A Pact Between Patient and Caregiver to Avoid Opioid Misuse

The Massachusetts hospital community continues to take important steps to address the opioid crisis affecting Massachusetts and the U.S.

Last week, MHA, working with Tufts Medical Center and various clinicians and operational staff within member facilities, released two documents to assist hospitals in addressing a trend of patients misusing opioids within their facilities. Hospitals have reported that patients being treated for substance use disorder are frequently reverting to opioid use during treatment, often assisted by friends and family who bring non-prescribed opioids into the hospital.

The documents – Inpatient Opioid Misuse Prevention Guidelines and Patient and Family Agreement on Opioids – were authored by Deeb Salem, M.D., Tufts Medical Center’s co-interim CEO and chair of the Department of Medicine at Tufts University School of Medicine; Steven Defossez, M.D., MHA’s Vice President for Clinical Integration; Tufts University School of Medicine student Ifeanyi D. Chinedozi; and Tufts University student Megan V. Fernandez, now at University of Massachusetts Medical School.

The prevention guidelines identify clinical practices and operational policies to optimize patient care, and include among other strategies: screening for opioid use disorder; prevention of acute withdrawal through medication assisted therapy; management of acute pain for those suffering from chronic opioid use; preventing patients and visitors from bringing opioids into a hospital; and care coordination for patients refusing to follow zero-tolerance of opioid misuse.

The patient and family agreement documents are consent forms spelling out the steps the hospital’s care team will take to assist patients on their road to recovery, and the obligations of patients, family members, and visitors to help achieve those goals.

“Our nation’s opioid epidemic has become the great equalizer. No zip code, no income level, no background, is immune from its devastating reach.  It will take all of our best and collective efforts to solve this complex problem that has already taken far too many lives. Hospitals on the front lines of this battle are committed to using our resources and expertise to develop and effect solutions.  We’ve led the way on implementing prescription limits, which is beginning to make a significant difference in reducing access to opioids,” said Steve Walsh, president & CEO of MHA. “We are gravely concerned knowing that addicted patients bring heroin or non-prescribed opioids with them to the hospital, or try to obtain illegal drugs during their stay.  Today, we announce a new component in our initiative to prevent unlawful and dangerous opioid use within hospitals. We are working in tandem with our member hospitals and other concerned groups to launch inpatient guidelines and a patient/family agreement to provide a first-in-the-nation, comprehensive, statewide framework to screen, manage, and treat patients with Opioid Use Disorder.”