“They Never,Never,Never Give Up on Me”: Perspectives on an Addiction Consult Service From Hospitalized People Who Use Opioids at 6 New York City Public Hospitals

Abstract

Background:

Lifesaving medications for opioid use disorder (MOUD) exist; however, most people with opioid use disorder (OUD) do not receive treatment. Hospitalization is one important opportunity to engage people with OUD and offer treatment, including MOUD. Between 2018 and 2020, 6 public hospitals in New York City launched the “Consult for Addiction Treatment and Care in Hospitals” (CATCH) program to provide interprofessional addiction consult services to hospitalized patients.

Methods:

This qualitative study aims to add perspectives from 30 racially and ethnically diverse people with opioid-related diagnoses who were hospitalized at a CATCH hospital between October 2019 and April 2021. We used purposive sampling to recruit demographically diverse individuals who accepted or declined aspects of CATCH services. Interviews were audio-recorded, transcribed, and coded for emergent themes using grounded theory techniques. The framework of structural vulnerability was utilized to highlight how social context impacts patients’ experiences of healthcare, and in turn affects their addiction trajectories.

Results:

Participants overwhelmingly accepted MOUD to manage withdrawal symptoms during hospitalization, and many planned to continue MOUD after discharge. Participants appreciated the interprofessional support of CATCH teams which included medical providers, social workers, addiction counselors, and peers. While participants felt that CATCH made holistic addiction treatment including MOUD more accessible, structural issues created barriers to continuing treatment long term. Some participants still felt stigmatized or “punished” for their drug use by non-CATCH providers.

Conclusion:

CATCH met an urgent need for nonjudgmental care and medical management of opioid withdrawal. Additional interventions that address broader needs, including housing and social supports, as well as trust-building healthcare encounters for patients who have been historically marginalized, are needed to meet the public health goal of preventing overdose and reducing drug-related morbidity for this population.