A hospital-wide initiative to redesign substance use disorder care: Impact on pharmacotherapy initiation

Abstract

Background: Substance use disorder (SUD) treatment in general medical settings remains underutilized. We evaluated 5 years of a hospital-wide SUD initiative which included an inpatient addiction consult team (ACT), low-threshold Bridge Clinic, recovery coaches, and office-based addiction treatment (OBAT) nurses. Methods: Naturalistic registry study. We calculated frequencies of patient contacts, types of substance use diagnoses, and medication treatment initiation and duration. Results: From 2014 to 2019, 7,036 unique patients were seen, including 4,959 by ACT, 1,197 in Bridge Clinic, 2,250 by a recovery coach, and 979 by an OBAT nurse. The median age was 47, 31% were women, 80% were white, 7% were black, 6% were Hispanic/Latinx, and 25% were experiencing homelessness. Alcohol use disorder was seen in 62%, opioid use disorder in 54%, cocaine use disorder in 29%, benzodiazepine use disorder in 14%, and stimulant use disorder in 7%. Co-occurring medical and psychiatric illnesses were common; 35% had hepatitis C, 59% depression, 66% anxiety, and 13% schizophrenia. 1,623 patients received a prescription for buprenorphine during the study period (42% of patients with OUD), 877 for oral naltrexone, and 163 for extended-release naltrexone. The mean length of continuous treatment was 178.4 days for buprenorphine, 47.7 days for oral naltrexone, and 1.29 injections for extended-release naltrexone. Conclusion: A hospital SUD initiative effectively initiated SUD pharmacotherapy with naltrexone and buprenorphine. Medication treatment episodes were longer with buprenorphine.

Keywords:

• Addiction consult
• Bridge Clinic
• recovery coach
• medications for opioid use disorder
• substance use disorder
• office-based addiction treatment
• buprenorphine
• naltrexone

Author contributions

SW contributed to the program design and implementation, research conception and design, interpretation of the results, writing, and revision of the manuscript. SR contributed to the research conception and design, collection of data, analysis, writing and revision of the manuscript. SH contributed to the collection of data, analysis, writing and revision of the manuscript. MK, EP, CS, LK, JR and JQ contributed to the program design and implementation, writing and revision of the manuscript.

Disclosure statement

Dr. Wakeman received salary support from Optum Labs during the study period.

Additional information

Funding

The work represented in the manuscript was funded by Massachusetts General Hospital. In addition, Dr. Wakeman received research support from the National Institutes of Health [1R01DA044526-01A1], the National Institute on Drug Abuse [3UG1DA015831-17S2], the Substance Abuse and Mental Health Services Administration [1H79TI081442-01], the Laura and John Arnold Foundation, and received salary support from OptumLabs as a co-investigator on a research project during the study period.