High-yield Pearls from the APA Council on C-L Psychiatry Workgroup on Treatment of Opioid Use Disorder in the General Hospital: A Guide for C-L Psychiatrists

The morbidity, mortality and financial burden of the opioid epidemic have dramatically increased over the past two decades necessitating a call-to-action for healthcare systems, medical specialties, and practitioners to reassess the current approach to OUD treatment. The general hospital CL psychiatrist is poised to play a vital role in the early engagement of patients with OUD, serving as liaison with medical/surgical specialties and other key stakeholders to facilitate seamless transitions and early initiation of medication for OUD (MOUD). Unfortunately CL psychiatry is often not a member of the OUD treatment team with barriers including: prevailing hospital culture, the presence of other specialty services who have “owned” the role (addiction medicine, pain), lack of knowledge about the scope of psychiatry by consulting members of the treatment team, and lack of psychiatrist comfort, education, and experience treating OUD.

In recognition of this gap, the American Psychiatric Association (APA) Council on Consultation-Liaison Psychiatry convened a workgroup on the Treatment of OUD in the General Hospital, in collaboration with the APA Council on Addiction Psychiatry, and with representation from ACLP, the American Academy of Addition Psychiatry, and the Association of Medicine and Psychiatry. The goal of the workgroup was to produce a comprehensive resource for psychiatrists treating OUD in the general hospital. To best inform the process, in December 2020, the workgroup convened a roundtable discussion with officially designated representatives from stakeholder specialty organizations (addiction medicine, surgery, emergency medicine, infectious disease, ob/gyn, hospital administration) to learn about specialty-specific approaches to OUD and opportunities for collaboration with psychiatry.

In this high-yield workshop for both the novice and experienced practitioner, presented by faculty and trainee members of the APA Workgroup on Treatment of OUD in the General Hospital, we will address must-know pearls for every CL psychiatrist. Dr. Margo Funk, chair of the workgroup, will introduce and moderate the session, giving an overview of findings from the APA Workgroup stakeholder roundtable discussion, including considerations identified by our medical and surgical peers across specialties. Dr. Shawn Jin will review social, political and systemic barriers to access MOUD. Dr. Alison Smith will discuss MOUD prescribing regulations and protocols for early induction, maintenance and micro-dosing of buprenorphine. Dr. Joji Suzuki will discuss the role of bridge clinics and patient navigators in facilitating the transition of care from the hospital to the community or post-acute care facilities, as well as discharges from inpatient psychiatric units. Dr. Stefania Buonocore will discuss strategies for overcoming stigma and shifting hospital culture through identification of champions, highlighting success stories, and use of non-carceral approaches to front-line clinical care. To best engage the learner, interactive case examples will be used throughout the session to highlight best-practice approaches to common clinical scenarios.