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5 Strategies to Improve Opioid Use Disorder Care in Hospitals

Analysis  |  By Christopher Cheney  
   November 15, 2019

A new report that presents five approaches to hospital-based opioid use disorder care focuses on organizational best practices.

A new report provides five system-level strategies with specific initiative examples for hospitals to improve prevention, identification, and treatment of opioid use disorder.

Hospitals are on the frontline of the opioid epidemic. In 2016, the rate of opioid-related inpatient stays in hospitals increased to about 300 per 100,000 population—nearly double the 2008 rate, according to the federal Agency for Healthcare Research and Quality. From 2008 to 2017, opioid-related emergency department visits more than doubled, according to AHRQ's Healthcare Cost and Utilization Project.

The new report was released this week by two Boston-based healthcare organizations: the Institute for Healthcare Improvement and the Grayken Center for Addiction at Boston Medical Center. The report says hospitals can play a key role in addressing the opioid epidemic.

"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," the report's coauthors wrote.

The five strategies described in the report are focused mainly on organizational best practices rather than specific forms of clinical care.

1: Identify and Treat Opioid Use Disorder Patients in Key Clinical Settings

  • Identify patients with opioid use disorder in the emergency room and provide urgent treatment and referrals. For example, ER clinicians should be trained to treat acute withdrawal.
     
  • Identify and treat inpatients with opioid use disorder. For example, provide peer services and case management.
     
  • Integrate addiction treatment into primary care and other appropriate care settings. For example, nurse care managers can conduct consistent follow up.
     
  • Boost specialty addiction treatment offerings. For example, build links to specialty addiction treatment programs for targeted groups such as adolescents and young adults.
     
  • Improve clinician training and competency to offer evidence-based comprehensive treatment—medications in combination with behavioral therapy. For example, educate clinicians about substance use disorder treatment throughout their training from medical school to continuing medical education courses.

2. Minimize Harm and Maximize Benefit in Opioid Prescribing

  • Improve prescribing practices for acute and chronic pain patients. For example, opioids are not first-line medications for many acute pain conditions and alternatives should be tried first.
     
  • Improve opioid dispensing. For example, require clinicians to check your state's prescription drug monitoring program before dispensing opioids and to make treatment referrals when appropriate.
     
  • Prevent diversion of opioids from patients to other people for illicit use. For example, create secure drug disposal sites at community facilities such as pharmacies and police stations.
     
  • Increase access to multimodal pain management strategies. For example, improve clinician pain management training.

3. Train Stakeholders About Opioid Use Disorder Risks and Prejudice

  • Educate healthcare professionals, patients, and the public about opioid risks. For example, provide clear information on addiction risk to patients.
     
  • Decrease prejudice about substance use disorders. For example, speak clinically rather than judgmentally with patients.

4. Identify and Screen High-Risk Patients

  • Screen high-risk patients for developing opioid use disorder and educate them about addiction risks. For example, screen patients with a co-occurring substance use disorder or a history of substance use.

5: Reduce Substance Use Disorder Harms

  • Improve access to supportive social services and connections to ongoing, comprehensive treatment. For example, increase access to social services that support recovery such as affordable housing agencies and childcare.
     
  • Develop and promote harm reduction services that boost the safety of patients with addictions. For example, provide syringe exchanges and safe use instructions.

Christopher Cheney is the CMO editor at HealthLeaders.


KEY TAKEAWAYS

The rate of opioid-related inpatient stays nearly doubled from 2008 to 2016.

Key hospital-based settings to identify and treat opioid use disorder include emergency departments and inpatient wards.

Opioids are not first-line medications for many acute pain conditions and alternatives should be tried first.

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