Research to improve hospital treatment for people who use opioids

UCLH is to trial a set of interventions to improve hospital care for people who use opioids such as heroin.

The iHOST (Improving Hospital Opioid Substitution Therapy) project at UCLH and UCL and led by the London School of Hygiene and Tropical Medicine (LSHTM) will focus on improving opioid substitution therapy (OST) – a crucial part of treatment where medication is given to prevent withdrawal from opioid use.

OST needs to be given promptly, as withdrawal can cause severe physical and psychological distress. But delays in OST can occur, leading to use of illicit drugs in hospitals and patients leaving hospital against medical advice (known as discharge against medical advice). This can lead to readmission.

The project has been developed in partnership with people who use opioids and community drug treatment services – people who have been traditionally harder to reach and engage in health research – and five key interventions will be:

• A ‘My Meds’ patient card which can be carried by a person who uses opioids which will help the hospital provide the OST they need
• A helpline for patients
• Training for hospital staff
• The development of best practice hospital OST policy
• A local iHOST champion in the hospital

The team will develop and trial these interventions at UCLH, before trialling the interventions at hospitals in Leeds and Stoke.

The IHOST team then plan to produce a toolkit that can be used by hospitals across the country. This toolkit will support hospitals in implementing and embedding evidence-based practice for optimal management of people who use opioids.

Study co-investigator and UCLH consultant Dr Mike Brown said: “This is one of several areas of inclusion health that is a focus for UCLH and its partners, which seek to improve healthcare for vulnerable patients from populations traditionally subject to extreme social exclusion.

“iHOST complements the recent appointment of Inclusion Health consultants improving care of inpatients who fall into this category, the Find and Treat service which has been working on the streets of London to provide care for vulnerable adults, the RESPOND refugee health service working with primary care to address the health needs of refugee families, and the integrated care projects that support ongoing care of homeless patients discharged from NCL hospitals.”

Chief Investigator of the study at LSHTM Dr Magdalena Harris said: “The iHOST intervention responds to findings from my previous research with people who inject drugs in London. Many avoided going to hospital until they were at death’s door, and often would leave hospital before their treatment was completed. This is a huge problem – contributing not only to poor health outcomes for a vulnerable population, but increasing the burden placed on hospital staff.

“We found that fear of opioid withdrawal and experiences of delays in receiving OST was the main reason people were not accessing and completing hospital care. We are excited to be working with UCLH to trial iHOST as it holds great potential to improve outcomes for both patients and health care providers.”

Study co-investigator and PPI lead for the study Adrian Noctor said: “We want to make the hospital a more welcoming environment for people who use opioids. An important way of doing this is making sure the right substitution therapy is given as quickly as possible.

“We are grateful to the patients and members of the public we worked with to get this work up and running alongside the local drug treatment services we work with.”

A new inclusion health theme will be part of Biomedical Research Centre at UCLH form the end of 2022. This theme will support initiatives to address health inequalities and help improve early diagnosis, access to care and engagement with vulnerable populations.

To find out more about the iHost study, visit the project website.