Do hospitals give their patients Suboxone? It seems like a question that shouldn’t have to be asked. Hospitals have a lot of different kinds of medication. In fact, they have their own complete pharmacies with many more medications than a regular pharmacy. Why wouldn’t a hospital be prepared to treat opioid-addicted patients with Suboxone?
In the years since this was published, in 2019, unfortunately not much has changed. While there are enlightened ER physicians who are experienced in buprenorphine induction and coordinating with local MAT clinics, it is all too common to be turned away from hospital ERs. In fact, instead of either offering appropriate Suboxone therapy or turning the patient away, many institutions are admitting opioid-dependent patients to psych wards and rehabs, using the Baker Act, Marchman Act, or similar compulsory admission law. Mental health care without medication-assisted treatment, using either buprenorphine or methadone, has a low success rate and a high relapse rate.
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Unbelievably, many hospitals do not provide any sort of Suboxone therapy to patients. So, if a patient goes to such a hospital, presenting to the emergency department with an opioid overdose, they may simply be stabilized and sent home, the addiction left untreated.
Is this normal? What happens if a patient presents to the ER with uncontrolled diabetes? The ER doctor makes the diagnosis with lab tests and stabilizes the patient. Then, the patient is admitted to the hospital. They may even stay for several days while further evaluation is performed and medications are started. When the patient leaves the hospital, medication is prescribed and a followup appointment is recommended. In many cases, the patient can even return to the hospital outpatient clinic to continue treatment.
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How is opioid use disorder different from diabetes? Both are chronic medical conditions. Both respond well to medical therapy. And, both diabetes and opioid addiction require regular medical follow up visits with a doctor for the best results. Why do hospitals get to pick and choose what medical conditions they will treat?
In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, known as The Parity Act. It requires health insurance plans that cover addiction treatment to cover it on terms no more restrictive than the coverage for other medical conditions. The Affordable Care Act later built on that law, making substance use disorder treatment an essential health benefit in individual and small group plans. So, when your insurance plan covers addiction treatment, it must treat addiction just like heart disease and diabetes.
Do we need a similar law for hospitals? Imagine going to a hospital with high blood pressure and the ER doctor tells you that they can’t help you. Or, maybe they perform some temporary medical stabilization and then recommend that you go to support group meetings to talk about why your blood pressure is high. Sounds crazy? We expect hospitals to handle the basics. Medication-assisted treatment of opioid use disorder is a basic medical treatment for a chronic medical condition.
Fortunately, things are changing. ER doctors are being trained in MAT. They are learning how to get patients started on treatment and to make arrangements for continuity of care. There are also hospitals that provide ongoing free or low cost MAT services to the underserved community.
The hospital ER is an ideal place to start medical addiction treatment. We should come to expect that hospitals will begin to routinely treat addiction with the current standard of medical care that has been proven to have the highest level of efficacy.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
