Addiction Inpatient Medicine (AIM)

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1. Identify a program. 

• Usually, people choose a program that is covered by their insurance because treatment is expensive.
• If you have MediCal you can call you county helpline and they will help you start finding a treatment program. Find the phone number to your county helpline here: MediCal Substance Use Treatment Program Helplines for Rehabs and IOP.
• If you do not have MediCal and you have commercial insurance, call the phone number on your insurance card and talk with a representative to find treatment programs in your area that is covered by your insurance. If you are unsure, you can also work with the hospital's social workers or the addiction medicine team to identify a program covered by your insurance.
• If you do not have any insurance, speak with the social worker as soon as possible to explore your options for coverage.
   

2. Start calling programs early.

• If you decide you want to get into a treatment program on discharge, the research shows that starting the process in the hospital and getting into a program immediately after discharge is associated with better success than waiting to setup a program after you discharge. We see the most success with people who transfer directly from the hospital to a treatment program, assuming they are medically cleared for a residential program. If you are planning to enter an IOP, this means having one setup before you discharge if possible. If you are not feeling well, have your family or the addiction medicine team help you set the program up. 
   

3. Choose the right level of care

• The right level of treatment depends on the severity of your addiction. Most people need a lot of structure and support to break the cycle of addiction in the beginning of their journey. Treatment programs can be either a residential program (a rehab that you live at for 30 days or more) or it can be an intensive outpatient program (a program you go to daily while you continue to live at home).
  
  If you currently do not have a home or residence, we suggest you enter into a residential program so you have a safe place to sleep and eat. Once you complete this program you can transition to an aftercare program, sober living environment, or recovery residence to help maintain your sobriety and save money up for a longer-term living situation.
  

1. Identify a buprenorphine provider before discharge.

• Although it is legal for all doctors to prescribe buprenorphine (aka suboxone or subutex), not all doctors are comfortable prescribing buprenorphine on discharge. You will need to work with your social worker or addiction medicine team to identify a prescriber on discharge.
• You can use the internet to find providers in your area using the following links:
  • Choose Change MAT Clinic Finder
  • Find a SuboxoneDoctor.com
     

2. Make sure your pharmacy carries buprenorphine before you discharge.

• Not all pharmacies carry buprenorphine. If your pharmacy does not carry buprenorphine, this will likely lead to a delay of a day or two before you get your medications, and you should have your buprenorphine sent to another pharmacy. You can work with your case managers and social workers to help you do this, but you can also call your pharmacy yourself to make sure that they carry buprenorphine, and call around to identify other pharmacies that carry buprenorphine. 

1. Work with your social workers to identify a methadone clinic on discharge.


2. Methadone clinics require daily dosing

• Methadone clinics require you to come in every day to take your liquid methadone while someone supervises you to make sure you have ingested your medications. This means you need to take your full daily dose of methadone in the hospital before you are discharged and ensure you have a methadone clinic appointment setup after discharge so that you don't miss a day of your methadone. 
   

3. Arrange transportation so you can make it to the methadone clinic daily.

• Helping Families Help: 
  Uses CRAFT-based approaches to help families with their own self-care and help their addicted loved ones get into treatment and reduce their substance use. Website includes helpful resources, list of CRAFT counselors, and CRAFT virtual and in-person groups for loved ones.
  
  
• SMART Friends and Family Support Group 
  This group is also based on CRAFT and you can join anonymously online using this online meeting schedule link to find “Friends and Family” Meetings. You can also find in-person meetings on the website as well.  
   

• Al-Anon Family Groups: 
  Al-Anon members are people who have been affected by someone else’s drinking. No matter what our specific experience has been, we share a common bond: we feel our lives have been affected by someone else’s drinking.
  • Alateen Family Groups: Alateen, for younger family members and friends, is a part of Al-Anon Family Groups.
     

• Codependency Anonymous (CODA): 
  The only requirement for membership is a desire for healthy and loving relationships. Coda’s purpose is to carry the message of recovery from codependency.
  
  
• National Alliance of Mental Alliance (NAMI): 
  NAMI provides advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives.
  
  

• Substance Abuse and Mental Health Services (SAMHSA): 
  SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA was established in 1992 to make substance use and mental disorder information, services, and research more accessible.

Patients with substance use disorder (SUD) make up nearly one-third (29.1%) of hospitalized patients in the United States and have double the 30-day readmission rates. Hospital addiction medicine services that treat these patients have been consistently shown to reduce readmissions, increase the number of days of abstinence in the first month after hospital discharge, reduce addiction severity, improve engagement with addiction treatment, and decrease mortality.

In response to the national and local overdose epidemic, an addiction consult service was launched at Stanford Hospital and designed to deliver gold standard treatment for SUD, including bedside psychotherapy, medication management for cravings, withdrawal, and linkage to treatment programs on discharge. In the first year, Stanford’s new consult service reduced the 30-day readmission rate in SUD patients by over 60% without increasing hospital length of stay. This metric continued to improve to 67.8% in the second year, and 78.1% in the third year. The services provided by the consult service placed Stanford Medical Center in the Excellent category on the California Opioid Care Honor Roll and a press release regarding this designation was published in partnership with the California Health and Human Services. The consult service was also awarded three separate grants to expand the team that now consists of addiction medicine physicians, psychiatrists, licensed clinical social workers, certified alcohol and drug counselors, and peer mentors. The diverse experience of our team create a unique learning opportunity, and we provide clinical rotations with curriculums for medical students, residents, and fellows from varied specialties.

Our team also creates many advocacy events beyond Stanford. We host an event for international overdose day at Stanford Hospital open to the community. We started a free opioid overdose education and naloxone distribution program that provides free naloxone to the community, Stanford and Lucille Packard Hospitals, and several clinics. When regional fentanyl overdoses increased dramatically, we educated on how to respond to fentanyl overdoses and started a harm reduction program providing free fentanyl test kits to the community so users can test for and avoid fentanyl. When DEA restrictions affected hospital opioid use across the country, our service published a press statement urging hospitals to maintain evidence-based use of opioids. We developed a novel protocol to start buprenorphine specifically in hospitalized patients that minimized opioid withdrawal. This increased the use of buprenorphine by a factor of 10 in the hospital and has been adopted by hospitals across the nation. During the COVID pandemic, we piloted the first completely telehealth inpatient addiction service which improved engagement and outcomes. We plan to grow our inpatient addiction medicine interventions, study their outcomes to advocate for improved hospital care for SUD patients nationally, and monitor and respond to regional trends to combat the overdose epidemic.

Hosted by the Inpatient Addiction Medicine Team at Stanford Hospital to raise awareness on how our
community can combat increasing overdose deaths through compassion and evidence-based strategies.