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C326

  • Introduced by: Andrew Bland, MD, Delegate, for Sangamon County Medical Society

    Subject: Treating Opioid Use Disorder in Hospitals

    Referred to: Reference Committee C


    Whereas, the opioid epidemic has become a critical threat to public health in the U.S1; and

    Whereas, hospitalizations have been rapidly increasing for opioid overdose and for infectious complications of injection drug use such as hepatitis C, HIV, and deep tissue bacterial infections, reaching 1.27 million emergency room and inpatient stays in 20142; and

    Whereas, inpatient costs among those with opioid use disorder almost quadrupled to $15 billion between 2002 and 20123; and

    Whereas, there is a high risk of repeated hospitalization4 and overdose death following hospitalization due to loss of opioid tolerance5, but hospitals rarely address the underlying chronic disease of opioid use disorder6.7; and 

    Whereas, FDA-approved medications for treating opioid use disorder (buprenorphine, methadone and naltrexone) reduce illicit opioid use1; opioid agonist therapy (buprenorphine or methadone) reduces opioid overdose death by 50%6 in part by preventing loss of opioid tolerance; and buprenorphine provides further protection because of its high receptor affinity and ceiling effect on respiratory depression8; and

    Whereas, initiation of buprenorphine in the emergency department9 and inpatient setting10 and linkage to ongoing comprehensive treatment as an outpatient is an effective means for engaging patients and reducing illicit opioid use11-13; therefore, be it

    RESOLVED, that ISMS 1) adopt a policy in favor of hospitals in Illinois treating opioid use disorder with medications FDA-approved for that purpose (buprenorphine, methadone and naltrexone) along with appropriate counseling, and 2) advocate for legislation, standards, policies and funding to support that policy; and be it further

    RESOLVED, that ISMS advocates that the American Medical Association 1) adopt a policy in favor of hospitals in the United States treating opioid use disorder with medications FDA-approved for that purpose (buprenorphine, methadone and naltrexone) along with appropriate counseling, and 2) advocate for legislation, standards, policies and funding to support that policy; and be it further

    RESOLVED, that ISMS advocates that the AMA works together with relevant organizations such as the American Hospital Association, The Joint Commission and the American Society of Addiction Medicine to develop and promote a model hospital policy that would assist hospitals in addressing opioid use disorder as a chronic disease by:

    1. ensuring that medical and other clinical staff are educated about evidence-based treatment of opioid use disorder in order to appropriately advise and treat their patients,
    2. providing patient education about and access to all three FDA-approved medications in emergency and inpatient settings, and buprenorphine and methadone in obstetric settings,
    3. maintaining use of these medications for patients already on them,
    4. initiating use of these medications for assenting patients affected by the disease,
    5. establishing comprehensive discharge plans for ongoing medical and behavioral treatment in the community, and
    6. participating in the development of community-wide systems of care for patients with opioid use disorder to facilitate discharge planning.

    References

    1. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
    2. Weiss et al., Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009–2014. Statistical Brief #219, Agency for Healthcare Research and Quality, 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb219-Opioid-Hospital-Stays-ED-Visits-by-State.pdf
    3. Ronan et al., Hospitalizations related to opioid abuse/dependence and associated serious infections from 2002 to 2012. Health Aff (Millwood). 2016; 35(5): 832–837.
    4. Walley et al., Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med. 2012; 6(1):50–56.
    5. White et al., Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors. PLoS One. 2015;10(11):e0141073.
    6. Frazier et al., Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid inpatients and emergency department patients. JAMA. 2017; 318(8):750-752.
    7. Naeger et al., Post-Discharge Treatment Engagement Among Patients with an Opioid-Use Disorder. J Subst Abuse Treat. 2016 Oct;69:64-71.
    8. Lutfy K, Cowan A. Buprenorphine: a unique drug with complex pharmacology. Curr Neuropharmacol. 2004;2:395–402
    9. Pierce et al., Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2015; 111: 298–308.
    10. D’Onofrio et al., Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial. JAMA. 2015; 313(16): 1636–1644.
    11. Liebschutz et al., Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients: A Randomized Clinical Trial. JAMA Intern Med. 2014;174(8):1369-1376.
    12. Englander et al., Planning and Designing the Improving Addiction Care Team (IMPACT) for Hospitalized Adults with Substance Use Disorder. J Hosp Med. 2017; 12(5): 339–342.
    13. Fanucchi & Lofwall. Putting Parity into Practice — Integrating Opioid-Use Disorder Treatment into the Hospital Setting N Engl J Med. 2016; 375(9):811-813.


    Existing ISMS policy related to this issue:

    NOTE: ISMS is aggressively engaged across numerous fronts to raise opioid awareness. Our efforts have centered on medication disposal, safe prescribing, addiction treatment, use of the prescription monitoring program, reversing overdose and other aspects of addressing the opioid crisis. ISMS leaders have been featured in dozens of print, radio and television interviews on a range of opioid-related topics. In addition, ISMS engaged in an aggressive earned media campaign with our letters and guest editorials appearing in newspapers statewide. ISMS-developed public service announcements are currently airing on Illinois radio stations. ISMS mailed 13,000 printed kits promoting medication disposal to Illinois physicians. Our web and social media resources include downloadable resources for both physicians and patients. In addition, we’ve promoted dozens of opioid prescribing courses, including several developed and provided at no cost by ISMS. Our visible leadership has helped ISMS engage lawmakers and other stakeholders seeking legislative solutions to address the opioid epidemic. 

    ISMS supports initiatives to help those who are addicted to drugs and ask for help, and supports government initiatives to implement substance abuse programs that are appropriately designed and monitored for quality, cost-effectiveness, and reduced recidivism. (HOD 2005; Reaffirmed 2017; Last BOT Review 2014)

    ISMS supports the efficacious use of prescription medication in patients with severe, intractable pain in order to eliminate or reduce pain to tolerable levels. (HOD 1995; Last BOT Review 2013)     

    It is the policy of the Society to protect the rights of patients who are suffering in pain, by allowing them as wide a choice as possible of fellowship-trained, pain management physicians by prohibiting hospital exclusive contracting for pain management services. (HOD 1997; Last BOT Review 2013)

     ISMS supports legislative efforts that facilitate greater availability and use of naloxone, and expand existing "Good Samaritan" protections for those prescribing or administering naloxone. (BOT 2014) (Part of the Pain Management Principles)


     

  • The commenting period is now over.
    Comment List
    David W. Miller, M.D. I am not in favor of this resolution

    The trend due to the evidence base is clearly in favor of non-pharmacologic solutions.  Medications can play a role, but the idea that they are the be-all and end-all of treatment is simply not true. These should be used, but any efforts to make them the sole choice should be extinguished.  Beyond behavioral therapy, other options are available.

    Apr 20, 2018 at 9:42 p.m.

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