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Considerations for Safely Discharging Patients from MOUD Programs

Research has shown that mortality rates increase following discharge from opioid use disorder (OUD) treatment. To improve medication adherence, providers should recognize that patients may leave treatment for a variety of reasons including lack of transportation, conflicting work schedules, high cost of services, and relapse. Therefore, a program providing medication for opioid use disorder (MOUD) should consider ways to offer flexible long-term recovery options and connect patients to follow-up services. For example, one MOUD program in rural Utah offers patients access to case management services for at least six months after graduating from the program.

Recovery from OUD is often cyclical, rather than linear. Policies and practices that leave the door open, rather than discharge patients when they relapse, allow patients to return to treatment whenever they would like. Providers can, for example, work with the patient to revise their treatment plan.

If it is known in advance that a patient will be discharged from MOUD treatment, individualized, post-treatment planning can be crucial for ensuring ongoing recovery support. This could include offering aftercare services until the patient is connected with a new provider, linking the patient with community resources like vocational support, coordinating care across settings, and facilitating transitions with a warm hand-off. Aftercare services support recovery maintenance and can be as simple as phone-based check-ins.

Engaging the patient's support system, including family and friends, is also important in supporting long-term recovery, especially as medical supports and treatment teams may be shifting. Bridge clinics and other innovative technologies may be available to support individuals on a waitlist for MOUD programs or patients transitioning from inpatient or residential treatment to the primary care setting.

Patients may feel increasingly anxious as they approach discharge from treatment. MOUD providers may also face challenges anticipating future patient needs and potentially limited availability of community resources in their rural community. When implementing an MOUD program, organizations can mitigate some of these challenges by being proactive in the post-treatment planning process, defining discharge policies, writing down post-treatment planning protocols, standardizing planning forms, training staff involved in the process, fostering relationships with community organizations, and tracking patient follow-up data.

Resources to Learn More

Caring for Patients with Opioid Use Disorder in the Hospital
Document
Discusses the underuse of addiction-specific interventions for adult patients with opioid use disorder (OUD) during acute hospital admissions and at time of discharge. Covers current guidelines and studies on the use of opioid therapy, management of opioid withdrawal and overdose, and treatment for acute pain. Includes a checklist with factors to consider before hospital discharge.
Author(s): Donroe, J.H., Holt, S.R., & Tetrault, J.M.
Citation: Canadian Medical Association Journal, 188(17-18), 1232-1239
Date: 2016

Medication-Assisted Treatment (MAT) in SUD Residential Toolkit
Document
Provides information and resources for residential treatment programs developing practices and policies for MAT and MOUD services. Includes specific guidelines for establishing client discharge procedures.
Organization: Alaska Department of Health and Social Services Division of Behavioral Health
Date: 2019