“Now hospital leaders are paying attention”: A qualitative study of internal and external factors influencing addiction consult services

Background: Hospitalizations related to opioid use disorder (OUD) are increasing, necessitating an increase in the delivery of opioid agonist therapy (OAT) among hospitalized adults. The addiction consult service (ACS) is a promising organizational intervention to address this growing clinical need. Little is known about the barriers and facilitators of ACS development and operations. Methods: We completed 17 semi-structured telephone interviews with board-certified or board-eligible addiction physicians across 16 U.S. acute care hospitals. Interviews explored contextual facilitators and barriers for ACS development and operations. We transcribed, coded, analyzed interviews, and derived final themes using a directed content analysis. Results: We identified six themes that promoted or inhibited ACS development and operations: 1) stigma and discrimination; 2) internal (e.g., hospital administrators) and external stakeholders (e.g., State Medicaid programs); 3) addiction-informed institutions with addiction-related resources; 4) access to community-based treatment programs (e.g., local opioid treatment programs); 5) restrictive and misinterpreted OAT policies; and 6) service financing. The first theme, stigma and discrimination, is presented as a stand-alone-theme but permeates the five other themes as a broader meta-theme. Conclusions: As OUD-related hospitalizations increase, and the opioid-related overdose crisis continues, understanding the constraints related to the development and operations of ACSs are important preliminary steps for improving the care of patients hospitalized with OUD. Clinical champions, hospital leaders, and hospital societies could act, through practice and policy initiatives, to support ACS development and increase the delivery of evidence-based services (e.g., OAT) to patients hospitalized with OUD.