Addressing substance use and pain key to limiting self-directed hospital discharge

It is not uncommon for people with opioid-related conditions, including opioid dependence and opioid use disorder (OUD), to be regularly hospitalized to treat infections, trauma, or other emergent conditions. Data show that patients with substance use disorders (SUD) are much more likely to self-discharge against medical advice than patients admitted for similar conditions without SUDs. This can lead to poorer health outcomes including worsening illness, readmissions, and death.

Doctor with a face mask and gloves writing with a pencil on a clipboard.

Could poorly treated pain be a reason for these self-directed discharges, and if so, what approaches could be tried to prevent patients who have been historically marginalized from experiencing avoidable harm and suffering?

A new study from the School of Nursing, published in the Harm Reduction Journal, suggests that stigma toward persons with SUDs, including OUD, may account for an under-assessment and management of pain.

The study finds that patients with acutely painful admitting diagnoses were almost twice as likely to have a self-directed discharge than those without. These diagnosis codes were extremely common among patients who had a self-directed discharge on six or more occasions within a single year. The study also finds that a diagnosis of chronic pain was inconsistently noted in the patient group, leading to the conclusion that inadequate pain assessment is a potential motivator of self-directed discharge in this patient population.

“These findings underscore the importance of pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial costs and suffering,” says lead author Peggy Compton, van Ameringen Chair in Psychiatric and Mental Health Nursing and Professor of Nursing at Penn Nursing. “Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.”

Read more at Penn Nursing News.