Open Funding Opportunities

This notice of special interest (NOSI) is part of the NIH's Helping to End Addiction Long-term (HEAL) initiative to speed the development and implementation of scientific solutions to the national opioid public health crisis by bolstering research across NIH to (1) improve treatment for opioid misuse and addiction and (2) enhance pain management. More information and periodic updates about the HEAL Initiative are available at: https://heal.nih.gov/.

In the United States, a relatively small number of high-need patients account for a disproportionately high level of healthcare utilization, including hospital admissions and costs. Having a substance use disorder (SUD) increases the risk of an individual falling into this high-risk, high-need population. Furthermore, the co-occurrence of general medical conditions and SUD, including opioid use disorder (OUD) complicates the treatment and can worsen the outcomes of both. Screening for SUD and OUD is not routine for most medical or surgical admissions. Even when identified, individuals can experience worse outcomes for their medical or surgical conditions because of stigma or because their SUD may complicate their hospitalization in other ways (e.g., poor venous access in people who inject drugs). At the same time, individuals being treated in medical or surgical wards may not receive evidence-based treatment or linkage to outpatient OUD/SUD treatment upon discharge.

There are existing models for initiation of treatment for OUD during general inpatient hospital medical stays, some of which involve linkage to care post-discharge (e.g., addiction consult services, consultation liaison psychiatry referrals, care coordinators, patient navigators, bridge clinics). Some of these have been studied formally for short time periods and/or at limited scale. Others may have both emergency department (ED) and inpatient treatment initiation and linkage, but far more evaluation has been done on the ED initiation and linkage than the inpatient components. These models have not been scaled up and used widely to date, indicating possible limitations with the models, additional barriers to implementation, or limited experience with the models in varied health systems.

In addition, there is literature to support the idea the hospital may be an appropriate place to screen for and assess SUDs including OUD, that OUD may complicate or extend the hospital stay and increase costs, and that initiation of treatment during hospitalization and linkage to continued outpatient care can be beneficial in reducing hospital re-admissions.