Hospital policies for opioid use disorder treatment: A policy content analysis and environmental scan checklist

Objective: Hospital-based delivery of opioid agonist therapy ([OAT]; buprenorphine, methadone) is an often-overlooked component of the opioid use disorder (OUD) care continuum. Hospitals are complex clinical environments and organizational policies may inform access to care. This study aimed to identify and describe OUD-related hospital policies. Methods: We obtained policies through a purposive sampling of addiction physicians affiliated with 10 U.S. hospitals. Experts provided 25 documents that we analyzed using a framework analysis. We then assessed policy concordance with national recommendations and conducted a post-hoc synthesis to create an environmental scan checklist. Results: We observed two hospital policy domains, with four sub-domains, each: 1) OAT management (a. acute pain and perioperative; b. OAT continuation; c. OAT initiation; d. opioid withdrawal) and 2) security and behavioral management (a. aberrant drug use; b. patient-directed discharge; c. safety protocols; d. peripherally inserted central catheters). OAT policy concordance with national guidance varied by sub-domain. Our post-hoc synthesis resulted in a hospital policy environmental scan checklist. Conclusions: Hospital policies are not a singular solution to increasing OAT access, however, in the midst of a worsening drug-related overdose crisis, we observed the divergence of policies from federal recommendations. Policies should enhance, rather than deter OAT access.