Inpatient Addiction Medicine Consult Service: Harnessing the Reachable Moment

Substance use disorders are common among hospitalized patients. The feasibility of initiating addiction treatment in the hospital and directly linking to outpatient treatment has been established, but barriers exist to operationalizing this practice. Inpatient Addiction Medicine consult services may facilitate linking patients to care. This study describes the initial experience of the Addiction Consult Service (ACS) at Boston Medical Center, which began providing services in 2015.

  • In the first 26 weeks of the service, 367 consults were placed to the ACS, with 337 consults completed on 319 unique patients. A mean of 2.8 consults were requested for each weekday that the service was available.
  • Of the 337 completed consults: 78% of patients had opioid use disorder (OUD), 37% alcohol use disorder (AUD), 28% cocaine use disorder, 9% benzodiazepine use disorder, 3% cannabinoid (including synthetic) use disorder, and <1% methamphetamine use disorder.
  • Methadone was initiated in 70 inpatients and buprenorphine in 40 inpatients. Naltrexone was recommended 45 times (for OUD, AUD, or both).
  • Of the patients initiated on methadone, 76% linked to an opioid treatment program, with 54%, 39%, and 29% retained at 30, 90, and 180 days, respectively. For buprenorphine initiates, 49% linked to ongoing buprenorphine, with 39%, 27%, and 18% retained at 30, 90, and 180 days, respectively. For naltrexone, 26% linked to ongoing naltrexone, all with AUD alone.

Comments: In this single-site descriptive study, implementation of an inpatient Addiction Consult Service was feasible and effective at linking patients to outpatient treatment. This was especially true for patients with OUD who were initiated on methadone. Additional strategies are needed to address outpatient addiction treatment retention among this population.

Jeanette M. Tetrault, MD

Reference: Trowbridge P, Weinstein ZM, Kerensky T, et al. Addiction consultation services – linking hospitalized patients to outpatient addiction treatment. J Subst Abuse Treat. 2017;79:1–5.

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