Background: The US has a heavy burden of deaths from opioid overdoses, and New Mexico is not excepted from this. Treatment options for opioid use disorder (OUD) are buprenorphine/naloxone (“Suboxone”), methadone, naltrexone, counseling, and/or behavioral therapy. Long-acting oral opioids like Suboxone, are the most effective methods for treating opioid withdrawal and OUD. They are often prescribed in conjunction with counseling for the best long-term maintenance of the disease. Therefore, access to Suboxone can be life-saving in the event of OUD. However, treatment is often delayed due to limited access. Many small hospitals do not have access to addiction services and many hospitalists do not have experience prescribing Suboxone. We aim to investigate the availability of Suboxone in New Mexico hospitals.
Methods: We obtained a list of all hospitals in New Mexico that admit patients for acute medical care. Rehabilitation and behavioral health hospitals were excluded. Hospitals were contacted via phone and the inpatient pharmacy staff were asked if they have Suboxone on their formulary (“secret shopper”). If they did not, they were asked about their ability to obtain Suboxone within one day. No personal information was collected.
Results: Of the 46 New Mexican hospitals meeting the inclusion criteria, one refused to answer and one could not be contacted. Of 44 hospitals surveyed, 24 (54.5%) had Suboxone on their inpatient pharmacy formularies. Twenty (45.5%) did not. Of those 20, none were able to obtain Suboxone within the day. One of these hospitals without Suboxone carried buprenorphine. At least five allowed patients to bring their medications from home, and one was in the process of adding Suboxone to their formulary. Of the 26 counties in New Mexico with acute care hospitals, ten counties do not have any acute care hospitals with Suboxone available (figure 1).
Conclusions: This study shows gaps in the treatment of patients with OUD in acute care hospitals in New Mexico. The ten counties without hospitals that prescribe Suboxone are Chaves, Cibola, Colfax, Curry, Lea, Lincoln, Los Alamos, Luna, Roosevelt, and Taos. Of those counties, Lincoln has a drug overdose death rate significantly higher than the state average. Colfax and Taos counties have drug overdose death rates commensurate with the state average (figure 2). OUD deaths can be prevented with Suboxone, and these results may prompt New Mexico’s hospitals to update their inpatient formularies to increase the availability of Suboxone and OUD treatment throughout the state. It is likely that hospitalists in other states have similar challenges providing Suboxone, and further research should delineate this and interventions to address this disparity.Study limitations include the lack of research on how increased Suboxone availability in hospitals changes treatment rates. Additionally, treatment with Suboxone alone is often not sufficient for long-term recovery. Behavior health support, whether it be from formal counseling or family support, increases recovery rates3,6,7. If Suboxone access does increase but behavior health support does not, long-term recovery may not change. However, without access to Suboxone during hospitalizations, patients on Suboxone will be at risk for relapse and worse outcomes, and inpatients seeking treatment for an OUD will have limited access to this service.
