Patients with opioid use disorder often rejected for skilled follow-up care, study finds

Some health care facilities in Massachusetts that care for patients after hospitalization are more likely to reject those with an opioid use disorder than patients who don't have the disorder, a new study from Boston Medical researchers finds.

The research, published in this month's Health Affairs, compared placements in skilled nursing, rehabilitation hospitals and other post-acute facilities for patients with and without opioid use disorder (OUD). It found patients with OUD were rejected twice as often.

"The real takeaway is that the system is not working for patients with opioid use disorder," said Dr. Simeon Kimmel, lead author of the study and an infectious disease and addiction medicine specialist at Boston Medical Center's Grayken Center for Addiction. "That has a lot of implications for patients. Many of them [get] stuck in the hospital or end up getting discharged home without the necessary services."

The study looked at 2,463 hospitalizations at Boston Medical Center that resulted in 16,503 referrals to 244 private post-acute care facilities in Massachusetts and New Hampshire in 2018. Massachusetts has the second-highest rate of opioid-related hospitalizations in the country.

Many OUD patients are referred to post-acute care facilities, Dr. Kimmel said, to treat injuries and provide physical or occupational therapies after accidents, overdoses, severe infections, strokes or lung or heart disease diagnoses.

Kimmel said he's concerned the study may not have captured the full extent of the issue, because case managers often automatically refer patients to those post-acute care facilities that are known to accept OUD patients. Many facilities may not have the necessary infrastructure to accept such patients, he said, or provide medications to treat addiction. But, Kimmel added, rejecting patients because of OUD is a violation of state policies and the federal Americans with Disabilities Act.

“The post-acute care facilities in this study disproportionately reject individuals with OUD from medically necessary care despite public health guidelines and legal scrutiny," Dr. Kimmel said. "And the impact of this problem has intensified during COVID as hospitals and nursing facilities have had to reduce the number of beds that are available."

The research follows a 2020 Grayken Center for Addiction study, which found that 29% of private post-acute care facilities in Massachusetts discriminated against individuals with OUD by rejecting their referrals explicitly because of an OUD diagnosis or because of the use of medications used to treat addiction.

Correction: Due to an error in a release about the study, an earlier version of this story gave an incorrect percentage of private post-acute care facilities in Massachusetts that a 2020 Grayken Center for Addiction study found had discriminated against individuals with OUD. It's 29%. The story has been updated.

This article was originally published on March 07, 2022.


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Deborah Becker is a senior correspondent and host at WBUR. Her reporting focuses on mental health, criminal justice and education.



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