Objective: Despite high rates of opioid use disorder (OUD) among patients admitted for acute inpatient psychiatric treatment, medications for opioid use disorder (MOUD) are not routinely prescribed in this setting. Dually diagnosed individuals are more likely to present to the mental health system for treatment than to substance use disorder programs; therefore, initiating MOUD in psychiatric units would increase treatment access. Following the implementation of a protocol to offer MOUD to patients admitted to psychiatric units, clinical staff perspectives were evaluated. Methods: Semistructured interviews were conducted with 15 staff members following protocol implementation in 2 psychiatric units. Interviews were inductively coded and thematically analyzed. Results: Five themes emerged: (1) co-occurring OUD and psychiatric disorders are common in psychiatric units; (2) opioid withdrawal treatment during psychiatric admission is widely acceptable to staff, but support for maintenance treatment varies; (3) misconceptions regarding MOUD persist among staff; (4) patients with co-occurring disorders have complex psychosocial needs requiring multimodal treatment; (5) stigma can be a barrier to OUD treatment. Conclusions: Staff recognized the high prevalence of OUD in psychiatric units and the need for treatment. Despite some reluctance about MOUD initiation in this setting, MOUD remains the gold standard and should be available to patients with OUD wherever they seek medical care, consistent with a “No Wrong Door” approach. Improved education and multidisciplinary collaboration may increase staff acceptance of MOUD. Finally, MOUD initiation for dually diagnosed patients will be most successful when integrated within a multidisciplinary treatment model and coordinated community-based care.
Nedell et al. (Tue,) studied this question.