Hospitals Struggle to Deal With National Opioid Epidemic

(CN) – Thousands of people have died during the nation’s ongoing opioid epidemic, which has also led to increasing rates of hospitalizations related to overdoses, infections and other surgical issues related to substance use.

This trend is particularly stark in Oregon, with a recent national report finding the Beaver State had one of the highest cumulative spikes in opioid-related hospitalizations in the nation between 2009 and 2014.

Despite the scope of the crisis, most hospitals are ill-prepared to engage with patients with substance-use disorder, begin life-saving treatment or steer people to care options post-hospitalization. This produces considerable distress among both health care providers and patients.

A study published Wednesday in the Journal of Hospital Medicine offers ways to lessen such problems.

“Existing research shows the life-saving benefits of medications for addiction and that most hospitals are not well-prepared to manage complex needs of adults with substance use disorder,” said lead author Honora Englander, an associate professor of medicine at the Oregon Health & Science University (OHSU) School of Medicine. “Our study shows that not addressing addiction contributes to burnout and frustration among hospital providers.

“And that by introducing high-quality addiction care, providers feel empowered and relieved,” she continued. “We found that providers’ distress was not inevitable; that by treating people’s addiction not only do we help patients, but we can fundamentally change how providers understand the disease of addiction and change culture.”

The team details a “sea change” following implementation in 2015 of a hospital-based addiction treatment unit at OHSU known as the Improving Addiction Care Team (IMPACT). The report includes hospital staff impressions before and after IMPACT, which brings together doctors, peer-recovery mentors, social workers and community providers to treat the root causes of addiction when patients are hospitalized.

Patients suffering from addiction can be disruptive and difficult to treat for hospital staff who have limited understanding of the disease and little experience managing it. Some providers acknowledged their own resistance to interacting with patients due to negative perceptions associated with addictions. Many staff members described feelings of “moral distress,” such as frustration, sparked by the ineffectiveness of administering intensive surgical and medical care with limited resources or knowledge to address addiction.

Hospital staff report that IMPACT is producing major changes by fundamentally reframing substance-use disorder.

“Participants felt the IMPACT ‘completely reframes’ addiction as a treatable chronic disease, improving patient engagement and communication, and humanizing care,” the authors write.

Providers included in the study reported relief, feeling that IMPACT transformed care by focusing on patients’ withdrawal, prescribing medications to treat the underlying brain disease of addiction, enabling direct communication between staff and patients, and presenting compassionate care.

The report finds that hospital-based interventions for substance-use disorder serve a major role in treating the nation’s opioid epidemic.

“Hospitals need a workforce and systems that can address both the physical and behavioral health needs of this population,” the authors write. “By doing so, hospitals can support staff and reduce burnout, better engage patients, improve care, and reduce stigma from this devastating disease.”


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