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Hospitals and policymakers must take bold action to reduce drug-related harm

OHSU physician’s call-to-action published in New England Journal of Medicine
Boxes of Naloxone sit on a shelf inside the OHSU pharmacy in Portland on Thursday, August 18, 2022.
Boxes of Naloxone sit on a shelf inside the OHSU pharmacy in Portland on Thursday, August 18, 2022. Naloxone is a medication that can treat narcotic overdose in an emergency situation. It is available at any OHSU pharmacy without a prescription. OHSU physicians are calling for hospitals and policymakers to work together to reduce drug-related harm. (OHSU/Christine Torres Hicks)

U.S. hospitals have a key role to play in addressing a national drug epidemic that claimed more than 100,000 lives last year, a physician from Oregon Health & Science University writes in a perspective published by the New England Journal of Medicine.

Honora Englander, M.D., near a window at OHSU.
Honora Englander, M.D. (OHSU)

Too often hospitals are missing a prime opportunity to treat addiction, said Honora Englander, M.D., professor of medicine (hospital medicine and general internal medicine and geriatrics) in the OHSU School of Medicine.

"One in nine hospitalized adults has a substance use disorder, yet most U.S. hospitals do not offer evidence-based addictions care,” she said. “Hospitalized adults with opioid use disorder die at rates similar to acute myocardial infarction. Yet unlike cardiac care, which has widely adopted quality and financial incentives to deliver high-quality care, hospitals lack systems and standards for addictions care.”

Englander directs a first-of-its-kind addiction intervention formed at OHSU in 2015. Project IMPACT, or Improving Addiction Care Team, brings together physicians, social workers, peer-recovery mentors and community addiction providers to offer substance use disorder (SUD) treatment when patients are admitted.

The perspective published today is a call to action.

Englander co-authored it with Corey S. Davis, J.D., M.S.P.H., director of the Harm Reduction Legal Project at the Network for Public Health Law in Los Angeles and a member of the Center for Opioid Epidemiology and Policy at New York University’s Grossman School of Medicine.

“To reduce stigma and improve outcomes, hospitals can make a concerted, visible commitment to improve SUD care,” they write. “To date, most reform has relied on highly motivated champions, individual hospital priorities, and local incentives.” However, “changing the standard of care requires reforms well beyond what individual champions or hospitals can accomplish.”

In the perspective, Englander and Davis call for bold action among hospitals, state and federal policymakers, and federal agencies to improve addiction care in hospitals. They recommended changes in hospital policies and formularies; financing and regulatory standards that incentivize hospital-based treatment; clinician education and support; and regulatory changes, including certifying that hospitals adopt evidence-based clinical guidelines. For example, the U.S. Centers for Medicare and Medicaid Services could require hospitals to offer medications such as buprenorphine or methadone for patients with opioid use disorder.

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