Managing In-Hospital Substance Use

EP 04

🎙 Special Series: Advances in Buprenorphine Education

This episode is part of a special series on improving hospital and clinic-based buprenorphine treatment for opioid use disorder.

 

In this episode of ASAM Practice Pearls, Dr. Carolyn Chan and Dr. Shawn Cohen welcome addiction medicine expert Dr. Marlene Martin. With extensive experience in helping care teams navigate the complexities of in-hospital substance use, Dr. Martin provides insights on how hospital-based providers can effectively address these challenges with confidence and compassion.

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Host

Carolyn Chan, MD MHS

Dr. Carolyn Chan is board-certified in both internal and addiction medicine. She completed her IM residency at UH Hospitals Cleveland Medical Center, followed by an addiction medicine and medical education fellowship at Yale. She provides care in both inpatient and outpatient addiction medicine settings. Currently, she is the Program Director of the University of Cincinnati Addiction Medicine Fellowship and is committed to educating all health professionals on how to provide evidence-based care to individuals with substance use disorders.

Co-Host

Shawn Cohen, MD

Dr. Shawn Cohen is an addiction medicine doctor at Yale New Haven Hospital. He provides care on a hospital-based addiction consult service and is interested in lowering barriers to MOUD, improving the care of patients experiencing alcohol withdrawal, and making the hospital a more person-centered and less stigmatizing place for people who use substances.

Expert

Marlene Martin, MD

Dr. Marlene Martin is an Associate Professor at UCSF and hospitalist at San Francisco General Hospital. She is the founding director of the Addiction Care Team, which provides compassionate, evidence-based care for hospitalized people with substance use disorders. As Director of Addiction Initiatives for the Latinx Center of Excellence, she coleads PEDAL, a Spanish-language addiction training program for community health workers, aiming to improve care for Latine individuals with substance use disorders. Her work focuses on health equity, harm reduction, and innovative care models.

📖 Show Segments

• 00:05 – Introduction
• 02:20 – Case Scenario: Managing In-Hospital Substance Use
• 03:26 – Approaching In-Hospital Substance Use
• 07:16 – Best Practices for Hospital Policies
• 12:55 – Handling Substances and Paraphernalia in Hospitals
• 16:15 – Engaging Stakeholders in Policy Development
• 17:59 – Navigating Policy Concerns
• 21:47 – Managing Adverse Outcomes
• 23:35 – Mitigating Patient Discomfort When a Search Occurs
• 26:15 – Engaging Nurses in Substance Use Management
• 28:15 – Revisiting the Case Scenario
• 30:00 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Prioritize compassionate care. Approach in-hospital substance use with empathy, understanding, and kindness to foster trust and better outcomes for both patients and healthcare workers.
• Avoid punitive measures. Minimize the involvement of security or law enforcement unless there is an imminent safety threat.
• Maintain open communication. Be transparent with patients about hospital policies, concerns, and available support resources.
• Follow evidence-based treatment. Provide medications and interventions aligned with best practices for managing substance use disorders.
• Incorporate harm reduction strategies. Integrate harm reduction principles into hospital care plans to support patient safety and recovery.
• Address root causes. Identify and manage underlying issues such as untreated pain or withdrawal symptoms that may contribute to substance use.
• Engage a multidisciplinary team. Involve nursing staff, regulatory teams, and hospital leadership to develop and implement effective partnerships and policies.
• Continuously review policies. Regularly update hospital guidelines to reflect evolving best practices and improve outcomes for both patients and staff.
• Empower nursing teams. Provide training and resources to help nurses lead addiction care efforts within hospital settings.
• Consider patient agreements. Use collaborative agreements with patients as a proactive step before resorting to stricter measures.

🔗 Resources

• ASAM’s Advanced Buprenorphine Education Series: Explore here.
• Martin M, Snyder HR, Otway G, Holpit L, Day LW, Seidman D. In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care. J Addict Med. 2023;17(1):10-12. doi:10.1097/ADM.0000000000001046.
• Calcaterra SL, Martin M, Bottner R, Englander H, Weinstein Z, Weimer MB, Lambert E, Herzig SJ. Management of opioid use disorder and associated conditions among hospitalized adults: A Consensus Statement from the Society of Hospital Medicine. J Hosp Med. 2022 Sep;17(9):744-756. doi: 10.1002/jhm.12893. Epub 2022 Jul 26; PMID: 35880813; PMCID: PMC9474708. Read more.

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