Psy-Q: How did community and hospital policy changes early in the pandemic affect hospitalized patients with SUD?

Caroline King, PhD, MPH

Caroline King, PhD, MPH

Honora Englander, MD

Honora Englander, MD

Answer: Rapid changes that took place at the beginning of the pandemic affected hospitalized patients with substance use disorder (SUD) in several ways, according to a qualitative study in PLOS ONE. Based on interviews with study participants, the researchers found, to name a few examples, that business and community closures made basic needs more difficult to obtain, that the lack of a smartphone could mean little to no access to outpatient substance use services, that people turned to hospitals when other outpatient services were closed, and that housing was a top concern after discharge.

Two of the authors shared more about their study with Psycom Pro. Lead author Caroline King, PhD, MPH, is an MD/PhD program student in the Oregon Health & Science University (OHSU) School of Medicine. Senior author Honora Englander, MD, is an associate professor of medicine and the director/PI of the Improving Addiction Care Team (IMPACT) at OHSU’s Division of Hospital Medicine, Department of Medicine.

Psycom Pro: Your team wrote that marginalized people, including those with addiction, are “rarely considered before disaster strikes, and thus disproportionately impacted by disruptive events like pandemics and natural disasters.” What steps can be taken to reduce the impact on marginalized individuals in the event of another disruptive event and what can be done now to support them?

Drs. King and Englander: This is a really important question. Future disruptive events will happen – be it a natural disaster, a particularly bad flu season, or another infection. To reduce the impact on marginalized populations, we need to do two things:

  • fund and support community-driven solutions to reduce marginalization
  • include the perspectives of people who are marginalized in planning for future disruptive events.

A good example from our paper is the huge impact that closed restaurants and shops had in March 2020 on our patients, who lost access to places they would go to get warm, use the restroom, or charge their phones, as community leaders tried to prevent SARS-CoV-2 from spreading. More sustainable housing in our communities would mean fewer people were reliant on public spaces for warmth to begin with.

Given that these solutions will not happen overnight, we also need to understand how decisions that seem beneficial to the average person in our communities (ie, closing restaurants) will impact people who are marginalized. To do this, we need to actively seek out their voices in planning for future disruptive events. (See also, how to deliver trauma-informed care.)

As the pandemic continues, there is increasing evidence that substance use is worsening in the United States. Now more than ever, offering comprehensive and patient-centered addiction care to hospitalized patients is essential.

Psycom Pro: Needle exchange services and a hospital-based addiction consult service were two systems that were able to adapt to the changes brought on by the pandemic; these services provided support for the patients in your study. Why were these services better suited to help people with SUDs than others?

Drs. King and Englander: Both of these systems are oriented at baseline to quickly respond to community needs; in fact, that’s why both systems were originally created. It is built into the ethos of both programs to prioritize the care of people who are vulnerable. This core value, held by staff and leadership alike, made it possible to quickly reorient to providing care and services during the pandemic.

Psycom Pro: What can clinicians who are treating people with SUDs take away from your study, such as ideas to consider when working with this patient population during the pandemic?

Drs. King and Englander: In our study, people with SUDs experienced changes from the pandemic differently than other patients, often for the worse. Patients in the hospital with SUDs may experience new and compounding psychosocial challenges that, without adequate support, may impact their ability to recover from illness. For example, many people lacked phones – which in the pandemic was immediately a basic health need. Another example is that patients continued to be discharged to homelessness. This is never safe, but in a pandemic, the toll is even worse. Hospital leadership needs to provide access to support that care teams need to adequately care for their patients.

Through patient-clinician encounters, we’ve learned that seeing patients in person when possible, recognizing the impact that the pandemic may have on the patient, offering increased psychosocial support, and reevaluating what a safe discharge may mean for patients in a pandemic, are all components of providing excellent patient care for patients with SUDs as the pandemic continues.

Psycom Pro: What should future research consider in this area of study?

Drs. King and Englander: One big question for the months ahead is vaccination hesitancy among patients with SUDs. We need more research to understand how to best disseminate information about vaccines to patients with SUDs. Connecting with patients during hospitalization, particularly where peer-mentor services are available, may be particularly useful.


See additional research and clinical thinking on SUD hospitalization and homelessness and Dr. Michael McGee’s experience with the homeless and mental health, including his call for supportive housing that provides comprehensive care.

Last Updated: Apr 22, 2021