Response to substance use during hospitalization: A survey study of current and ideal policies and practices

Abstract

People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient‐directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross‐sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)‐accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME‐addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient‐centered policies to address this.

Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl

“…Hospitals have traditionally required patients to abstain from in-hospital substance use . These policies are enacted with the goal of preventing drug use and overdose, protecting staff from needle sticks, and protecting clinicians and hospitals from medical-legal liability.…”

“…A large international body of research describes harm reduction in community settings. Some hospitals are extrapolating this evidence (Table 1) to implement policies that disallow premature discharge solely on the grounds of suspected or confirmed substance use, providing access to sterile syringes and naloxone kits and giving staff training that engages people with lived experience of OUD in content delivery …”

“…Develop organizational substance use policies that do not make admission contingent on abstinence from drugs …”

“…Implementing OUD best practices relies on prepared hospital environments. Improvement efforts often include educating staff, engaging diverse leaders, revising hospital policies, developing community partnerships, and building responsive interprofessional teams (Table 2) . These efforts require implementation expertise and infrastructure and often rely on strong clinical champions …”