The number of drug-overdose deaths in the U.S. has declined over the last two years. However, 96,000 lives are projected to be lost to the drug crisis in 2024 alone. This ongoing epidemic has also led to a rise in hospitalizations related to opioid use and a growing need for post-acute care.
Following a hospital stay, patients with opioid use disorder (OUD) may stabilize enough that they no longer require intensive hospital care but could still benefit from medical attention before returning home. For these patients, skilled nursing facilities (SNFs)—inpatient facilities designed for short-term care needs without the high costs associated with hospitals—can be a solution.
But there are obstacles: People with OUD face barriers to admission to SNFs due to stigma, financial constraints and regulatory obstacles. SNFs also often lack adequate funding and staff, especially for Medicaid patients. Further, providing methadone, one of three proven treatments for OUD, is difficult due to federal regulations that limit the distribution of these medications to opioid treatment programs (OTPs).
A team of researchers led by Patience Moyo Dow, associate professor of health services, policy and practice at Brown, has published a policy commentary outlining strategies to improve access to care and medication for people with OUD in SNFs. They stress potential policy changes that address stigma against people with OUD, better financial support for SNFs and stronger SNF-hospital partnerships that could ease the transitions of patients between facilities.
“One key motivator for this research is the aging population in the U.S. with OUD,” said Dow. “Data suggests that the prevalence of OUD among older adults is increasing, and this group is also experiencing higher rates of overdose fatalities. Older adults, by nature, tend to use SNFs more frequently due to age-related factors like reduced independence and chronic conditions.”
With this study, the researchers are seeking to prepare the health care system for the rise in older patients with OUD who require post-acute care, ensuring their unique needs are met effectively.
One of the research team’s key recommendations is to expand access to medications for opioid use disorder—or MOUD—in SNFs. Here, progress has been made with support from the U.S. Department of Justice, which found that SNFs violate the Americans with Disabilities Act when they refuse to admit a patient who takes MOUD. Additionally, in 2022, the Drug Enforcement Administration eliminated its requirement that buprenorphine be dispensed by trained clinicians.
