Hospital Addiction Consultations Associated With Increased Receipt of Medications for Opioid and Alcohol Use Disorder and Reduced Hospital Readmission

Substance use disorder (SUD) often causes and complicates hospitalization and is associated with increased readmission rates. Addiction consultation services have the potential to increase medication initiation for SUD and improve outcomes. This observational study at a US academic medical center from 2019 to 2023 evaluated the association between addiction consultation and initiation and continuation of medications for opioid and alcohol use disorder (MOUD/MAUD), and the association between consultation and medication provision with 30-day hospital readmission.

• Of 19,697 SUD admissions (10,453 unique patients), 12,792 had AUD, 7795 had OUD, and 2568 had both. Addiction consultation occurred in 43 percent of admissions.
• Among admissions with OUD and addiction consultation, 84 percent had MOUD prescribed during hospitalization, compared with 49 percent without consultation. Among admissions with AUD, 33 percent had inpatient MAUD prescribed, compared with 6 percent without consultation.
• Discharge prescriptions for OUD and AUD were higher for admissions with consultations, although results were less clear for OUD prescriptions because methadone data were not captured.
• The 30-day readmission rate was significantly reduced for admissions with consultation compared with those without (17 percent versus 20 percent; adjusted rate ratio, 0.82). Results were similar for OUD and AUD, and more pronounced for new initiation of medication for SUD.

Comments: This observational study enhances the rationale for hospital addiction consultation by finding associations between consultation and important outcomes. Most study biases would likely disfavor consultation, strengthening these positive findings. The large number of hospitalized patients who might benefit from addiction consultation may preclude the development of comprehensive access to these services and may require dissemination of these practices across services and specialties, especially hospitalists.

Joseph Merrill, MD, MPH

Reference: Lambert E, Regan S, Wakeman SE. The impact of addiction consultation and medication for opioid or alcohol use disorder on hospital readmission. J Gen Intern Med. 2025 [Epub ahead of print]. doi: 10.1007/s11606-024-09301-9.