Table 1 How the START addresses treatment barriers for inpatients with OUD with evidence-based tools and resources

 Diagnosis and assessment for OUD, pain, withdrawal and psychosocial issues

Primary medical team focused on acute issues and may not identify or provide treatment for the underlying OUD

CM and AMS trained to assess OUD and relevant comorbidities, and to address key problems during the hospitalization in a non-judgmental and respectful way; whole person focus

DSM-5 diagnostic criteria [102]

ASAM level of care criteria tool [103]

 Motivational interviewing/harm reduction/trauma-informed care

Patient ambivalence, disempowerment and perceived stigma; mistrust

CM uses motivational interviewing, psychoeducation and trauma-informed care

Brief Negotiated Interview (BNI) [104, 105], adapted for hospital setting

Education about safe injecting practices and overdose, provision of intranasal naloxone at discharge

Culturally appropriate trauma-informed care [77]

 Assessment of indications for MOUD

Inpatient provider lack of knowledge about MOUD, training and protocols

AMS with DEA X-waiver; MOUD protocols

ASAM national practice guideline for the use of medications in the treatment of addiction involving opioid use [103]

Protocol for use of MOUD in the inpatient setting (adapted from California Bridge Project) [81]

 OUD-focused discharge planning

Poorly coordinated care transitions; discharge planning not OUD-specific

CM uses adapted evidence-based discharge planning protocol and facilitates appropriate communication between key medical providers

Project Reengineered Discharge (RED), adapted for patients with OUD [69]

Electronic registry to monitor protocol delivery and track patients after discharge [73]

 Access to post-discharge OUD care

Limited outpatient capacity

Rapid-access discharge pathways set up

Relationships with community OUD providers to establish rapid-access discharge pathways, resource lists