New report from ICH – Inpatient Addiction Consult Services in Massachusetts: Insights and recommendations from six model programs

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RIZE Massachusetts Report Calls for Bolstering Hospital Inpatient Addiction Consult Services

Evidence-Based Programs in Hospital Setting Can Reduce Effects of Substance Use Disorder

BOSTON (March 4, 2024) – A new report from RIZE Massachusetts, an independent nonprofit foundation solely dedicated to funding and creating solutions to end the overdose crisis in Massachusetts, shows how inpatient hospital addiction consult service (ACS) programs can effectively identify people at risk of overdose and connect them to services, and calls for the development of more ACS programs.

Using data from leading hospital ACS programs statewide, the report – “Inpatient Addiction Consult Services in Massachusetts: Insights and recommendations from six model programs” – outlines the barriers and challenges these programs face and offers recommendations and guidance on developing and expanding these evidence-based programs in the Commonwealth and nationally. The report was produced by the Institute for Community Health, a nonprofit consulting organization.

“Many individuals in inpatient care have a substance use disorder (SUD) that is left untreated and the risk of opioid-related overdose mortality is heightened following a hospital discharge,” said RIZE President and CEO Julie Burns. “The inpatient hospital setting is the perfect opportunity to identify at-risk individuals and provide accessible harm reduction and recovery services that they desperately need once they return to the community.”

Research has shown that ACS programs provide a solution for maximizing patient and provider satisfaction, increasing SUD treatment post-discharge, reducing hospital readmission, lessening addiction severity and substance use and potentially reducing overdoses and improving additional health outcomes.

“Despite the strong evidence, these programs are not widely utilized and remain
unstandardized,” said Ranjani Paradise, Director of Evaluation at the Institute for Community Health and lead author of the report. “Additionally, stigma among hospital staff, including physicians, has been shown to lead to unpleasant encounters and contribute to patients with substance use disorders fearing hospitals and avoiding treatment. Without ACS protocols, individuals may leave the hospital early due to withdrawal symptoms or use drugs unsafely without the knowledge of their care team.”

Bridge clinics, low-threshold programs that provide rapid initiation of medication for SUD treatment as well as stabilization during high-risk transitions, are seen as a key missing link in post-discharge care to manage risks and lessen harm in the community.

Three key recommendations for building out an effective system of hospital addiction care across Massachusetts include:

  • Improving ACS programs by implementing policies and protocols that support harm reduction goals and address stigma among hospital staff and leadership, so as to increase patient trust and comfort in receiving treatment.
  • Improving connections to services after discharge in order to reap long term benefits of ACS programs by providing patients with appropriate follow-up care, expanding access to methadone and investing in bridge clinics and community-based harm reduction and treatment services.
  • Facilitating sustainability by optimizing the insurance reimbursement system,
    increasing reimbursement rates and coverage of addiction services, continuing research on the return-on-investment of ACS programs and using government and philanthropic funding to cover remaining costs.

The report also offers implementation guidelines for hospitals to initiate or expand ACS programs. RIZE has committed funding to support the development of broad-based, multi-stakeholder networks between hospitals, outpatient providers, community-based organizations, clients and their families, and other key stakeholders to improve linkages to social needs, community, and recovery supports in the near future.

“We are proud to see hospitals across Massachusetts embrace ACS programs, which by now are a proven tool in introducing critical SUD services to patients on the front lines of care,” said Leigh Simons, Senior Director of Healthcare Policy at the Massachusetts Health & Hospital Association. “These are lifesaving interventions, but we agree they cannot reach their full potential without better access to post-hospital services, improved insurance supports, and bold efforts to build and train the healthcare workforce. MHA and our members applaud RIZE for its leadership in advancing ACS programs and its partnership to improve equitable SUD treatment
throughout the commonwealth.”

The report is available online here.

About RIZE Massachusetts

RIZE Massachusetts Foundation is solely dedicated to funding and creating solutions to end the overdose crisis. Guided by those with lived experience and unafraid of new ideas, RIZE is building networks, designing programming, and supporting community partners who are using novel approaches to preventing overdose and increasing access to treatment. Learn more at https://www.rizema.org/.