Hospital addiction consultation service boosts treatment initiation for opioid use disorder

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.

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