Hospitalist perspectives on buprenorphine treatment for inpatients with opioid use disorder

Reed, Megan; Murali, Vignesh; Sarpoulaki, Nazanin; Zavodnick, Jillian; Hom, Jeffrey; Rising, Kristin L

doi:10.1016/j.dadr.2022.100106

Cited by 4 publications

(6 citation statements)

References 49 publications

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“…These findings build on previous qualitative work among hospital providers focusing on OUD specifically or substance use more broa dly. 13,15,27,[32][33][34] We also found that the specific substances involved in "polysubstance use" were rarely differentiated, likely limiting providers' ability to develop effective, substance-specific treatment plans in the hospital. 35,36 Stigmatizing views and behaviors toward people with OUD are a well-documented barrier to accessing treatment.…”

Section: Discussionmentioning

confidence: 94%

“…10,11 In one multisite study these strategies supported increasing the rate of MOUD prescribing from <1% to 14.6% among patients seen in the Emergency Department. 12 Previous qualitative research has largely focused on opportunities to expand MOUD access, 13 assessing current addiction medicine services, 14,15 or the experience of patients with specific medical comorbidities (eg, infective endocarditis). [16][17][18] However, interventions developed based on provider experiences treating patients with OUD alone may not adequately support patients with opioid and stimulant co-use.…”

Section: Providers' Experiences and Perspectives In Treating Patients...mentioning

confidence: 99%

“…Informed by relevant literature, 10,13,22,23,[26][27][28] we developed a semi-structured interview guide, including open-ended key questions and detailed follow-up probes. Seventeen key questions focused on hospitals' current procedures for treating patients with opioid or stimulant use disorders, existing support for patients, challenges treating patients with co-use, and suggestions for additional services or resources.…”

Section: Data Collectionmentioning

confidence: 99%

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Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Shearer,

Hernandez,

Beebe

et al. 2024

Substance Use & Addiction Journal

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Background: The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management for stimulant use disorders, most individuals with these co-occurring conditions are not engaged in treatment. Hospitalization is an important opportunity to engage patients and initiate treatment, however existing hospital addiction care is not tailored for patients with co-use and may not meet the needs of this population. Methods: Semi-structured interviews were conducted with hospital providers about their experiences and perspectives treating patients with opioid and stimulant co-use. We used directed content analysis to identify common experiences and opportunities to improve hospital-based treatment for patients with co-use. Results: From qualitative interviews with 20 providers, we identified 4 themes describing how co-use complicated hospital-based substance use treatment: (1) patients’ unstable circumstances impacting the treatment plan, (2) co-occurring withdrawals are difficult to identify and treat, (3) providers holding more stigmatizing views of patients with co-use, and (4) stimulant use is often “ignored” in the treatment plans. Participants also described a range of potential opportunities to improve hospital-based treatment of co-use that fall into 3 categories: (1) provider practice changes, (2) healthcare system changes, and (3) development and validation of clinical tools and treatment approaches. Conclusions: We identified unique challenges providing hospital addiction medicine care to patients who use both opioids and stimulants. These findings inform the development, implementation, and testing of hospital-based interventions for patients with co-use.

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Section: Discussionmentioning

confidence: 94%

Section: Providers' Experiences and Perspectives In Treating Patients...mentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Providers’ Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital

Shearer,

Hernandez,

Beebe

et al. 2024

Substance Use & Addiction Journal

View full text Add to dashboard Cite

show abstract

“…Even with training, ongoing mentorship from experienced clinicians is crucial for less experienced hospitalists to feel comfortable prescribing buprenorphine 6 . A qualitative study of hospitalist perspectives on buprenorphine identified a lack of training, inpatient management resources, and community referral networks as barriers to prescribing 7 . Hospitalists may also be concerned about precipitating opioid withdrawal in the setting of lipophilic opioids like fentanyl 8 .…”

Section: Policy In Clinical Practicementioning

confidence: 99%

“…6 A qualitative study of hospitalist perspectives on buprenorphine identified a lack of training, inpatient management resources, and community referral networks as barriers to prescribing. 7 Hospitalists may also be concerned about precipitating opioid withdrawal in the setting of lipophilic opioids like fentanyl. 8 Finally, stigma is a barrier to prescribing buprenorphine among clinicians.…”

Section: Terminology and Acronyms Background And Historymentioning

confidence: 99%