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Continuing Medical Education College of Medicine
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The Case for Hospital-Based Addiction Treatment

Activity
Post Test

Presented by:
Julie Teater, MD, DFAPA, FASAM
Associate Clinical Professor

Medical Director of Addiction Medicine, OSUWMC
Addiction Medicine Fellowship Program Director
Department of Psychiatry & Behavioral Health
Ohio State University Wexner Medical Center

Faculty Disclosure:

Dr. Teater has disclosed that she has no relevant financial relationship(s). No one else in a position to control content has any financial relationships to disclose. Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/. All relevant financial relationships have been mitigated.

Release Date: February 2, 2024
Expiration Date:  February 1, 2026

Target Audience: All physicians

Learning Objectives:

As a result of participation in this activity, participants should be able to:

  1. Discuss the evidence surrounding the benefits of addiction care in the emergency department and inpatient hospital setting.
  2. Review interventions undertaken by an academic medical center to improve addiction care in the hospital.
  3. Describe the outcomes of these interventions.

Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resource(s) for further study:

  1. https://www.cdc.gov/drugoverdose/data/
  2. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
  3. Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA.2019;322(20):1996–2016. doi:10.1001/jama.2019.16932
  4. https://www.cdc.gov/drugoverdose/images/epidemic/3WavesOfTheRiseInOpioidOverdoseDeaths.png
  5. https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2018.html
  6. https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/violence-injury-prevention-program/Drug-overdose/
  7. Hall OT, Hall OE, Kolodny A, Teater J, McGrath RP. Assessment of Excess Mortality Associated With Drug Overdose in Ohio From 2009 to 2018.JAMA NetwOpen.2020;3(4):e202183. doi:10.1001/jamanetworkopen.2020.2183
  8. https://www.harmreductionohio.org/may-2020-deadliest-month-ever-for-overdose-death/
  9. https://public.tableau.com/views/CFCAP/ODdeath_Dash?%3Adisplay_count=y&publish=yes&%3Aorigin=viz_share_link&%3AshowVizHome=no
  10. https://www.dispatch.com/news/20200226/overdoses-suicides-homicides-in-franklin-county-up-at-least-40-this-year
  11. Centers for Disease Control and Prevention. Evidence-Based Strategies for Preventing Opioid Overdoses: What’s Working in the United States. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, 2018. http://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf
  12. Blevins C, Rawat N, and Stein M. Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions. J Addict Med. Vol 12, no 4. July/Aug 2018.
  13. Babu K, Brent J, and Juurlink D. Prevention of Opioid Overdoses. N EnglJ Med. 2019; 380: 2246-55. DOI: 10.1056/NEJMra1807054
  14. NIDA. Many People Treated for Opioid Overdose in Emergency Departments Die Within 1 Year. National Institute on Drug Abuse website. https://www.drugabuse.gov/news-events/nida-notes/2020/04/many-people-treated-opioid-overdose-in-emergency-departments-die-within-1-year. May 12, 2020 Accessed August 22, 2020.
  15. D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636-1644. doi:10.1001/jama.2015.3474
  16. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Ann Intern Med. 2018 Aug 7;169(3):137-145. doi: 10.7326/M17-3107. Epub2018 Jun 19. PMID: 29913516; PMCID: PMC6387681.
  17. Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, Dossabhoy S, Stein M. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014 Aug;174(8):1369-76. doi: 10.1001/jamainternmed.2014.2556. PMID: 25090173; PMCID: PMC4811188.
  18. Moreno J, Wakeman S, Duprey M et al. Predictors for 30-Day and 90-Day Hospital Readmission Among Patients with Opioid Use Disorder. J Addict Med. Jan. 8, 2019.
  19. Simon R, Snow R, Wakeman S. Understanding why patients with substance use disorders leave the hospital against medical advice: A qualitative study. SubstAbus. 2020;41(4):519-525. doi: 10.1080/08897077.2019.1671942. Epub2019 Oct 22. PMID: 31638862.
  20. Chutuape, M. A., Jasinski, D. R., Fingerhood, M. I., & Stitzer, M. L. (2001). One-, three-, and six-month outcomes after brief inpatient opioid detoxification. The American Journal of Drug and Alcohol Abuse,27(1), 19-44.
  21. Houchard G, et al., Hospital Opioid Requirements Following Continuation Versus Discontinuation of Buprenorphine for Addiction–A Retrospective Cohort Study, Journal of Pain & Palliative Care Pharmacotherapy. Volume 33, 2019 -Issue 3-4
  22. Dunlap B, CifuAS. Clinical Management of Opioid Use Disorder.JAMA.2016;316(3):338–339. doi:10.1001/jama.2016.9795
  23. Sordo Luis, Barrio Gregorio, Bravo Maria J, Indave B Iciar, Degenhardt Louisa, Wiessing Lucas, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studiesBMJ2017;357:j1550
  24. Wakeman SE, Larochelle MR, Ameli O, Chaisson CE, McPheeters JT, Crown WH, Azocar F, Sanghavi DM. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA NetwOpen. 2020 Feb 5;3(2):e1920622. doi: 10.1001/jamanetworkopen.2019.20622. PMID: 32022884.
  25. Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, O’Grady KE, Selby P, Martin PR, Fischer G. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010 Dec 9;363(24):2320-31. doi: 10.1056/NEJMoa1005359. PMID: 21142534; PMCID: PMC3073631.
  26. https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/violence-injury-prevention-program/projectdawn/
  27. Van Boekel LC, Brouwers EP, van Weeghal J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: a systematic review. Drug Alcohol Depend. 2013;131:23-35.
  28. Wakeman S, Barnett M. Perspective. Primary Care and the Opioid-Overdose Crisis-Buprenorphine Myths and Realities. N. Engl J. Med.2018; 379:1-4 DOI:10.1056/NEJMp1802741
  29. http://utmc.utoledo.edu/depts/quality/cicip-team.html
  30. Chua KP, Dahlem CHY, Nguyen TD, Brummett CM, Conti RM, Bohnert AS, Dora-Laskey AD, Kocher KE. Naloxone and Buprenorphine Prescribing Following US Emergency Department Visits for Suspected Opioid Overdose: August 2019 to April 2021. Ann Emerg Med. 2022 Mar;79(3):225-236. doi: 10.1016/j.annemergmed.2021.10.005. Epub2021 Nov 19. PMID: 34802772; PMCID: PMC8860890.
  31. Jones CM, Noonan RK, Compton WM. Prevalence and correlates of ever having a substance use problem and substance use recovery status among adults in the United States, 2018. Drug Alcohol Depend. 2020 Sep 1;214:108169. doi: 10.1016/j.drugalcdep.2020.108169. Epub2020 Jul 12. PMID: 32682218.
  32. National Institute on Drug Abuse (NIDA) Medications to Treat Opioid Use Disorder. June 2018. https://www.drugabuse.gov
  33. Santo T, Clark B, Hickman M, et al. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021;78(9):979–993. doi:10.1001/jamapsychiatry.2021.0976

If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at nancy.boyd@ufl.edu