Hospital Addiction Consultative Service Increases MOUD Initiation and Linkage to Follow-up After Discharge
Clinical question: Does an addiction-focused consult service increase medications for opioid use disorder (MOUD) initiation during inpatient hospitalization and connect patients to follow-up care post-discharge?
Background: Hospitalization is an opportunity to prescribe evidence-based treatments for opioid use disorder (OUD).
Despite the evidence for MOUD, medications are often not prescribed at the time of discharge. Prior studies have shown the benefits of an addiction-medicine team. This is the first parallel-assignment, randomized, controlled trial comparing the effectiveness of an addiction-medicine consult team to usual care.
Study design: Randomized controlled trial
Setting: Three U.S. hospitals in separate healthcare systems
Synopsis: This trial enrolled English- and Spanish-speaking patients aged greater than 18 years with a life expectancy of more than six months who were not currently being treated for OUD. Patients were randomized to the Substance Use Treatment and Recovery Team (START) intervention versus usual care. The START intervention consisted of an interprofessional team, including a physician and a case manager. The two primary outcomes were the proportion of patients who initiated MOUD prior to discharge and the proportion of patients attending at least one OUD-related follow-up visit within 30 days of discharge.
The 325 patients were randomized, 164 to START and 161 to usual care. START participants were significantly more likely to receive MOUD during their hospitalization compared to those receiving usual care (57.3% versus 26.7%; adjusted risk ratio, 2.1 [97.5% CI, 1.51-2.91]) and to be linked to follow-up care (72.0% versus 48.1%; adjusted risk ratio, 1.49 [97.5% CI, 1.15-1.93]).
Bottom line: The START interprofessional team increased the proportion of patients initiating MOUD during hospitalization and linkage to follow-up care at discharge for patients with OUD.
Citation: Ober AJ, et al. Hospital addiction consultation service and opioid use disorder treatment: the START randomized clinical trial. JAMA Intern Med. 2025;185(6):624-633. doi:10.1001/jamainternmed.2024.8586.
Dr. Cunningham is a hospitalist at UT Health San Antonio and an associate clinical professor in the division of internal medicine at the Joe R. & Teresa Long School of Medicine in San Antonio.