Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis

  • Honora EnglanderEmail author
  • Konrad Dobbertin
  • Bonnie K. Lind
  • Christina Nicolaidis
  • Peter Graven
  • Claire Dorfman
  • P. Todd Korthuis
Original Research



Hospitalizations due to medical and surgical complications of substance use disorder (SUD) are rising. Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge.


Determine the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement.


Cohort study using multivariable analysis of Oregon Medicaid claims comparing IMPACT patients with propensity-matched controls.


18–64-year-old Oregon Medicaid beneficiaries with SUD, hospitalized at an Oregon hospital between July 1, 2015, and September 30, 2016. IMPACT patients (n = 208) were matched to controls (n = 416) using a propensity score that accounted for SUD, gender, age, race, residence region, and diagnoses.


IMPACT included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge.


Healthcare Effectiveness Data and Information Set (HEDIS) measure of SUD treatment engagement, defined as two or more claims on two separate days for SUD care within 34 days of discharge.


Only 17.2% of all patients were engaged in SUD treatment before hospitalization. IMPACT patients engaged in SUD treatment following discharge more frequently than controls (38.9% vs. 23.3%, p < 0.01; aOR 2.15, 95% confidence interval [CI] 1.29–3.58). IMPACT participation remained associated with SUD treatment engagement when limiting the sample to people who were not engaged in treatment prior to hospitalization (aOR 2.63; 95% CI 1.46–4.72).


Hospital-based addiction medicine consultation can improve SUD treatment engagement, which is associated with reduced substance use, mortality, and other important clinical outcomes. National expansion of such models represents an opportunity to address an enduring gap in the SUD treatment continuum.


substance-related disorders hospitalization substance use treatment Medicaid 



Authors would like to acknowledge the entire IMPACT clinical and research teams. Specifically, they would like to thanks Alisa Patten and Devin Collins for their contributions to this paper, and Dr Melissa Weimer, Daren Ford, and O'Nesha Cochran Dumas for their dedication as the original IMPACT clinical team

Funding Information

This study was funded by the OHSU School of Medicine. IMPACT is funded by Oregon Health & Science University and CareOregon. The OHSU School of Medicine funded IMPACT evaluation activities. Dr. Korthuis’ time was supported by the National Institutes of Health and National Institute on Drug Abuse (UG3DA044831, UG1DA015815). This publication was made possible with support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1TR002369 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

Compliance with Ethical Standards

This study was approved by the Oregon Health & Science University (OHSU) Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The funders had no role in the design, conduct, and reporting of this study.

Supplementary material

11606_2019_5251_MOESM1_ESM.xlsx (37 kb)
ESM 1 (XLSX 36 kb)


  1. 1.
    Tedesco D, Asch SM, Curtin C, Hah J, McDonald KM, Fantini MP, et al. Opioid abuse and poisoning: trends in inpatient and emergency department discharges. Health Aff (Millwood) 2017;36(10):1748–53.CrossRefGoogle Scholar
  2. 2.
    Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002-12. Health Aff (Millwood) 2016;35(5):832–7.CrossRefGoogle Scholar
  3. 3.
    Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, et al. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med 2012;6(1):50–6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Weiss A, Elixhauser A, Barrett M, Steiner C, Bailey M, O’Malley L. Opioid-related inpatient stays and emergency department visits by state, 2009-2014. Statistical Brief #219. Healthcare Cost and Utilization Project. 2016. Accessed May 21, 2019.
  5. 5.
    Winkelman TA, Admon LK, Jennings L, Shippee ND, Richardson CR, Bart G. Evaluation of amphetamine-related hospitalizations and associated clinical outcomes and costs in the United States. JAMA Netw Open 2018;1(6):e183758.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in drug use-associated infective endocarditis and heart valve surgery, 2007 to 2017: a study of statewide discharge data. Ann Intern Med. 2018 Dec 4.
  7. 7.
    Naeger S, Ali MM, Mutter R, Mark TL, Hughey L. Prescriptions filled following an opioid-related hospitalization. Psychiatr Serv 2016;67(11):1262–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Englander H, Collins D, Perry SP, Rabinowitz M, Phoutrides E, Nicolaidis C. “We’ve learned it’s a medical illness, not a moral choice”: qualitative study of the effects of a multicomponent addiction intervention on hospital providers’ attitudes and experiences. J Hosp Med 2018;13(11):752–8.PubMedGoogle Scholar
  9. 9.
    Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health 2015;105(12):e53–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    McNeil R, Small W, Wood E, Kerr T. Hospitals as a ‘risk environment’: an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Soc Sci Med 2014;105:59–66.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ (Clinical research ed). 2017;357:j1550.CrossRefGoogle Scholar
  12. 12.
    Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889–900.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenthal ES, Karchmer AW, Theisen-Toupal J, Castillo RA, Rowley CF. Suboptimal addiction interventions for patients hospitalized with injection drug use-associated infective endocarditis. Am J Med 2016;129(5):481–5.CrossRefGoogle Scholar
  14. 14.
    Winetsky D, Weinrieb RM, Perrone J. Expanding treatment opportunities for hospitalized patients with opioid use disorders. J Hosp Med 2018;13(1):62–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Saitz R. Treatment for opioid addiction must be offered in general hospitals: but how? J Addict Med 2019;13(2):83–4.CrossRefPubMedGoogle Scholar
  16. 16.
    D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. Jama. 2015;313(16):1636–44.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Merrall EL, Bird SM, Hutchinson SJ. A record-linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996–2006. Addiction 2013;108(2):377–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014;(2):CD002207.Google Scholar
  19. 19.
    Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016;(5):Cd011117.Google Scholar
  20. 20.
    Saxon AJ, Ling W, Hillhouse M, Thomas C, Hasson A, Ang A, et al. Buprenorphine/naloxone and methadone effects on laboratory indices of liver health: a randomized trial. Drug Alcohol Depend 2013;128(1–2):71–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Harris AH, Humphreys K, Bowe T, Tiet Q, Finney JW. Does meeting the HEDIS substance abuse treatment engagement criterion predict patient outcomes? J Behav Health Serv Res 2010;37(1):25–39.CrossRefPubMedGoogle Scholar
  22. 22.
    Arria AM. Drug treatment completion and post-discharge employment in the TOPPS-II Interstate Cooperative Study. J Subst Abus Treat 2003;25(1):9–18.CrossRefGoogle Scholar
  23. 23.
    Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Ann Intern Med 2016;164(1):1–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Englander H, Weimer M, Solotaroff R, Nicolaidis C, Chan B, Velez C, et al. Planning and designing the Improving Addiction Care Team (IMPACT) for hospitalized adults with substance use disorder. J Hosp Med 2017;12(5):339–42.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174(8):1369–76.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wakeman SE, Rich JD. Barriers to post-acute care for patients on opioid agonist therapy; an example of systematic stigmatization of addiction. J Gen Intern Med 2017;32(1):17–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Shanahan CW, Beers D, Alford DP, Brigandi E, Samet JH. A transitional opioid program to engage hospitalized drug users. J Gen Intern Med 2010;25(8):803–8.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Trowbridge P, Weinstein ZM, Kerensky T, Roy P, Regan D, Samet JH, et al. Addiction consultation services - linking hospitalized patients to outpatient addiction treatment. J Subst Abus Treat 2017;79:1–5.CrossRefGoogle Scholar
  29. 29.
    Fanucchi L, Lofwall MR. Putting Parity into Practice - Integrating Opioid-Use Disorder Treatment into the Hospital Setting. N Engl J Med 2016;375(9):811–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. J Gen Intern Med 2017;32(8):909–16.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Englander H, Gregg J, Gullickson J, Cochran O, Colasurdo C, Alla J, et al. Recommendations for intergrating peer mentors in hospital-based addiction care. Subst Abus In press.
  32. 32.
    Englander H, Mahoney S, Brandt K, Brown J, Dorfman C, Nydahl A, et al. Tools to support hospital-based addiction care: core components, values, and activities of the Improving Addiction Care Team. J Addict Med 2019;13(2):85–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Priest KC. Hospital-based services for opioid use disorder: a study of supply-side attributes. Dissertation and Theses. 2019. Paper 4829. Available from:
  34. 34.
    Rubin DB. Using multivariate matched sampling and regression adjustment to control bias in observational studies. J Am Stat Assoc 1979;74(366):318–28.CrossRefGoogle Scholar
  35. 35.
    Kronick R, Gilmer T, Dreyfus T, Lee L. Improving health-based payment for Medicaid beneficiaries: CDPS. Health Care Financ Rev 2000;21(3):29–64.PubMedPubMedCentralGoogle Scholar
  36. 36.
    National Committee for Quality Assurance. Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET). 2017. [Cited 2019 June 7]. Available from:
  37. 37.
    Centers for Medicare & Medicaid Services. ICD-10-CM/PCS MS-DRG v34.0 Definitions Manual. [cited 2019 Apr 12]. Available from:
  38. 38.
    Socías ME, Wood E, Kerr T, Nolan S, Hayashi K, Nosova E, et al. Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016. Drug Alcohol Depend 2018;189:90–5.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Dehejia R, Wahba S. Propensity score matching methods for non-experimental causal studies. Rev Econ Stat 2002;84:151–61.CrossRefGoogle Scholar
  40. 40.
    Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD 2018. [cited 2019 Apr 12]. Available from:
  41. 41.
    Potier C, Laprevote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend 2014;145:48–68.CrossRefGoogle Scholar
  42. 42.
    Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav 2013;17(9):2878–92.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O’Reilly C, et al. Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review. Ann Intern Med 2017;167(12):867–75.CrossRefPubMedGoogle Scholar
  44. 44.
    Thakarar K, Weinstein ZM, Walley AY. Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist. Postgrad Med J 2016;92(1088):356–63.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Borders TF, Booth BM. Research on rural residence and access to drug abuse services: where are we and where do we go? J Rural Health 2007;23 Suppl:79–83.CrossRefPubMedGoogle Scholar
  46. 46.
    Ziller EC, Anderson NJ, Coburn AF. Access to rural mental health services: service use and out-of-pocket costs. J Rural Health 2010;26(3):214–24.CrossRefPubMedGoogle Scholar
  47. 47.
    Deaton A, Cartwright N. Understanding and misunderstanding randomized controlled trials. Soc Sci Med 2018;210:2–21.CrossRefPubMedGoogle Scholar
  48. 48.
    Frieden TR. Evidence for Health Decision Making - Beyond Randomized, Controlled Trials N Engl J Med 2017;377(5):465–75.CrossRefPubMedGoogle Scholar
  49. 49.
    Weiss AJ, Heslin KC. Payers of opioid-related inpatient stays and emergency department visits nationally and by state, 2010 and 2015. HCUP Statistical Brief #239. Agency for Healthcare Research and Quality, Rockville (MD). 2018. [cited 2019 Apr 12]. Available from:

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.Center for Health Systems EffectivenessOregon Health & Science UniversityPortlandUSA
  3. 3.Portland State University School of Social WorkPortlandUSA
  4. 4.Oregon Clinical and Translational Research InstituteOregon Health & Science UniversityPortlandUSA

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