Hospital admission presents a critical opportunity to address opioid use disorder (OUD), yet this window is often missed in standard care. New research published in JAMA Internal Medicine demonstrates that specialized addiction consultation services during hospitalization can dramatically improve treatment initiation and continuity of care for patients with OUD.
START Clinical Trial Shows Promising Results
The Substance Use Treatment and Recovery Team (START) clinical trial (NCT05086796) evaluated a structured intervention approach against usual care across three medical centers: Cedars-Sinai Medical Center, Baystate Medical Center, and the University of New Mexico. The study randomized 325 hospitalized patients with OUD to either receive the START addiction consultation service (n=164) or usual care (n=161).
Results showed striking differences in treatment outcomes. Patients receiving the START intervention were significantly more likely to initiate medications for opioid use disorder (MOUD) during hospitalization—57.3% compared to just 26.7% in the usual care group. This advantage extended beyond discharge, with 72% of START patients successfully linking to OUD care within 30 days post-discharge, versus 48.1% in the control group.
"This opportunity is particularly important for patients who may face barriers to accessing MOUD in the health care system and other community access points due to stigma, unstable housing, costs, logistical issues, lack of knowledge among practitioners, racial and ethnic discrimination, and other social determinants of health," the study authors noted.
Intervention Components and Treatment Patterns
The START model pairs an addiction medicine specialist with a care manager to deliver personalized interventions based on motivational interviewing techniques and addiction-focused discharge planning. This comprehensive approach appears to address multiple barriers that typically prevent effective OUD treatment.
Methadone was the most commonly prescribed MOUD, administered to 66% of patients across both groups who received medication. Buprenorphine was used in approximately 39% of cases. The START group showed more comprehensive discharge planning, with 49.4% receiving OUD-focused discharge plans compared to 27.3% in usual care.
Dr. Itai Danovitch, chair of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center and senior researcher on the study, emphasized the significance of these findings: "Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge."
Addressing a Public Health Crisis
The research comes amid a worsening opioid crisis in the United States. More than 81,000 people died from opioid overdoses in 2023, and hospital admissions for OUD more than tripled between 2002 and 2018, rising from nearly 302,000 to just under 942,000.
"Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use," explained Dr. Jeffrey Golden, executive vice dean for research and education at Cedars-Sinai, who was not involved in the study.
Systemic Changes Needed
In an accompanying editorial, Drs. Susan L. Calcaterra and Dale Terasaki called for improvements to usual care standards for hospitalized patients with OUD. They emphasized that after more than two decades of the opioid epidemic, hospital-based clinicians are unlikely to organically integrate OUD treatment into practice without support from hospital leadership and systemic changes.
"To motivate hospital leaders to enact these changes, CMS and other insurers should link hospital payments to the quality of OUD care provided, including initiation of MOUD with OUD treatment linkage and naloxone provision," they wrote. "Similar value-based measures have successfully incentivized hospitals to address health care–associated infections, 30-day readmissions, and patient safety."
Translational Potential
The START model shows promise beyond OUD treatment. Researchers suggest the approach could be adapted to enhance treatment uptake for people with other substance use disorders and behavioral health problems, offering a comprehensive solution to widespread healthcare gaps.
The study demonstrates that with structured intervention, hospitals can play a pivotal role in addressing the opioid crisis by initiating treatment during a critical window of opportunity and ensuring continuity of care after discharge. As healthcare systems continue to grapple with rising OUD rates, the START model provides an evidence-based framework that could significantly improve outcomes for this vulnerable patient population.
