Cristina Murray-Krezan of the University of Pittsburgh School of Medicine; Kimberly Page, Jess Anderson, and Sergio Huerta of the University of New Mexico Health Sciences Center; Peter D. Friedmann, Stephen Ryzewicz and Randall A. Hoskinson, all of University of Massachusetts Chan Medical School; Karen Chan Osilla of the Stanford School of Medicine; and Katherine E. Watkins, Louis T. Mariano, Richard Garvey and Alexandra Peltz, all of RAND.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.

Source:

RAND Corporation

Journal reference:

Ober, A. J., et al. (2025). Hospital Addiction Consultation Service and Opioid Use Disorder Treatment. JAMA Internal Medicine. doi.org/10.1001/jamainternmed.2024.8586.

Posted in: Medical Condition News | Healthcare News

Comments (3)

Download PDF Copy

Comments

Addictions and addicts are still largely perceived by sober society as

Frank Sterle says:

April 8, 2025 at 5:31 PM

Addictions and addicts are still largely perceived by sober society as being products of weak willpower and/or moral crime. At the same time, pharmaceutical corporations have intentionally pushed their own very addictive and profitable opiate resulting in immense suffering and overdose death numbers — indeed the actual moral crime! — and got off relatively lightly and only through civil litigation.

There are many ‘sober’ people who still believe that addiction often originates from a bout of boredom or simple recklessness, where a person consumed recreationally but became heavily hooked on a substance that eventually destroyed their life and by extension even the lives of loved-ones.

In the book (WHAT HAPPENED TO YOU?: Conversations on Trauma, Resilience and Healing) he co-authored with Oprah Winfrey, Dr. Bruce D. Perry (M.D., Ph.D.) writes in regards to self-medicating trauma, substance abuse and addiction:

“But here’s what’s interesting about drug use: For people who are pretty well-regulated, whose basic needs have been met, who have other healthy forms of reward, taking a drug will have some impact, but the pull to come back and use again and again is not as powerful. It may be a pleasurable feeling, but you’re not necessarily going to become addicted.

“Addiction is complex. But I believe that many people who struggle with drug and alcohol abuse are actually trying to self-medicate due to their developmental histories of adversity and trauma. …”

Decades ago, I, while always sympathetic, looked down on those who had ‘allowed’ themselves to become addicted to hard drugs or alcohol. Yet, I myself have suffered enough unrelenting PTSD symptoms to have known, enjoyed and appreciated the great release upon consuming alcohol or THC.

The unfortunate fact about self-medicating is: the greater the induced euphoria or escape one attains from it, the more one wants to repeat the experience; and the more intolerable one finds their non-self-medicating reality, the more pleasurable that escape will likely be perceived. In other words: the greater one’s mental pain or trauma while not self-medicating, the greater the need for escape from one's reality — all the more addictive the euphoric escape-form will likely be.

0 0

Reply
The unfortunate fact about self-medicating is: the greater the induced

Frank Sterle says:

April 8, 2025 at 5:32 PM

The unfortunate fact about self-medicating is: the greater the induced euphoria or escape one attains from it, the more one wants to repeat the experience; and the more intolerable one finds their non-self-medicating reality, the more pleasurable that escape will likely be perceived. In other words: the greater one’s mental pain or trauma while not self-medicating, the greater the need for escape from one's reality — all the more addictive the euphoric escape-form will likely be.

When substance abuse is due to past formidable mental trauma, the lasting solitarily-suffered turmoil can readily make each day an ordeal unless the traumatized mind is medicated. (Not surprising, many chronically addicted people won’t miss this world if they never wake up.)

Regardless, societally neglecting, rejecting and therefore failing people struggling with crippling addiction should never be an acceptable or preferable political, economic or religious/morality option. They definitely should not be consciously or subconsciously perceived by sober society as somehow being disposable. Too often the worth(lessness) of the substance abuser is measured basically by their ‘productivity’ or lack thereof. They may then begin perceiving themselves as worthless and accordingly live and self-medicate their daily lives more haphazardly.

Meanwhile, most of us self-medicate in some form or another (besides caffeine), albeit it’s more or less ‘under control’. And there are various forms of self-medicating, from the relatively mild to the dangerously extreme, that include non-intoxicant-consumption addictions, like pornography, chronic shopping/buying, gambling, or over-eating.

With food, the vast majority of obese people who considerably over-eat likely do so to mask mental pain or even PTSD symptoms. I utilized that method myself during much of my pre-teen years, and even later in life after ceasing my (ab)use of cannabis or alcohol. I don’t take it lightly, but it’s possible that someday I could instead return to over-eating.

0 0

Reply
Decades ago, I, while always sympathetic, looked down on those who had

Frank Sterle says:

April 8, 2025 at 5:34 PM

Decades ago, I, while always sympathetic, looked down on those who had ‘allowed’ themselves to become heavily addicted to hard drugs or alcohol. Yet, I myself have suffered enough unrelenting PTSD symptoms to have known, enjoyed and appreciated the great release upon consuming alcohol or THC.

Addictions and addicts are still largely perceived by sober society as being products of weak willpower and/or moral crime. At the same time, pharmaceutical corporations have intentionally pushed their own very addictive and profitable opiate resulting in immense suffering and overdose death numbers — indeed the actual moral crime! — and got off relatively lightly and only through civil litigation.

The unfortunate fact about self-medicating is: the greater the induced euphoria or escape one attains from it, the more one wants to repeat the experience; and the more intolerable one finds their non-self-medicating reality, the more pleasurable that escape will likely be perceived. In other words: the greater one’s mental pain or trauma while not self-medicating, the greater the need for escape from one's reality — all the more addictive the euphoric escape-form will likely be.

When substance abuse is due to past formidable mental trauma, the lasting solitarily-suffered turmoil can readily make each day an ordeal unless the traumatized mind is medicated. (Not surprising, many chronically addicted people won’t miss this world if they never wake up.)

Societally neglecting, rejecting and therefore failing people struggling with crippling addiction should never be an acceptable or preferable political, economic or religious/morality option. They definitely should not be consciously or subconsciously perceived by sober society as somehow being disposable. Too often the worth(lessness) of the substance abuser is measured basically by their ‘productivity’ or lack thereof. They may then begin perceiving themselves as worthless and accordingly live and self-medicate their daily lives more haphazardly.

Meanwhile, most of us self-medicate in some form or another (besides caffeine), albeit it’s more or less ‘under control’. And there are various forms of self-medicating, from the relatively mild to the dangerously extreme, that include non-intoxicant-consumption addictions, like pornography, chronic shopping/buying, gambling, or over-eating.

With food, the vast majority of obese people who considerably over-eat likely do so to mask mental pain or even PTSD symptoms. I utilized that method myself during much of my pre-teen years, and even later in life after ceasing my (ab)use of cannabis or alcohol. I don’t take it lightly, but it’s possible that someday I could instead return to over-eating.

0 0

Reply