scholarly journals Adapting inpatient addiction medicine consult services during the COVID-19 pandemic

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Miriam T. H. Harris ◽  
Alyssa Peterkin ◽  
Paxton Bach ◽  
Honora Englander ◽  
Emily Lapidus ◽  
...  
Keyword(s):  
Substance Use ◽  
Discharge Planning ◽  
Medical Center ◽  
Health Care Systems ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
New Haven ◽  
Opioid Use ◽  
Addiction Medicine ◽  
The Impact

Abstract Background We describe addiction consult services (ACS) adaptations implemented during the Novel Coronavirus Disease 2019 (COVID-19) pandemic across four different North American sites: St. Paul’s Hospital in Vancouver, British Columbia; Oregon Health & Sciences University in Portland, Oregon; Boston Medical Center in Boston, Massachusetts; and Yale New Haven Hospital in New Haven, Connecticut. Experiences ACS made system, treatment, harm reduction, and discharge planning adaptations. System changes included patient visits shifting to primarily telephone-based consultations and ACS leading regional COVID-19 emergency response efforts such as substance use treatment care coordination for people experiencing homelessness in COVID-19 isolation units and regional substance use treatment initiatives. Treatment adaptations included providing longer buprenorphine bridge prescriptions at discharge with telemedicine follow-up appointments and completing benzodiazepine tapers or benzodiazepine alternatives for people with alcohol use disorder who could safely detoxify in outpatient settings. We believe that regulatory changes to buprenorphine, and in Vancouver other medications for opioid use disorder, helped increase engagement for hospitalized patients, as many of the barriers preventing them from accessing care on an ongoing basis were reduced. COVID-19 specific harm reductions recommendations were adopted and disseminated to inpatients. Discharge planning changes included peer mentors and social workers increasing hospital in-reach and discharge outreach for high-risk patients, in some cases providing prepaid cell phones for patients without phones. Recommendations for the future We believe that ACS were essential to hospitals’ readiness to support patients that have been systematically marginilized during the pandemic. We suggest that hospitals invest in telehealth infrastructure within the hospital, and consider cellphone donations for people without cellphones, to help maintain access to care for vulnerable patients. In addition, we recommend hospital systems evaluate the impact of such interventions. As the economic strain on the healthcare system from COVID-19 threatens the very existence of ACS, overdose deaths continue rising across North America, highlighting the essential nature of these services. We believe it is imperative that health care systems continue investing in hospital-based ACS during public health crises.

scholarly journals Substance use Treatment and Harm Reduction Services for Migrants and Refugees in the COVID-19 Pandemic: Findings from a Global Survey

2020 ◽  
Author(s):  
Cornelis De Jong ◽  
Ali Farhoudian ◽  
Mehrnoosh Vahidi ◽  
Mohsen Ebrahimi ◽  
Hamed Ekhtiari ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorders ◽  
Mental Health Problems ◽  
World Health ◽  
Substance Use Treatment ◽  
Second Phase ◽  
Addiction Medicine ◽  
Global Survey ◽  
The Impact

Abstract Migrants and refugees are considered vulnerable to mental health problems and substance use disorders; and may be particularly affected by service disruptions associated with the COVID-19 pandemic The International Society of Addiction Medicine (ISAM) ran a multi-phased global survey among clinicians and health professional that are actively working in the field of addiction medicine to investigate the impact of the COVID-19 pandemic on substance use and related services. In March 2020, the first month after the announcement of the pandemic by the World Health Organization, 177 informants from 77 countries took part in the global survey, and only 12.9% of them reported their countries’ substance use treatment and harm reduction services for the migrants and refugees with substance use disorders continued as usual. In May 2020, 11.7% of respondents of the second phase reported that the services for refugees and migrants improved in comparison to March 2020; 11.7% reported that these services in their country discontinued. Results suggest that refugee and migrants access to treatment and harm reduction services has been reduced as a result of COVID-19. It can be concluded that it is crucial to improve the visibility of migrants’ needs and exploit appropriate interventions for those with substance use disorders.

Effectiveness of a substance use treatment program for veterans with chronic pain and opioid use disorder

2021 ◽  
pp. 108635
Author(s):  
Ralph Ward ◽  
Yi-lang Tang ◽  
Robert Neal Axon ◽  
Jennifer Casarella ◽  
Natasha Whitfield ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Treatment Program ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
Opioid Use

scholarly journals 616. Patients Experiencing Homelessness and Opioid Use Disorder with Infectious Complications Treated with OPAT at Medical Respite: Evaluation of Retention in Care at 30 days and Role of Addictions Consultation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S368-S369
Author(s):  
Alison M Beieler ◽  
Alison M Beieler ◽  
Jared W Klein ◽  
Elenore Bhatraju ◽  
Matthew Iles-Shih ◽  
...  
Keyword(s):  
Mental Health ◽  
Case Management ◽  
Clinical Cure ◽  
Medical Center ◽  
Opioid Use Disorder ◽  
Care Plan ◽  
Social Risk ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Common Diagnosis

Abstract Background Patients experiencing homelessness and opioid use disorder (OUD) admitted for severe infections often require prolonged hospital stays. These patients, typically evaluated by Infectious Disease (ID) providers, are often excluded from Outpatient Parenteral Antimicrobial Therapy (OPAT) due to social risk factors. Medical respite, near Harborview Medical Center (HMC), offers a supportive environment for patients to receive OPAT with daily nurse administered antibiotics. For further support, our institution created a dedicated Addiction medicine consult service March 1, 2019 to assist with initiation of medications for opioid use disorder (MOUD) and linkage to outpatient care for interested patients. Methods We performed retrospective review of all patients > 18 years with OUD admitted for procedure/inpatient stay from 1/31/2018 – 1/31/2020 who discharged to medical respite for OPAT. The minimum follow up period was 90 days. We recorded demographics, OUD history, diagnosis, discharges against medical advice (AMA), and total readmissions. We evaluated outcomes of 4 care interventions (ID consult, Addiction consult, linkage to case management and/or mental health, linkage to MOUD) in relation to successful OPAT completion, clinical cure, and retention in MOUD at 30 days. Results Fifty-three patients had 63 OPAT episodes of care (Table 1). Median length of stay (LOS) was 19 days inpatient, and 33 days at medical respite. Common diagnosis included, osteomyelitis 46 (73%), bacteremia 27 (43%), septic joint 17 (27%), epidural abscess 10 (16%), and endocarditis 10 (16%). There were 24 OPAT episodes which received all 4 interventions (Table 2). Episodes during which 4 interventions occurred were more likely to result in clinical cure (p = 0.03) and retention in MOUD treatment at 30 days (p = 0.003) compared to episodes where 3 or fewer interventions occurred (Table 3). Table 1. Demographics Table 2. OPAT Care Interventions, n =63 Table 3. Summary of Outcomes, n =63 Conclusion Patients discharged to medical respite who received the combination of ID consult, Addiction consult, case management and/or mental health, and MOUD had higher rates of clinical cure compared to those who did not receive all four interventions. Developing a patient-centered comprehensive care plan, including ongoing support and access to MOUD should be a priority to ensure successful treatment of infections. Disclosures All Authors: No reported disclosures

scholarly journals Emergency department patients with untreated opioid use disorder: A comparison of those seeking versus not seeking referral to substance use treatment

2021 ◽  
Vol 219 ◽  
pp. 108428
Author(s):  
Edouard Coupet ◽  
Gail D’Onofrio ◽  
Marek Chawarski ◽  
E. Jennifer Edelman ◽  
Patrick G. O’Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
Opioid Use ◽  
Emergency Department Patients
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