Background: The inpatient hospital setting is a potential intervention point where people at risk for overdose can be identified and connected to evidence-based substance use disorder (SUD) treatment and harm reduction services. Inpatient addiction consult service (ACS) programs have been shown to have a range of positive outcomes, but there remains an implementation gap, and ACS programs are not offered in many hospital settings.

Objectives: 1) to understand implementation practices and challenges at established ACS programs, and 2) to identify recommendations for creating a more robust and effective system of hospital-based addiction care

Methods: The sample consisted of six inpatient ACS programs in Massachusetts that included academic and community hospitals of varying sizes in different regions. Data on ACS services were gathered through document review and semi-structured qualitative interviews with 2-5 providers or staff members at each hospital. Data were coded and analyzed to develop individual program profiles and identify cross-cutting themes.

Results: All programs shared a common core staffing structure, prioritized effective withdrawal management as the first step in a patient’s care, took a patient-centered harm reduction approach, and operated a low-barrier bridge clinic and/or another model for outpatient SUD treatment services. Insufficient access to post-discharge follow-up care was a significant concern for participating hospitals. Participating programs also described stigma within their institutions towards people who use drugs or people with SUD, and highlighted financial sustainability as a major challenge.

For new programs, participating hospitals recommended starting by identifying leadership champions and building support among key stakeholders. They emphasized the importance of building a strong staff team and developing protocols for care within the hospital and for follow-up care after discharge. Hospitals also recommended dedicating time to internal training and advocacy to raise awareness of the value the ACS program can offer and how to use it.

Conclusions: This work identified successful implementation practices used by established ACS programs as well as challenges they face. The findings can inform development of new ACS programs as well as policy and practice changes to expand, improve, and sustain this model of care.