Stanford Hospital Addiction Services
Stanford Hospital Addiction Services (SHAS) cares for hospitalized patients with substance use disorders through counseling, medications, and linkage to treatment on discharge. SHAS is made up of three dedicated Addiction Inpatient Medicine (AIM) services across Stanford Health Care locations: Palo Alto (AIM-PA), Tri-Valley (AIM-TV), and Sequoia (AIM-SQ).
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.
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