Research

(P53) “Breaking Bad” Barriers: An Opioid Use Disorder Transitions Program©

Presenting Author(s)

Scott Bolhack, MD, CMD, MBA, CWSP, PCWC, FACP (he/him/his)

Regional Medical Director
Genesis Physician Services
Tucson, Arizona, United States

Primary Author(s)

SH

Sergio Huerta, MD

University of New Mexico Hospital
Albuquerque, New Mexico, United States

Introduction: In New Mexico, hospitalizations for patients with opioid use disorder (OUD) have increased, even above the rising national average for these patients. Across the nation, SNFs do not routinely admit patients on medications for opioid use disorder (MOUD), like buprenorphine or methadone, due to misperceptions and prejudices including a younger age, inappropriate visitors, seeking for narcotics, social service needs that cannot be met, and reimbursement issues .These misperceptions prevent delivering skilled care for the appropriate needs of these patients, and prevents the initiation of medications in the hospital for patients with OUD. Overall, this practice violates multiple federal antidiscrimination laws, such as the Americans with Disabilities Act, which has resulted in litigation against SNFs in other states.

Design/Methodology: An OUD Transitions Program© was developed to admit patients with a skilled need on MOUD to a SNF. The OUD Transitions Program© originally included one hospital, a single skilled nursing facility, a community opioid treatment program (methadone clinic) and a specialist in Addiction Medicine. We measured demographics and outcomes of the OUD Transitions Program© with the intent of quickly identifying challenges and improving the process(es).

Results: From November 2021 to October 2022, twenty-four patients were enrolled in the pilot. Nineteen patients (79%) were prescribed buprenorphine and five (21%) were prescribed methadone. Twenty-two patients (92%) were on prescribed MOUD at the time of hospital admission and two patients (8%) were newly started on MOUD during hospitalization. There was no reported in-facility substance use, complications related to MOUD, peripherally inserted central catheter (PICC) misuse, behavioral disturbances or patient directed discharge in the pilot group. Twenty-three (96%) patients were successfully transitioned to their outpatient treatment center.

Conclusion/

Discussion: With specific planning and admission criteria, SNFs can have successful rehabilitation stays for residents diagnosed with OUD that require either buprenorphine or methadone. The model OUD Transitions Program© will continue to be developed over time to include additional resources and collaboration with other transitions for these patients.