Nursing Homes Discriminate Against Opioid Use Disorder Patients at Alarming Rate

July 22, 2020

In 2018 alone, nearly four in ten people who were hospitalized in Massachusetts for their opioid use disorder (OUD) were refused referred post-acute medical services because of their drug use or addiction medication prescription, found a study published July 15 in the Journal of Addiction Medicine found.

“This study documents normalized discriminatory conduct towards individuals hospitalized with OUD and the failure of a single settlement to change these practices. Discrimination is widespread and ongoing, resulting in poor access to needed healthcare,” wrote the Boston-based authors.

The discrimination—involving 82 referral refusals out of 219 OUD-patient hospitalizations at Boston Medical Center that year—was uninterrupted by a lawsuit settlement reached between the US Attorney’s Office and two nursing homes that refused to accept patients receiving buprenorphine treatment, an opioid agonist therapy. Both before and after the settlement in May 2018, the proportion of referrals met with discrimination (11 percent) out of all referrals rejected by facilities (not just discriminatory) remained steady.

“Despite being classified as discriminatory under the federal ADA [Americans with Disabilities Act) and unequivocally prohibited by state regulation, explicit discrimination due to substance use and receipt of OAT is widespread,” wrote the authors. “In fact, rejecting individuals with OUD was so normalized that facilities continued communicating their openly discriminatory conduct to the referring hospital even after the settlement.”

The study is believed by its authors to be the first quantifying post-acute OUD discrimination, and it has implications for politics: Federal anti-discrimination laws, like the ADA, and state regulations don’t seem to have enforcement teeth as they exist now in Massachusetts.

In addition to “enhanced enforcement” of state policy and federal law, the authors recommends stakeholders make efforts to educate facility staff about OUD and the provision of OAT, and develop “workflows to streamline care.”


Photograph of a nursing home corridor by Thomas Bjørkan via Wikimedia Commons/Creative Commons

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