Thread by @honoraenglander

New in @NEJM: Most US hospitals do not offer evidence-based #addiction care. This missed opportunity harms patients, is an urgent need.

We describe how policymakers can incentivize & facilitate change. I'd love to partner w @CMSGov @samhsagov others 🧵/1
nejm.org/doi/full/10.10…

WHY treat #addiction in hospitals? 1 in 9 hospitalized adults has SUD.

A rapidly expanding evidence base shows benefits of hospital-based addiction care, including ↑SUD treatment engagement, ↑patient-clinician trust, ↓mortality/ 2

Most efforts in hospital-based addiction care to date have been led by motivated clinicians making a business and quality case for improvement.

However, absent clear funding or financial incentives, most hospitals do not offer evidence-based care/3

Some examples of widespread gaps:
@EileenBarrettNM & colleagues found that 46% of New Mexico hospitals had no buprenorphine–nx on formulary, and nearly 40% of NM counties had no hospital with bup-nx available/4

https://twitter.com/honoraenglander/status/1435625953602850820?s=20&t=N2G6mRyFQ_3MVUjyHMFbrg

@kelseycpriest et al found that in VA (which likely outperforms most US hospitals), only 15% of people with opioid use disorder received any methadone or bup in hospital (mostly for withdrawal management), and only 2% of initiated with linkage after DC/ 5 pubmed.ncbi.nlm.nih.gov/32291723/

7.8% of hospitalized people w/ opioid use disorder die w/in 12 months, similar mortality to #heartattack.

Imagine if US hospitals had no standards or incentives to treat heart attacks? No metoprolol, no door-to-balloon time, no cardiologists on staff/6

https://twitter.com/honoraenglander/status/1437933569238654980?s=20&t=N2G6mRyFQ_3MVUjyHMFbrg

#Stigma is both cause and consequence of hospitals' failure to provide appropriate SUD care, and manifests on individual and structural levels. This includes judgment & mistrust of patients, an unprepared workforce, harmful policies, federal policies restricting MOUD access/7

There is no one-way to approach improving hospital-based addiction care — and individual clinicians, hospital leaders, hospital organizations, community agencies, educators, and policy-makers all have a role to play/ 8

pubmed.ncbi.nlm.nih.gov/35534663/

To reduce stigma and improve outcomes, hospitals must make a concerted, visible commitment to improving #SUD care. The path forward will require bold actions across multiple agencies and policy domains/9

In sum, there is urgent need to improve SUD care in US hospitals.

We need policies, incentives and metrics to drive broad and meaningful change. And we are eager to work with federal leaders and agencies to do better. @CMSGov @samhsagov @ONDCP @NatQualityForum @NIDAnews/ 10

Finally, huge thanks to co-author @coreysdavis and many colleagues & friends who are working to make hospital care better and who I learn so much from.
Pls amplify & join us in advocating change. @DrSarahWakeman @MarleneMartinMD @jessgregg1 @ZoeWeinstein @CarolineAKing23 /11

@CalcaterraSusan @especially_APT @kelseycpriest @HannahSnyderMD @XimenaLevander @NoaKrawczyk @DrMelissaWeimer @RichBottner @salisburyafshar @DrChinazo @miriamh_harris @DrAyanaJordan @rayraywino @suenlw @LarochelleMarc @KinnaThakarar @JMPerroneMD @BuchheitBradley @LindaPengMD/12

@DrScottHadland @liebschutz @PaulJoudreyMD @DrKimSue @DrDeannaWilson @SarguniSingh @sandyspringermd @ehyshka @MollieMarr @rachelanjenee @Raaginizzle @Paxbach @DrKristineTL @StefanKertesz @LauraMarks5 @AyeshaAppaMD @RS_McNeil @do_less_harm @MorganGodvin/13

@KorthuisTodd @cnicolaidis @DesaisSima @DavidBangsberg @PDX_Tom @MParshleyMD @robinson_erik @SaraHottmanPDX & so many @ohsunews, @AMERSA_tweets, @ohsu_adm & folks not on twitter/ fin