What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals

Abstract

Objectives Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

“…For example, empirical evidence suggests that prolonged drug use may result in impaired volitional control [47]. Additionally, there are currently no evidence-based pharmaceutical treatments for those with stimulant use disorders [48] and many acute care facilities still do not provide patients with opioid use disorders evidence-based medication treatment or harm reduction interventions [49]. Clinicians therefore should be educated and encouraged to engage patients with previous or active injection drug use in non-stigmatizing and factual conversations about reducing harms associated with drug use, including the potential risks of injecting into VADs [15,50].…”

Nonprofit Hospital Community Benefits

“…7 More specific to the opioid epidemic, several studies have examined how NFPs have responded to the epidemic through their CB programs and the impact of Federal and State policies on NFPs' response to the epidemic. 7,[33][34][35][36][37] One study found that in urban communities most affected by the opioid epidemic NFPs address it by providing additional treatment capacity. Another study found that NFPs may prefer to support opioid treatment either in primary care or in formal treatment services rather than initiate treatment in the hospital.…”

“…33 The authors also found that state policies focused on opioid use disorder may be effective in nudging hospitals to expand their portfolio of interventions to address the opioid epidemic beyond their area of expertise, including harm reduction. 33,35 Another study found both institutional (eg, lack of resources) and community-level factors (eg, poverty rate) are associated with the decision of NFPs not to address opioid use disorder even after having identified it as a community need in their CHNAs. 36 The authors conclude that policies supporting NFP-LHD partnerships may assist NFPs in addressing community needs that fall outside their expertise to include the social and economic determinants of the opioid epidemic.…”

“…More specific to the opioid epidemic, several studies have examined how NFPs have responded to the epidemic through their CB programs and the impact of Federal and State policies on NFPs’ response to the epidemic 7,33–37. One study found that in urban communities most affected by the opioid epidemic NFPs address it by providing additional treatment capacity.…”

Mu-opioid receptor and receptor tyrosine kinase crosstalk: Implications in mechanisms of opioid tolerance, reduced analgesia to neuropathic pain, dependence, and reward

“…Unfortunately, to date, no safer alternative with equal analgesic efficacy to opioids has been found ( Stuart et al, 2018 ). Many other proposed strategies involve reducing opioid dosage by locally targeting injured tissue (and limit central penetration), or reducing opioid prescriptions including establishing multimodal pain treatment regimens (as opposed to opioid monotherapy), opioid prescription monitoring, and restricted prescribing guidelines ( Saloner et al, 2018 ; Mir et al, 2019 ; Franz et al, 2021 ). Yet this has not been enough.…”