Background: In utero opioid exposure can result in neonatal abstinence syndrome (NAS). NAS incidence has increased five-fold in the last decade. NAS is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system and gastrointestinal tract dysfunction. Newborns with NAS may have several potential complications, may require pharmacological management, have increased hospital [...]

Background: Patients with Substance Use Disorder (SUD) are a nationwide concern. They have significant morbidity, mortality & for several reasons, such as comorbid psychiatric conditions, medication noncompliance, low income or poor access to healthcare services, have an increased risk of hospital readmissions. Processes aimed at reducing readmission rates in this population are important for improving [...]

Background: Hospitalizations among patients with opioid use disorder (OUD) have skyrocketed in the past 10 years (1). These patients represent an ever-growing portion of the typical hospital medicine census and often have readmission rates greater than expected for their age and other health status. Discharge against medical advice (AMA) is common in this population, and [...]

Background: Project Caring for Patients with Opioid Misuse through Evidence-Based Treatment (COMET) launched in 2019 to provide patients with opioid use disorders (OUD) individualized and evidence-based care at Duke University Hospital (DUH). Patients with OUD have higher rates of self-directed discharge (SDD) which is associated with higher healthcare utilization costs, hospital readmissions, and adverse health [...]

Background: Biases related to people with substance use disorder (SUD) actually increase during time spent in formal medical education, and continue into practice. Leading health professional education groups across medicine, nursing, pharmacy, and social work, including the Association of American Medical Colleges (AAMC), have recognized addressing substance use disorders including stigma and bias as a [...]

Background: Driven by the current opioid epidemic, drug overdose has become the leading cause of unintentional death nationwide. Efforts are underway to decrease unnecessary opioid prescribing. Hospitalists care for many patients with preexisting opioid prescriptions or appropriately prescribed new opioids at discharge. Though naloxone decreases the morbidity and mortality associated with opioid overdose, most patients [...]

Background: Opioid overdose in the United States continues to rise. Naloxone is an opioid antagonist that is FDA-approved for reversing opioid overdose. Current CDC guidelines recommend prescribing naloxone to patients at high risk of opioid overdose, including patients with concurrent benzodiazepine use, a prior history of overdose, and those receiving high doses of opioids (>50 [...]

Background: Inpatient addiction consultant services are an innovative and proliferating tool used to confront the opioid epidemic. As healthcare systems seek to address gaps in care for patients with substance use disorder (SUD), the inpatient setting is increasingly understood as a unique opportunity for counseling, referral for treatment, and initiation of medication assistance treatment (MAT) [...]

Background: In 2021 there were over 80,000 opioid overdose deaths. Studies show that inpatient hospitalizations are a vital moment in treating patients with opioid use disorder (OUD). Initiation of opioid agonist therapy (OAT: buprenorphine or methadone) is associated with a profound mortality benefit, with some studies suggesting a number needed to treat of less than [...]

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 [...]