New hospital program helps opioid patients stay in treatment after discharge

Offering hospitalized patients who are struggling with opioid use disorder a medication to treat their addiction makes it more likely that they will continue with follow-up care after they are discharged, a new study finds.

The intervention, described in a paper published this week in JAMA Internal Medicine, also directly pairs patients with treatment programs after they leave the hospital, said co-author Kimberly Page, PhD, MPH, a professor of Internal Medicine in The University of New Mexico School of Medicine.

We know that we're doing the right thing for the patients. It reduces the length of their hospital stay and they get connected to treatment. I'd like to think that this is the kind of program that contributes to the decline of overdose death mortality in New Mexico."

Kimberly Page, PhD, MPH, Professor of Internal Medicine, The University of New Mexico School of Medicine

UNM Hospital was one of three medical centers where the Substance Use Treatment and Recovery Team (START) approach was tested between November 2021 and September 2023. Researchers randomized 325 participants to receive the START intervention or treatment as usual. UNMH accounted for 190 of the study participants, Page said.

The patients receiving the START intervention were more than twice as likely as usual care patients to initiate medication for opioid use disorder in the hospital and were 50 percent more likely to continue with treatment following discharge, the study found.

During the START trial, study co-author Sergio Huerta, MD, a UNM addiction medicine specialist and associate professor of Internal Medicine, teamed up with a case manager to engage with patients admitted to UNMH for a variety of ailments. They were offered medications to treat opioid addictions, including buprenorphine and methadone, which attenuate withdrawal symptoms, he said.

"Patients usually feel immediately relieved upon getting those medications," he said. "They may not ever have had exposure to those medications out in the community, so we call it a reachable moment. Oftentimes they're so acutely ill, and sometimes the substance use disorder is the underlying mechanism for them to be ill."

In the START study, the case manager connected the patients with local programs where they could continue receiving treatment once they left the hospital, Huerta said. "We were developing relationships with community partners even outside of the university, which I think was really unique about this project as well."

The hospital's participation in the START trial led to the creation of a new addiction treatment consult service at UNMH called CAMINOS – Spanish for "Pathways," Huerta said. The acronym stands for Coordinating Addiction Medicine with Inpatient and Outpatient Services.

"We're here to start people on treatment and make sure they continue that treatment when they leave," he said. "It's really been an awesome opportunity to more and more people. As our service continues to grow, we look forward to expanding our services next year."

The CAMINOS program also provides an opportunity to disseminate knowledge about how to treat substance use disorder to other providers, Huerta said.

"We weren't really taught that much about substance use disorder in medical school," he said. "This is kind of a relatively new thing, and I think physicians and providers alike want to provide the best care they can. If they can't, sometimes they just won't approach something, right? That's part of what CAMINOS says: We know what those things are, we're here to help you. A lot of the providers are just so appreciative of that."

The CAMINOS team has been educating other providers in treating substance use disorders, Huerta said.

"My big vision would be that other teams are starting patients on these medications, even without consulting us so it just becomes the standard of care," he said. "The ideal state in the future is that it's just so commonplace. That's what we're working towards, but until then, we're here to lead that charge."