(113) Addiction Medicine Consultation for Patients at Post-Acute Long-Term Care Facilities

Background & Introduction: Substance Use Disorders (SUD) remain a common problem, with statistics indicating that approximately 17% of Americans over 18 years of age suffer from a SUD. Hospitalization is a frequent event for people with SUD, and many hospitalized people with SUD require prolonged care in a residential facility (including skilled nursing facilities [SNF] and other post-acute long-term care [PALTC] facilities) after hospital discharge.

While patients with SUD often require admission to nursing facilities, historically, PALTC facilities generally care for older adults without SUD, and are therefore unfamiliar with the specific needs and logistics for caring for patients with SUD. In addition, many patients with SUD are often denied admission to PALTC facilities, likely due to stigma, lack of education around caring for patients with SUD, and feeling under-resourced to care for patients with SUD. This experience and exposure gap can impact the care of residents with SUD, perhaps contributing to conflict, undertreatment of pain, and patient-directed discharges. There is limited data on programs specifically designed to care for patients with SUD in PALTC facilities.

Methods: At Cooper Center for Healing in Camden, NJ, for the past 4 years, board-certified addiction medicine physicians have provided on-site consultative support for residents of six PALTC facilities in southern New Jersey. Services provided include consultation regarding dosing of medications for opioid use disorder (MOUD), advising on treatment of anxiety and other triggers for return to use, and initiation of medications to treat alcohol use disorder. Residents are seen for initial consultations, and then at variable intervals based on resident need, staff request, and physician discretion. The physicians also act as advocates for patients with SUD, in conversations with nursing, physicians, advance practice providers, and administration. One physician has been certified as a provider at a local Opioid Treatment Program (OTP), allowing for methadone dose adjustment without the need for travel to the OTP. They have initiated and delivered long-acting injectable therapies (buprenorphine and naltrexone), and arranged for the on-site treatment of several patients for Hepatitis C.

Results: In calendar year 2025, a total of 234 PALTC residents were seen in consultation at 6 long-term care facilities in southern New Jersey. There were 807 total patient encounters. The number of patients seen at each facility ranged from 6 residents to 113 residents. 10 residents were seen during admissions to more than one facility. Twenty patients received a total of 34 injections of long-acting injectable therapy (1 naltrexone and 19 long-acting injectable buprenorphine), and 3 patients initiated care for Hepatitis C. Four patients were seen for initiation of methadone or modification of methadone dosing.

Conclusion & Discussion: In-person addiction medicine consultation in PALTC facilities represents a pragmatic approach to addressing gaps in care for residents with SUD. In-person consultation may help normalize addiction care within long-term care settings while improving patient experience and retention in care. It can reduce stigma, facilitate connections to care after discharge, and enable the use of newer therapies as well as treatment for associated diseases such as Hepatitis C. Future work will evaluate the impact of addiction-focused education on PALTC staff knowledge, attitudes, and clinical practices, as well as identify patient-level and system-level predictors of sustained engagement in addiction treatment. A further aim is to increase the number of patients receiving methadone dose adjustments as well as treatment for Hepatitis C. Together, these efforts may inform scalable models for integrating addiction care into long-term care and improve outcomes for a historically marginalized population.

References: Bazzi A, Ghazanfari MJ, Aghaei I, et al. A Systematic Review of Knowledge and Attitude of Nurses Towards Substance Use or Users. Addict Health. 2024;16(4):297-304. doi:10.34172/ahj.1326
Kelly LM, Flori JN, Sabella KA, Zajac K. Demographic Differences Among Adults and Emerging Adults With, Without, and in Recovery from Alcohol and Other Drug Use Disorders. Subst Use Misuse. 2025 Nov 30:1-11. doi: 10.1080/10826084.2025.2577281. Epub ahead of print. PMID: 41320815.
Mitchell SG, Nordeck CD, Lertch E, et al. Patients with substance use disorders receiving continued care in skilled nursing facilities following hospitalization. Subst Abus. 2022;43(1):848-854. doi:10.1080/08897077.2021.2007512
Moyo P, Nishar S, Merrick C, et al. Perspectives on Admissions and Care for Residents With Opioid Use Disorder in Skilled Nursing Facilities. JAMA Netw Open. 2024;7(2):e2354746. Published 2024 Feb 5. doi:10.1001/jamanetworkopen.2023.54746
Waters K, Handa L, Caballero B, Telahun A, Bann M. Substance Use Disorder as a Predictor of Skilled Nursing Facility Referral Failure. J Gen Intern Med. 2022;37(13):3506-3508. doi:10.1007/s11606-022-07534-0