Improving Care for Hospitalized Patients with Opioid Use Disorder

by Susan Calcaterra, MD, MPH, MS Director, Addiction Medicine Consultation Service | University of Colorado Hospital Associate Professor of Medicine | Divisions of General Internal Medicine and Hospital Medicine University of Colorado, Anschutz Medical Campus

Marlene Martin, MD Director, Addiction Care Team | San Francisco General Hospital Associate Professor of Clinic Medicine University of California, San Francisco

Opioid use disorder (OUD) is diagnosed when a person meets two or more of the 11 criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) over a 12-month period.[1] There is a significant treatment gap for patients with OUD who are hospitalized. Screening hospitalized patients for unhealthy opioid use can help identify those who may benefit from evidence-based OUD treatment.

OUD medications like buprenorphine, methadone, and intramuscular naltrexone are safe and effective for reducing OUD-related morbidity and mortality. Buprenorphine prevents opioid withdrawal symptoms and cravings by binding to opioid receptors. Initiating buprenorphine treatment during hospitalization can facilitate management of other medical issues by relieving withdrawal symptoms.[2] Methadone is a full opioid agonist that can be initiated when patients report opioid cravings or withdrawal in the hospital. Intramuscular naltrexone blocks opioid receptors and may be given to hospitalized patients after confirming no recent opioid use.[3]

Patients with OUD have a high risk of resuming opioid use after hospital discharge. Connecting these patients with continued OUD treatment and providing naloxone upon discharge for overdose reversal is beneficial. Hospital clinicians can access key OUD educational resources like primer documents, discussion guides, patient education, and video modules to improve care for these vulnerable patients.

Access key educational resources for hospital-based clinicians

• Opioid Use Disorder Primer

• Discussion Guide

• Patient Education Resource

• Educational Module for Clinicians

References

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing; 2013.

[2] Calcaterra SL, Lockhart S, Callister C, Hoover K, Binswanger IA. Opioid Use Disorder Treatment Initiation and Continuation: a Qualitative Study of Patients Who Received Addiction Consultation and Hospital-Based Providers. Journal of General Internal Medicine. 2022.

[3] Sudakin D. Naltrexone: Not Just for Opioids Anymore. Journal of Medical Toxicology. 2016;12(1):71-5.