Cedars-Sinai to Test New Opioid Abuse Treatment Method

A $5 million grant from the National Institutes of Health will enable the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences to lead a multi-site study that aims to improve care for hospitalized patients with opioid use disorder.

Patients with opioid use disorder are commonly hospitalized for medical complications of drug use, such as infections and overdose. Between 2002 and 2012, hospitalizations for complications of opioid use increased to over one half million admissions per year. Effective treatments are available for opioid use disorders, yet few hospitals offer these treatments during the inpatient stay. Hospitals typically focus on treating acute medical problems. All too commonly, if patients are given anything, it is merely a list of referral options without any follow-up. While internists and surgeons see the ravages of addiction and want to intervene, they often have limited training or experience and may defer addressing conditions like opioid use disorder to outpatient providers. Yet few hospitals directly link patients to community aftercare programs, and many patients slip through the cracks.

To help solve this problem, a group of researchers at Cedars-Sinai, the RAND Corporation, the University of New Mexico Hospital in Albuquerque, New Mexico, and Baystate Health in Springfield, Massachusetts, will evaluate a new model of care that aims to identify individuals with opioid use disorders, start them on treatment, and directly link them to aftercare programs in the community. The intervention will involve a consultative care team, comprised of a care manager and physician specializing in addiction treatment, who will guide medical and surgical teams to help them incorporate evidence-based treatments for addiction. Addiction consultation teams have been established at several hospitals across the county, but they have never been evaluated in a patient-level randomized controlled trial.

"Hospitalization represents a critical window of opportunity to identify underlying health problems or disparities, and initiate interventions to address them,” said Itai Danovitch, MD, chair of the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences and co-principal investigator of this study. “Opioid use disorders are a very compelling example of this, because once somebody is hospitalized for an overdose, their long-term risk of returning to the hospital is exceptionally high. Offering addiction treatment and getting them on the road to recovery has a profound impact on health, and also helps to reduce avoidable readmissions and health care costs. This is an opportunity to improve value for patients and improve efficiency for systems of care.”

For the upcoming study — expected to begin this summer __ the three hospitals will enroll a total of 414 patients. Patients will be assigned to an addiction focused consultative team or receive standard care. The addiction physician will conduct a medical assessment and evaluate whether the patient is a candidate for treatment with certain FDA approved drugs such as methadone, buprenorphine/naloxone. The care manager will develop an addiction focused discharge plan with active follow-up care and post-discharge management. Researchers will evaluate the extent to which this consultative model of care increases the rate of addiction focused discharge planning, initiation of medication assisted treatment, and linkage to aftercare in the community. They will also assess variability and context across the three participating sites, the goal being to understand how this model of care, if proven to be effective, can be scaled across hospitals at large.

"The hope is that offering addiction care during the hospitalization will help us reach people who are suffering and disconnected, and help close the gap in treatment for this addressable disease," said Danovitch. "Knowledge from this study could transform the way care is provided in hospitals for opioid use disorders, as well as other behavioral health conditions such as depression."

The study and assembly of the interdisciplinary research teams, were made possible by a grant from the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH), as well as the collaborative efforts and resources of the individual Clinical and Translational Science Awards hubs (CTSA). They include the Trial Innovation Network, the Recruitment Innovation Center and translational and implementation researchers at the RAND Corporation. Cedars-Sinai, University of New Mexico, and Baystate Health are all members of the national network of Clinical and Translational Science Awards (CTSA) Program.

Read more on the Cedars-Sinai Blog: Understanding the Opioid Crisis