Hospitals could have a strategic opportunity to connect individuals with substance use disorder (SUD) with services.

Nearly 10% of adults who were diagnosed with SUD had past-year hospitalizations, according to a new study that looked at 60 million adults with SUDs. Patients with opioid use disorders (OUD) had the highest hospitalization rate at almost 24%, followed by individuals with stimulant use disorder who were hospitalized at a rate between 18-20%.

Despite the high prevalence of hospitalization, most patients do not receive any form of medication treatment at the hospital for their SUDs and are also not connected to other services for follow-up care after being discharged, past research has found, underscoring a missed opportunity for hospital-based treatment programs.

“I was surprised that so many patients with opioid use disorder were hospitalized,” Eden Bernstein, the lead author of the new study published in the Annals of Internal Medicine and an assistant professor in the University of Colorado Department of Medicine, told Addiction Treatment Business. “It really represents an opportunity to engage with a large fraction of those patients.”

Several barriers to initiating SUD care within routine hospitalizations also exist, ranging from stigma, lack of SUD education in medical schools, physician hesitancy and hospital funding gaps, Bernstein explained.

“It’s a really complicated issue. There’s a major knowledge gap in terms of physicians who are not addiction specialists and their comfort level with treating some of these things,” he said. “We’ve seen that sometimes educational programs can help bridge that gap, but I also think that there is a kind of stigma related to substance disorders that’s still pervasive in medicine, and that makes it challenging for hospitals and clinicians to adopt some of these evidence-based practices.”

The hospitals that do tend to incorporate medication treatment for patients hospitalized with SUDs also tend to be larger academic medical centers that have additional resources like addiction specialty services or similar programs.

The 10% or 5.8 million individuals with SUDs who reported past-year hospitalizations were more likely to have two or more chronic medical conditions, a serious mental illness (SMI) and be a Medicare or Medicaid enrollee, the study also found.

And while individuals with alcohol use disorder (AUD) only had a 7.3% hospitalization rate, because AUD is more common, even though it was a smaller fraction of the 60 million analyzed overall, the prevalence was still very high for that group, which was also surprising to Bernstein and his team.

“There are still a lot of people who see the hospital as a place where we treat the acute problem. The reason that you ended up in the hospital and may need treatment for some of these other things is not the job of the hospital-based clinicians and is something that should be addressed as an outpatient after you leave the hospital,” Bernstein said. “But I think the problem with that is that, realistically, we know that a lot of these patients might not engage with a longer-term care plan after they leave, so starting that treatment initially can provide that impetus of getting them linked with longer-term care.”

Overcoming barriers to hospital-based SUD treatment in a meaningful way will require more partnerships with community-based behavioral health providers, different referral models, stigma reversal and policy shifts.

“There are so many regulatory barriers to initiating treatment in the hospital. I think that methadone regulations pose a really large barrier for a lot of clinicians to utilize medication treatment within hospitals for patients, especially folks who are not addiction medicine trained,” Bernstein said.

Addressing prescribing regulations for individuals with substance use, and in particular, opioid use disorders, would greatly help, he noted.

Changing the way some of these treatments are delivered and investigating how to develop interventions to improve care linkages for patients with SUDs after hospitalization are two areas Bernstein hopes to investigate further to enhance care in this vein.