by Melissa Weimer, DO, MCR MedPage Today
Weimer is a physician and an associate professor of medicine and public health.
Two people are wheeled into a hospital at the same time: one for a heart attack and one for an opioid overdose. You might expect that both individuals will be offered standard of care treatment for their respective conditions — but unfortunately that is not the case.
The person with the heart attack will likely be met by a specialty cardiology team who will employ best practice medical evidence to treat the heart attack within 90 minutes.
Meanwhile, the person with the opioid overdose will most likely neither receive standard-of-care treatment for their addiction, nor be evaluated by a specialty addiction medicine physician or team. The patient with opioid overdose will subsequently have a 90% chance of using opioids again, increasing their risk of another overdose or death.
I am one of the few hospital-based addiction medicine physicians in the country. I received 2 years of training in the treatment of addiction, have board certification from the American Board of Preventive Medicine, and have worked in the field for the last 15 years. I work on the front lines of one of the largest healthcare systems in the country in a highly diverse city that has one of the highest rates of opioid overdose deaths in the state. Over the last 6 years, our hospital-based addiction medicine program has treated over 10,000 patients with substance use disorders.
Sadly, most hospitals in the U.S. don’t offer addiction treatment or the medications most effective at treating addiction. This means people who are admitted to the hospital with an opioid-related condition may have to suffer with untreated opioid withdrawal and have to wait for treatment until they are discharged. Some primary care practices, outpatient, and inpatient specialty care practices provide opioid use disorder treatment, but many are not readily accessible and may have extensive waiting lists. When someone is immediately ready to get help for their opioid use disorder, not offering this care in the hospital is a discouraging and dangerous missed opportunity.
Over the last 50 years, there have been major advances in the field of addiction. What was once considered a “moral failing” is now understood to be a medical disease, whose symptoms are detrimental behaviors that can have severe consequences on individuals’ health and livelihood and lead to premature death if not treated. However, with evidence-based treatment, it is a very treatable disease.
Given the massive human and financial toll of the opioid epidemic, it is imperative that national regulatory standards are updated to ensure U.S. hospitals are prepared to provide addiction treatment, which has advanced significantly. This would require organizations such as CMS and the Joint Commission, which accredits hospitals, to adopt these standards and require hospitals to adhere.
Currently, CMS and the Joint Commission do not require comprehensive addiction treatment to be provided in hospitals. As a result, only a handful of hospitals employ specialists to provide this care. To my knowledge, only two out of 27 acute care hospitals in Connecticut have addiction medicine specialists on staff, for example. Nationally, less than 40% of hospital offer specialty services or medications to treat addiction, and these numbers are lowest in rural areas and predominantly Black communities. Providing this treatment for opioid use disorder, for example, would cut risk of death by up to 60%opens in a new tab or window and increase the odds individuals will enter and stay in addiction treatment.
Creation of such a standard is well within the purview of CMS and the Joint Commission. For comparison, they have created a standard for hospitals to address heart disease. To be considered an Acute Heart Attack Ready Hospital, a hospital must provide cardiac catheterization — provided only by highly trained cardiologists — within 90 minutes of first medical contact.
Of course, several barriers must be overcome before addiction treatment requirements could be instituted for hospitals. For one, addiction medicine specialists are rare: currently, fewer than 2,500 physicians nationwide are certified in addiction medicine, and only 2,000 are certified in addiction psychiatry. To solve this, we need long-term government funding for addiction fellowships. Currently, most addiction medicine fellowship programs in the U.S. are funded by grants or private philanthropy. More robust funding, including federal funding, is essential to support addiction specialists, just as federal funding supports other medical specialties.
U.S. hospitals are not keeping up with the needs of our population or with the most recent treatments. To save lives, hospitals must invest more heavily in medical specialists who can provide lifesaving treatments to those suffering from overdoses or those at risk of death from substance use. Effective medication treatments have existed since the 1950s: we need to make sure people suffering from addiction are receiving them.
Melissa Weimer, DO, MCR, is a physician, associate professor of medicine and public health at Yale University in New Haven, and a Public Voices Fellow of the OpEd Project. Her book, The Hospital Addiction Medicine Handbook, will be published by Wolters Kluwer in 2025.
