Health

Treating Addicted Patients During, After Hospitalization Reduces Relapse

Distribution of rates of illicit opioid use during follow-up assessment by intervention in 116 individuals.
Distribution of rates of illicit opioid use during follow-up assessment by intervention in 116 individuals.JAMA Internal Medicine

There are approximately 2 million people in the United States who are currently addicted to opioids, according to the American Society of Addiction Medicine.

A 2013 analysis of hospital billing records found that hospital care for opioid abuse-related events cost an average of $18,891 per visit, and it’s only going up.

This costly, deadly, revolving door is only spinning faster, but hospitals are rarely taking initiative in the discharge process.

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In the emergency department alone, between 2004 and 2011, opioid-related emergency department visits increased 183 percent, according to the Substance Abuse and Mental Health Services Administration, yet interventions for this population have been rarely researched or examined. Until now.

Researchers at Boston Medical Center in collaboration with Butlet Hospital in Rhode Island have published new research examining the effectiveness of various strategies to treat this growing problem. The study, published Monday in JAMA Internal Medicine and funded by National Institute on Drug Abuse, tested the role providers play supporting addicted patients before and after treatment.

The typical approach is to treat opioid withdrawal symptoms that might occur in the hospital with a short-term detoxification substance, but it is uncommon for providers to refer patients to substance abuse treatment programs after discharge in order to continue the detoxification in an outpatient setting.

From 2009 to 2012, researchers examined 139 consenting hospitalized patients with opioid addiction who were not already receiving treatment and randomly divided them into two groups. The patients had all self-reported that they had illegally used opioids in the past 30 days.

Buprenorphine is an orally administered medication that the Food and Drug Administration approved in 2002 to treat opioid addiction because it works to combat withdrawal symptoms.

While both groups of patients received gradual doses of buprenorphine to detoxify, one group of patients received referral information for community treatment programs while the second group received referrals to a buprenorphone treatment program based out of a primary care office. The researchers then followed up wth the patients again after six months.

More than one-third of the “linkage” group who received referrals to primary care reported 0 days of illicit opioid use, compared with less than one-tenth of the detoxification group, showing the effectiveness of not only continuing outpatient treatment, but also the referral to a treatment center. Success rates were measured as days of illicit opioid use per 30-day follow-up, using the data for the entire available group.

The power of the referral is particularly striking because these addicts weren’t initially seeking treatment, and were simply offered the opportunity during a medically-necessary hospitalization.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” said Jane Liebschutz, MD, MPH, a physician in general internal medicine at BMC and associate professor of medicine at Boston University School of Medicine, who served as the study’s corresponding author, in a prepared statement. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

According to the research, hospitalized patients have high rates of substance abuse:

- 36 percent smoke cigarettes.

- 20 percent drink alcohol hazardously.

- 8 percent use illicit drugs.

The researchers outlined three steps hospitals would need to take to incorporate a similar program:

1. Find a systemic method to identify drug users

2. Maintain active, ongoing referral network willing to quickly take new patients.

3. Build substance use consulting team, such as discharge nurses with addiction training, dedicated to initiating detoxification treatment in the hospital and outlining outpatient visits.

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