Background: Opioid use disorder (OUD) is a chronic relapsing disease that has become an epidemic in the United States. Overdoses of prescription and illicit opioids have killed almost 450,000 Americans between 1999-2018 (1). Guidelines on OUD management recommend, in combination with behavioral therapy, opioid agonist therapy as the first-line treatment option with antagonist therapy as an alternative option. OUD-related inpatient admissions represent a key opportunity to identify OUD patients and initiate medications for OUD (MOUD). However, these opportunities are still missed due to a lack of standardized addiction medicine education and support (2,3).
Purpose: To promote the appropriate and safe prescription of MOUD through didactics and an electronic health record (EHR) clinical decision support system.
Description: Our multi-disciplinary OUD work group convened monthly to develop inpatient guidelines on MOUD. To standardize practice for inpatient providers across all disciplines, we built our protocol into an EHR order set. Our order set supports OUD diagnosis, provides a pre-medication check list, guides medication selection and dosing, and includes nursing care orders. Our protocol encouraged the use of buprenorphine/naloxone combinations due to their safety profiles and accessibility after discharge. To supplement the order set, we created smart phrases to aid in documentation and serve as an additional tool for clinical decision making. Next, we developed didactics targeting trainee and faculty physicians on different inpatient disciplines including hospital medicine, family medicine, and obstetrics and gynecology. We provided these lectures in live and pre-recorded formats that would be easily accessible for additional future reference. Preliminary feedback indicates high physician acceptance, improved patient-physician relationships and patient comfort, fewer discharges against medical advice (AMA), and reduced stigma associated with OUD. No MOUD associated adverse events have been reported.
Conclusions: By addressing barriers to MOUD prescription, we have safely improved physician comfort with and use of MOUD. Our interventions would easily transfer to other hospital settings. For next steps, we plan to monitor AMA discharges, readmission rates, treatment adherence, and adverse events (mortality, infections, overdose events). Our experience highlights the importance of early recognition and inpatient management of OUD to improve physician/patient experience and outcomes.