The opioid epidemic continues to ravage communities across the United States, with more than 75% of overdose deaths involving opioids. Despite the alarming numbers, the medical system is underutilizing one of the most effective tools available: hospital-based opioid treatment and medications for opioid use disorder (MOUD), such as buprenorphine, methadone, and extended-release naltrexone.
These medications significantly reduce the risk of overdose death, yet they remain out of reach for many. A recent study published in JAMA Network Open highlights a deeply troubling missed opportunity: hospital-based opioid treatment during and after hospitalizations for serious injection-related infections (SIRIs).
Hospitals Are Overlooking a Lifesaving Moment
The study analyzed data from nearly 9,000 Massachusetts residents, aged 18 to 64, who had both an opioid use disorder diagnosis and were hospitalized with a SIRI—such as endocarditis, sepsis, or abscesses—between 2011 and 2019.
Despite these being critical windows for intervention, only 41% of patients received MOUD within the year following their hospitalization. That means nearly 6 out of 10 patients were discharged without being connected to any form of hospital-based opioid treatment or follow-up care.
Even more concerning, the one-year mortality rate was 11.1% among these patients—showing how deadly this gap in care can be. This is not just a missed opportunity—it’s a public health failure.
Hospital-Based Opioid Treatment: Why Timing Matters
When someone is hospitalized due to a serious injection-related infection, they are often facing a personal and medical crisis. That moment can be a turning point—a time when they may be more open to change and motivated to engage in treatment.
This makes hospital-based opioid treatment not only a logical step but a potentially lifesaving one.
The study found that patients who had previously received MOUD were more likely to resume treatment post-hospitalization, especially those who had been treated with methadone. This suggests that introducing MOUD early—particularly during hospitalization—can make a lasting difference.
But for those who were not already in treatment, hospitals must act quickly and decisively to offer it. As the researchers noted, low MOUD treatment rates are likely due to failure to initiate or link patients to hospital-based opioid treatment during hospitalization.
Deep Disparities in Access
Beyond the overall low rates of treatment, the study uncovered troubling inequities in access to hospital-based opioid treatment:
- Non-Hispanic Black patients were significantly less likely to receive MOUD compared to white patients.
- Older adults (ages 50–64) were also less likely to receive treatment.
- Individuals discharged to skilled nursing facilities, rehabilitation centers, or home health services had lower MOUD uptake as well.
Dr. Sandra Springer of Yale School of Medicine addressed these disparities directly in her commentary on the study. “Stigma, ageism, and racism related to opioid use disorder exist across many health care settings, which impedes access to lifesaving MOUD,” she wrote.
These findings reveal a need to standardize hospital-based opioid treatment by adopting universal screening and removing bias from the decision-making process. By implementing protocols that automatically assess patients for OUD and initiate treatment regardless of age, race, or discharge plan, hospitals can begin to close this gap.
What Needs to Change: Solutions for a Stronger Response
To improve the implementation and reach of hospital-based opioid treatment, researchers and public health advocates recommend several key strategies:
- Universal OUD Screening in Hospitals
Every patient hospitalized with an infection related to drug use should be screened for opioid use disorder as part of their routine care. - Initiating MOUD During Hospitalization
Treatment shouldn’t wait until after discharge. Starting MOUD while the patient is still in the hospital increases the chance they’ll stick with it. - Addiction Medicine Consultant Programs
These in-hospital teams can assess patients, initiate treatment, and ensure follow-up—making hospital-based opioid treatment more seamless and consistent. - Training Clinicians to Address Bias
Hospitals need to actively train staff to recognize and combat stigma, racism, and ageism in their treatment approaches. - Better Coordination with Outpatient Care
Strong connections between hospitals and community providers ensure that hospital-based opioid treatment continues after discharge, reducing relapse and readmission rates.
The Urgency of Action
The findings from this study reflect a broader truth: hospital-based opioid treatment is a powerful but underused tool in the fight against the opioid epidemic. Serious injection-related infections are not only dangerous—they are loud warning signs that intervention is needed now, not later.
Unfortunately, hospitals too often miss that signal, discharging patients without connecting them to any form of treatment. This lack of action leads to recurring infections, overdoses, and—far too often—death.
By integrating hospital-based opioid treatment into routine care for patients with OUD, we can save lives, reduce suffering, and turn hospitalizations into meaningful turning points for recovery.
Dr. Springer put it plainly: “Adopting universal screening and diagnosis of OUD can lead to immediate initiation of MOUD, including in hospitals, and could reduce potential practitioners’ bias in deciding who receives assessment and treatment.”
A Call for Change
The research is clear. The tools exist. The evidence is overwhelming.
It’s time for hospitals to fully embrace hospital-based opioid treatment as a standard of care—not an optional extra. Every missed opportunity puts lives at risk. Every successful intervention could be the one that turns someone’s story around.
