The national opioid epidemic continues to take a significant toll on individuals, families, and communities. It also highlights longstanding deficiencies and opportunities within our healthcare system to better care for some of the most vulnerable and stigmatized members of our community: those struggling with addiction.

This crisis has prompted a series of pragmatic and interdisciplinary innovations at Harborview Medical Center that aligns the work and resources of internal medicine, psychiatry and behavioral health, the pain service, hospital administration and others in an effort to expand access to evidence-based treatments. In addition to expanding outpatient treatment, under the leadership of Matt Iles-Shih, MD, MPH, Rick Ries, MD, Joseph Merrill, MD, MPH, Jared Klein, MD, MPH, and Mark Snowden, MD, MPH, a new inpatient integrated addiction medicine consult service (AMCS) was recently developed to provide access to substance use disorders (SUDs) evaluation and treatment for hospitalized patients. Addiction is a significant direct and indirect driver of medical and psychiatric hospital admissions, and a failure to address a patient’s substance use disorder during hospitalization can result in poor in-hospital and post-discharge outcomes.

Using the existing SBIRT program for screening, assessment, and clinical triage, the AMCS leverages the additional expertise of a mental health nurse, peer specialist, psychiatrist and internists. The majority of the team’s work has focused on treatment of opioid use disorder and, to a lesser extent, alcohol (and sedative-hypnotic) use disorder – conditions that benefit from medication-assisted treatment for withdrawal management and long-term maintenance therapy. This team-based approach has been essential in effectively treating patients who frequently struggle with multiple and severe medical, surgical/trauma-related conditions requiring the coordinated efforts of multiple specialty teams.

Through these efforts, patients and their clinical teams have improved access to formal in-person addiction medicine physician consultations, increasing from three to over forty per month, on average. Moreover, the service has facilitated successful care transitions to outpatient settings as well as treatment retention for substance use disorder and other health conditions. For example, of nearly 150 patients referred from AMCS to the Harborview After Care Clinic, almost 60% remain currently active within After Care/Adult Medicine or were referred to other addiction services providers for ongoing treatment.

With additional SAMHSA funding, the AMCS will soon be able to increase nursing, peer, and physician support allowing the team to broaden its direct inpatient care, provide clinical education to colleagues, develop new learning opportunities for medicine and psychiatry trainees, identify and address institutional barriers, and better support transitions in care and improving retention in treatment.