Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA.
Division of General Internal Medicine, University of Colorado, Aurora, CO, USA.
J Gen Intern Med. 2024 Feb;39(3):385-392. doi: 10.1007/s11606-023-08411-0. Epub 2023 Sep 15.
Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP.
Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage.
Seven hundred-bed university hospital in Aurora, CO.
A physician dually affiliated with a hospital's addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins.
IN-MEET enrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments.
Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7 years, standard deviation [SD] 11.2 years vs. 36.1 years, SD 10.6 years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%).
IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.
美沙酮可改善患有阿片类药物使用障碍（OUD）的住院患者的阿片类药物戒断症状。根据联邦法规，为了在出院后继续使用美沙酮，患者必须参加阿片类药物治疗计划（OTP）。未得到控制的阿片类药物戒断是将患者从医院转到 OTP 的障碍。
描述一个符合联邦规定的住院美沙酮注册团队（IN-MEET），该团队通过促进医院与 OTP 的联系，将患有 OUD 的住院患者纳入 OTP 治疗。
科罗拉多州奥罗拉市的一家拥有 700 张床位的大学医院。
一名医生同时隶属于医院的成瘾咨询服务和社区 OTP，完成联邦法律要求的住院面对面医疗评估，并滴定美沙酮以达到舒适状态。一名拥有医院特权的 OTP 附属护士完成心理社会评估，并通过安排交通和提供每周电话检查来提供病例管理。
IN-MEET 完成注册、医院到 OTP 的衔接情况，以及与完成社区 OTP 注册的患者相比，完成 IN-MEET 注册的患者的描述性特征。
在 2019 年 4 月至 2023 年 4 月期间，我们的团队完成了 165 次 IN-MEET 注册。在 73 名 IN-MEET 患者的一个子集中，有 56 名（76.7%）在出院后到 OTP 就诊。与社区 OTP 注册患者（n=1687）相比，IN-MEET 患者中有更高比例的人年龄较大（39.7 岁，标准差[SD]为 11.2 岁 vs. 36.1 岁，SD 为 10.6 岁）和无家可归（n=43，58.9% vs. n=199，11.8%）。与社区 OTP 注册患者相比，IN-MEET 患者中有更高比例的人报告海洛因或芬太尼是他们的主要物质（n=53，72.6% vs. n=677，40.1%），报告他们的次要物质是冰毒（n=27，37.0% vs. n=380，22.5%），并报告他们注射了主要物质（n=46，63.0% vs. n=478，28.3%）。
IN-MEET 促进了弱势人群的医院与 OTP 的衔接。这种模式有可能改善可能不会寻求治疗的住院患者获得美沙酮的机会。
