Overcoming Barriers to Initiating Medication-assisted Treatment for Heroin Use Disorder in a General Medical Hospital: A Case Report and Narrative Literature Review
| Autor: | Karen Miotto, Sameer Hassamal, Waguih William IsHak, Itai Danovitch, Matthew Goldenberg, Margaret Haglund |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Referral Narcotic Antagonists media_common.quotation_subject Specialty 030508 substance abuse Disease Hospitals General Heroin 03 medical and health sciences 0302 clinical medicine Opiate Substitution Treatment medicine Humans 030212 general & internal medicine Intensive care medicine Psychiatry Referral and Consultation Cause of death media_common Inpatients Heroin Dependence business.industry Addiction Opioid-Related Disorders Buprenorphine Psychiatry and Mental health Female 0305 other medical science business medicine.drug |
| Zdroj: | Journal of Psychiatric Practice. 23:221-229 |
| ISSN: | 1527-4160 |
| Popis: | Deaths due to heroin overdoses are increasing and are the leading cause of death among intravenous heroin users. Although medication-assisted treatment (MAT) improves morbidity and mortality in patients with opioid use disorders, it is underutilized. Most efforts to expand access to MAT have focused on outpatient settings. Although the inpatient medical setting presents a critical opportunity to initiate treatment, general hospitals are often unfamiliar with MAT, creating a number of barriers to its use. In this report, we describe the case of a woman with heroin use disorder who was initiated on buprenorphine maintenance treatment while hospitalized for cardiac disease related to her intravenous heroin use. Barriers to initiating buprenorphine in this case included patient, practitioner, and organizational factors, and, ultimately, shared misperceptions about the feasibility of administering buprenorphine in a general medical hospital. These barriers were addressed, buprenorphine was initiated, and the patient demonstrated reduced craving, improved postoperative pain control, improved overall well-being, increased engagement in discharge planning, and acceptance of referral for addiction specialty aftercare. Our experience with this patient suggests that it is feasible to initiate buprenorphine in acute medical settings and that such treatment can improve patient outcomes. Our review of the literature reveals emerging evidence supporting the value of this practice. |
| Databáze: | OpenAIRE |
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