Since the emergence of the opioid epidemic in the United States at the beginning of the 21st century, more than 400,000 Americans have died as the result of an opioid overdose. As of 2018, the Substance Abuse and Mental Health Services Administration estimates that more two million people have an opioid use disorder. With the rate of opioid-related inpatient stays and the number of opioid-related emergency department visits continuing to rise dramatically in the US, it is crucial to learn from hospitals that have developed successful approaches to this work. The following is an excerpt adapted from Effective Strategies for Hospitals Responding to the Opioid Crisis, a resource produced by the Institute for Healthcare Improvement and the Boston Medical Center Grayken Center for Addiction to offer system-level strategies to address the challenges of preventing, identifying, and treating opioid use disorder.
Every day, hospitals experience the effects of opioid and substance use disorders. According to the Agency for Healthcare Research and Quality, in 2016 the rate of opioid-related inpatient stays in US hospitals rose to about 300 per 100,000 population — almost double the rate in 2008. At the same time, the number of opioid-related emergency department visits more than doubled from 2008 to 2017.
In response to the growing volume of inpatient admissions and outpatient visits for individuals with a substance use disorder, hospitals are the primary point of care for many patients in need of comprehensive substance use care. Fortunately, hospitals also have the opportunity to make a major impact in reducing morbidity and mortality related to opioid use, from prevention to screening, to treatment, to engaging with communities to reduce harms. They are also in a position to confront racial and ethnic disparities in care, which is particularly important as the opioid crisis evolves and opioid use patterns and demographics shift.
Effective Strategies for Hospitals Responding to the Opioid Crisis provides hospital and health system administrators and leaders with specific improvement ideas for five system-level strategies that address the challenges of preventing, identifying, and treating opioid use disorder.
- Identify and Treat Individuals with Opioid Use Disorder at Key Clinical Touchpoints
- Modify Opioid Prescribing Practices to Minimize Harm and Maximize Benefit
- Train Stakeholders on the Risks of Opioid Use Disorder and How to Reduce Stigma
- Identify and Screen Individuals at High Risk of Developing Opioid Use Disorder
- Reduce the Harms of Substance Use Disorder
The following case examples exemplify identifying and treating individuals with opioid use disorder in inpatient settings:
Johns Hopkins Bayview Medical Center Inpatient Addiction Consult Service
With fellows, faculty, and peer support available, the service provides consultation for inpatients identified as having alcohol, tobacco, or other substance use disorder. The service, available in all areas of the hospital (including the medical, trauma, and surgical units), provides brief behavioral interventions and counseling, guidance on clinical management, brief buprenorphine/naloxone bridges, education, and facilitates linkages. An early study found that the Consult Service made patients less likely to have more than three ED episodes and more likely to have more than one ambulatory care visit.
Boston Medical Center
Established an addiction consult service to engage patients in addiction care during acute hospitalizations. A review of relevant care needs concludes that addiction consult services have the potential to decrease readmissions and utilization costs for medical systems, improve substance use outcomes for patients, and increase provider knowledge.
Massachusetts General Hospital Substance Use Disorders Initiative
Created a multidisciplinary addiction consult team, including peers in recovery, to provide comprehensive evaluation, treatment recommendations, and connections to community resources. Validated substance use disorders screening tools are now part of the hospital’s standardized initial admission assessment.
Oregon Health Sciences University Improving Addiction Care Team (IMPACT)
Created a team-based inpatient addiction consult to assess patient needs and initiate MOUD where needed, as well as developed rapid-access pathways to community services.
To get many more improvement ideas, case examples, and supporting source literature and resources, download the Effective Strategies for Hospitals Responding to the Opioid Crisis.