Addiction patients who meet with an intervention team in the hospital are twice as likely to participate in treatment for substance use disorder after they are discharged, according to a new study published in the Journal of General Internal Medicine.
“This confirms that hospitalization is a reachable moment,” said lead author Honora Englander, M.D., an associate professor of medicine in the Oregon Health & Science University (OHSU) School of Medicine.
“We were able to sizably increase treatment engagement. That matters because treatment is associated with reduced health care costs, reduced mortality and a whole vast array of really important outcomes.”
Most hospitals do not treat substance use disorder (SUD) during hospitalization or connect people to treatment after discharge, and hospitalizations related to addiction are extremely costly. Hospitals may lack the staffing, financial resources, or interest in taking on addiction care.
However, people with substance use disorder often end up hospitalized, sometimes as a result of illness arising from their addiction. Examples include endocarditis caused by injection drug use, liver disease from overuse of alcohol, or various kinds of trauma.
Hospitals are well-equipped to handle the acute medical need, but not the underlying addiction.
“Stigma is a huge driver,” Englander said. “People don’t think of addiction as something that hospitals should be addressing. Our study pushes back at that.”
The study focused on the effectiveness of IMPACT, or Improving Addiction Care Team, an intervention program pioneered by OHSU in 2015. IMPACT brings together physicians, social workers, peer-recovery mentors and community addiction providers to address addiction when patients are admitted to the hospital. Englander is the project director.
The researchers compared 208 patients who received addiction medicine consultation at OHSU with a control group of Medicaid patients with similar conditions hospitalized in any Oregon hospital. The team compared the substance use treatment engagement in the month after they were released from the hospital.
The findings show that 38.9% of IMPACT patients engaged in substance use treatment, compared with 23.3% of similar patients who did not work with IMPACT.
OHSU’s program is one of only a handful in the nation, which remains beset by an opioid epidemic and a rising methamphetamine crisis that claimed more than 70,000 lives in 2017. The new study indicates the program makes a difference in engaging people in treatment.
“Hospital-based addiction medicine care can improve (substance use disorder) treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes,” the authors write.
“National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.”