New Strategy Brings Substance Abuse Treatment Into the Hospital

A Cedars-Sinai program attaches a substance abuse treatment doctor and social worker to the patient’s care team, improving treatment adherence and creating a better link to post-discharge treatment.

Cedars-Sinai is championing a new care management strategy aimed at linking patients dealing with substance abuse issues to medication-based treatment services after they’ve left the hospital.

The Los Angeles health system’s Substance Use Treatment and Recovery Team (START) pairs an addiction medicine specialist with a social worker or case manager to coordinate post-discharge care plans, including diagnostic assessments, information on treatments, psychosocial support and follow-up phone calls for one month.

The program builds on care transformation strategies that health systems and hospitals are exploring in an effort to redesign inpatient care and boost clinical outcomes. The idea is to create a personalized care team around the patient that includes clinicians and specialists and which can be expanded to include others such as pharmacists and social workers.

“Our program addresses a major challenge across hospitals,” Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, said in a press release. “Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge.”

According to a study authored by Danovitch and recently published in JAMA Internal Medicine, patients introduced to START were more than twice as likely to accept medication-based treatment during their hospital stay than those receiving the usual care, and they were almost twice as likely to embrace treatment after discharge.

Those numbers are important as health systems and hospitals try to battle the ongoing substance abuse epidemic, an integral part of the surge in mental health cases and a contributor to crowded Eds and declining public health outcomes.

The study, led by Cedars-Sinai, analyzed 325 patients hospitalized at three hospitals—one in Los Angeles, one in Albuquerque, New Mexico and one in Springfield, Massachusetts—between November 2021 and September 2023, with a final follow-up in December 2023.

Of that group, 164 patients received START care and 161 received traditional care. More than 57%, or 94, of the START patients initiated medication-based treatment (naltrexone, buprenorphine or methadone) during their hospital stay, compared to almost 27%, or 43 of the traditional care patients, and 72%, or 90, of the START patients continued care after discharge compared to 48%, or 50, of the traditional care patients.

“Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use,” Jeffrey A. Golden, MD, director of the Burns and Allen Research Institute and executive vice dean for Research and Education at Cedars-Sinai, said in the press release. “These important findings show how the medical community can significantly boost this engagement and help find solutions for the national opioid epidemic.”