Background: The opioid epidemic, well-recognized as a national emergency, is a wake-up call to physicians. Medication-assisted treatment (MAT) for opioid use disorder (OUD) has been shown to be safe, cost-effective, and reduce mortality; however, MAT use remains low (1-4). More recently, the hospital setting has been seen as a potential starting point for treatment for substance use disorders, with studies showing success with inpatient diagnosis, management and linkage to care post-discharge(5-8). These programs often involve psychiatry or addiction medicine specialists; however, this is not possible in all hospital-based settings. With the increasing demand for hospitalists to initiate medication for OUD(9), there is a need for development of practical and sustainable models for hospitalists to address the burgeoning opioid epidemic.
Purpose: Project COMET (Caring for patients with Opioid Misuse through Evidence-based Treatment) is a comprehensive, multi-disciplinary program to improve care for patients hospitalized with OUD. Our objectives include increasing access to and initiation of medication for OUD during hospitalization, as well as increasing referrals to the community for ongoing MAT following discharge.
Description: We collected preliminary data on patients hospitalized at a large, academic hospital for an acute medical issue who had a history of intravenous drug use and determined an annual estimated volume of 216 patients. We utilized this data to propose implementation of a program to treat hospitalized patients with OUD. Using this information, we successfully secured health system funding. We utilized a multidisciplinary, collaborative approach to prepare for and launch our hospital-based program. Hospital medicine physicians obtained their DEA-X license and participated in orientation to the program. We had key stakeholder involvement from pharmacy, nursing, acute pain service and infectious disease teams. We launched Project COMET on July 1, 2019. We have a hybrid model, consisting of a primary general medicine service of patients with OUD and also see consultation requests. In the first 4 months of the launch, we have seen 87 individual patients, far exceeding our initial projections. The full-time hospitalists and social worker currently evaluate and treat hospitalized patients with OUD. Our social worker creates partnerships with community organizations to facilitate post-discharge care for each patient. We have successfully discharged patients earlier than anticipated in their hospital stay. Selected patients considered lower risk were discharged home to continue IV antibiotics; others were discharged to a skilled nursing facility to receive IV antibiotics and concomitant MAT; some required no further IV antimicrobials and were discharged to continue MAT in community settings.
Conclusions: We have created an innovative, multidisciplinary program to improve care for patients hospitalized with OUD. We continue to refine and improve our program based on data collected and analyzed, as well as experience from those working as part of the program. Project COMET can serve as an example to hospitals and hospitalist providers at other institutions who are interested in implementation of similar services.