The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Bahji, Anees; Brothers, Thomas D.; Mauer-Vakil, Dane; Priest, Kelsey C.; Danilewitz, Marlon; Chopra, Nitin; Lamba, Wiplove; George, Tony P.; Crockford, David

doi:10.1097/cxa.0000000000000173

Cited by 3 publications

(2 citation statements)

References 83 publications

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“…38 Alternatively, implementation of a hospital ACS may reduce provider stigma through exposure to a harm-reduction philosophy and ability to offer effective SUD treatment. 33,39,40…”

Section: Discussionmentioning

confidence: 99%

“…38 Alternatively, implementation of a hospital ACS may reduce provider stigma through exposure to a harmreduction philosophy and ability to offer effective SUD treatment. 33,39,40 Previous research has identified both stigma and a lack of provider knowledge of clinical guidelines as reasons patients experience opioid withdrawal in healthcare settings. 23,28 Our study advances these findings by highlighting the difficulty some hospital providers had differentiating specific withdrawal symptoms, which could delay appropriate opioid withdrawal treatment.…”

Section: Discussionmentioning

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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“…38 Alternatively, implementation of a hospital ACS may reduce provider stigma through exposure to a harm-reduction philosophy and ability to offer effective SUD treatment. 33,39,40…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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Seeking Empirical Evidence for the Role of Pets

Nady¹

2023

Canadian Journal of Addiction

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As our communities reflect on the impact of COVID, our most recent pandemic, attention is being increasingly paid to our experiences with the lack of connection which arose from the isolation associated with the various public health measures advocated for public protection.Dell and Butt, 1 in a creative commentary, address the potential remedial benefits of animal companionship, which is receiving increased public support. Pets now appear to be present on public transportation, restaurants, care facilities, and other settings where animals were not previously welcome. Surprisingly, it is reported that the many attempts to garner empirical evidence on the positive role of pets have led to inconclusive results. This commentary adds 2 small, qualitative reports to the database. More consistent evidence arises from population surveys. As the commentary was being accepted for publication, an American Psychiatric Association (APA) Healthy Minds Monthly Poll concluded that 86% of pet owners reported a mostly positive impact on their mental health, 2 with most dog and cat owners equally likely to say so. The online poll was fielded in February 2023, among a sample of 2200 adults. The positive impacts reported include reduction of stress and anxiety, unconditional love and support, companionship, a calming presence, and true friendship. The APA, along with the American Veterinary Association, is now inviting pet owners to share their words and post pictures of their own pets on social media, under the hashtag #Paws4MentalHealth. We look forward to more feedback specific to our field. Submissions of Letters to the Editor or Brief Research Reports are welcome!

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Impact of inpatient addiction psychiatry consultation on opioid use disorder outcomes

Kast,

Le,

Stewart

et al. 2024

American J Addict

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Background and ObjectivesAddiction consultation services provide access to specialty addiction care during general hospital admission. This study assessed opioid use disorder (OUD) outcomes associated with addiction consultation.MethodsRetrospective cohort study of individuals with OUD admitted to an academic medical center between 2018 and 2023. The exposure was addiction consultation. Outcomes included initiating medication for OUD (MOUD), hospital length of stay, before‐medically‐advised (BMA) discharge, and 30‐ and 90‐day postdischarge acute care utilization.ResultsOf 26,766 admissions (10,501 patients) with OUD, 2826 addiction consultations were completed. Consultation cohort was more likely to be young, male, and White than controls. Consultation was associated with greater MOUD initiation (adjusted odds ratio [aOR], 5.07; 95% confidence interval [CI], 4.41–5.82), fewer emergency department visits at 30 (aOR, 0.78; 95% CI, 0.67–0.92) and 90 (aOR, 0.79; 95% CI, 0.69–0.89) days, and fewer hospitalizations at 30 (aOR, 0.65; 95% CI, 0.56 to 0.76) and 90 (aOR, 0.67; 95% CI, 0.59–0.76) days. Additionally, consultation patients were more likely to have a longer hospital stay and leave BMA.Conclusions and Scientific SignificanceAddiction consultation was associated with increased MOUD initiation and reduced postdischarge acute care utilization. This is the largest study to date showing a significant association between addiction psychiatry consultation and improved OUD outcomes when compared to controls. The observed reduction in postdischarge acute care utilization remains even after adjusting for MOUD initiation. Disparities in access to addiction consultation warrant further study.

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The Effectiveness of Inpatient Addiction Consult Services: A Systematic Review and Narrative Synthesis

Cited by 3 publications

References 83 publications

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

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

Seeking Empirical Evidence for the Role of Pets

Impact of inpatient addiction psychiatry consultation on opioid use disorder outcomes

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