Case Management

Tips for discharging patients with substance abuse problems

Case Management Monthly, April 1, 2011

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Patients that are active substance abusers present additional challenges when it comes to planning a hospital stay and eventual discharge.

Inpatient providers need to consider how a patient's substance abuse and dependence can affect the way the patient responds to medications and to make sure the patient does not become dependent on any of the medications he or she receives during the hospital stay, says ­Maria M. Garcia, MD, MPH, assistant professor of medicine and family and community health, hospitalist and physician advisor to utilization and care coordination at UMass Memorial Medical Center in Worcester, MA.

The Substance Abuse and Mental Health Services Administration's 2009 National Survey on Drug Use & Health estimated 5.3 million people had used prescription analgesics nonmedically within a month of the survey. This presents a large challenge for inpatient providers because patients who are opioid abusers typically incur higher healthcare costs.

According to a study published in the Journal of Managed Care Pharmacy by White et al. (2005), direct healthcare costs (physician's visits, outpatient costs, hospital inpatient costs, and drug costs) for opioid abusers were approximately eight times higher than for non-abusers.

"Some factors that may contribute to the cost in ­treating substance abusers are the associated medical and psychological comorbid conditions that often accompany the substance abuse," says Garcia.

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