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GETTING WELL: EXPANDING TOOLS TO ADDRESS OPIOID USE DISORDER IN THE HOSPITAL
Duffield, Olivia
Duffield, Olivia
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Thesis/Dissertation
Date
2024-05
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Urban Bioethics
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http://dx.doi.org/10.34944/dspace/10190
Abstract
Patients with opioid use disorder (OUD) are at a high risk of a patient directed discharge (PDD) from the hospital and subsequent readmission, which is a significant detriment to their health. Qualitative studies have shown that, amidst myriad other reasons, patients with OUD leave the hospital due to undertreatment of their withdrawal and pain. Current guidance for the inpatient medical management of both withdrawal and, more broadly, OUD is initiation of opioid agonist therapy in the form of methadone or buprenorphine. While both have been shown to be highly effective for maintaining remission from OUD, there exist a myriad of barriers to enacting and maintaining this therapy. One approach to address this gap is expanding the array of opioid medications available to patients in withdrawal to include long and short acting opioids. There is limited data on the patient reported outcomes and perspectives of such an approach. This thesis draws from qualitative interviews of patients with OUD about their experiences being treated with this expansive protocol in order to characterize the attributes of successful withdrawal management for this population. Being treated by an addiction medicine team has already been shown to successfully reduce premature discharge. I argue that this approach, considered unorthodox by some, centers a patient's agency in making the decisions that are best for their situation and reduces harm to patients. The current standards of care do a disservice to patients with opioid use disorder, and this is a more progressive and ethical approach to inpatient addiction medicine that should be applied to other hospitals with high volumes of patients with OUD.
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