Barriers to Management of Opioid Withdrawal in Hospitals in England: A Document Analysis of Hospital Policies

Author: Adam Holland Jenny Scott Dan Lewer Vivian Hope Michael Brown Niamh Eastwood Magdalena Harris

Theme: Social Science & Policy Research Year: 2022

People who use illicit opioids are more likely to be admitted to hospital than people of the same age
in the general population. Many admissions end in discharge against medical advice, which is
associated with readmission and all-cause mortality. Opioid withdrawal contributes to premature
discharge. We sought to understand the barriers to timely provision of opioid substitution therapy
(OST), which helps to prevent opioid withdrawal, in acute hospitals in England.
We requested policies on substance dependence management from 135 National Health Service
trusts, which manage acute hospitals in England, and conducted a document content analysis. We
worked closely with people with lived experience of OST and/or illicit opioid use, informed by
principles of community-based participatory research.
Eighty-six (64%) trusts provided 101 relevant policies. An additional 44 (33%) responded but could
not provide relevant policies, and five (4%) did not definitively respond. Policies illustrated
procedural barriers to OST provision, including inconsistent application of national guidelines.
Continuing community OST prescriptions for people admitted in the evening, night-time, or weekend
was often precluded by requirements to confirm doses with organisations that were closed during
these hours. The policies of 19/86 trusts (33%) did not include guidance on initiating OST in hospital,
and 5/86 trusts (6%) prohibited it. 42/101 trusts (42%) required or recommended a urine drug test
positive for OST medications or opiates prior to OST prescription. The language used in many policies
was stigmatising and characterised people who use drugs as untrustworthy.
Many hospitals in England have policies that likely prevent timely and effective OST. Delays to
continuity of OST between community and hospital settings may contribute to opioid withdrawal
and increase the risk of discharge against medical advice. Acute hospitals in England require
standardised best practice policies that account for the needs of this patient group.
Disclosure of Interest Statement:
NE works for Release, which has received a grant from Ethypharm. Otherwise, the authors declare no
conflicts of interest.

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