American Society of Addiciton Medicine
Apr 13, 2026 Reporting from Rockville, MD
Guest Editorial – New ASAM Implementation Guide for Hospital and Emergency Department Substance use Disorder Care
https://www.asam.org/news/detail/2026/04/13/guest-editorial---new-asam-implementation-guide-for-hospital-and-emergency-department-substance-use-disorder-care
Apr 13, 2026
Patients with substance use disorder (SUD) have frequent touchpoints with general hospitals and emergency departments (EDs). Between 2014 and 2018, 11.9% of inpatient hospitalizations and 9.4% of ED visits were for patients with SUD. The toll of not treating SUD is enormous, with high rates of premature discharge, cost, and mortality after discharge.

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American Society of Addictin Medicine

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Guest Editorial – New ASAM Implementation Guide for Hospital and Emergency Department Substance use Disorder Care

Apr 13, 2026
Guest Editorial - ASAM Implementation Guide for Hospital and Emergency Department Substance Use Disorder Care

By Sarah Wakeman, MD, FASAM

Patients with substance use disorder (SUD) have frequent touchpoints with general hospitals and emergency departments (EDs). Between 2014 and 2018, 11.9% of inpatient hospitalizations and 9.4% of ED visits were for patients with SUD.1 The toll of not treating SUD is enormous, with high rates of premature discharge, cost, and mortality after discharge.2-5 Patients with SUD have also reported feeling dehumanized and experiencing stigma in hospital and ED settings, which can result in individuals not seeking needed health care services.6-7 Not treating SUD in general medical settings additionally breeds pessimism amongst clinicians who may not have the tools needed to provide good care and feel demoralized, which in turn amplifies negativity toward patients with SUD.8 Integrating SUD care into hospitals can address these challenges and it also aligns with hospitals' responsibility to not just treat immediate crises, but also to address the underlying medical condition—reversing an overdose and not offering SUD care would be akin to treating diabetic ketoacidosis but not offering ongoing diabetes care.

Thankfully a broad body of research has demonstrated that treating SUD in hospital and ED settings improves outcomes, including increasing post-discharge addiction treatment engagement, reducing readmission and the associated costs, and reducing addiction severity.9-25 Recognizing the necessary and important role that hospitals and EDs can play in SUD care, the American Society of Addiction Medicine (ASAM) recently updated The ASAM Criteria®, to include standards for general hospitals.26 This framework offers one example for setting a benchmark for the elements of care that all hospitalized patients with SUD should receive.

To support the actual implementation of these standards, ASAM convened a Presidential Task Force to develop an Implementation Guide for Hospital and Emergency Department Substance Use Disorder Care. This guide outlines recommended competencies and evidence-based clinical care models which can help hospitals and EDs meet these competencies.

The core recommended substance-related competencies outlined in The ASAM Criteria standards for general hospitals are grouped into seven categories, described below.

  1. Identification, engagement, and approach to patient care: Providers should engage and build an alliance with patients who may benefit from SUD services, recognizing that historically SUD treatment has been built on punitive models, and patients may have declined to participate in care because it is neither welcoming nor engaging. Providers should approach patients with humanism and offer individualized care that is trauma-informed, nonjudgmental, rooted in autonomy, and pragmatic.
  2. Intoxication and withdrawal management: Providers should offer timely management of intoxication and withdrawal, with awareness to the changing drug supply. Recognizing that withdrawal management alone is not adequate treatment, it should be provided in parallel with treatment for the underlying SUD.
  3. Overdose and post-overdose care: Providers should be prepared to manage overdoses on site, utilizing the lowest dose of naloxone necessary to minimize precipitated withdrawal, and care for patients in the post-overdose period by providing both initial stabilization and further SUD care including offering immediate medications for opioid use disorder (MOUD) for patients with OUD and other services to support engagement and patient wellness.
  4. Initiation and continuation of addiction medications: Providers should offer evidence-based medication treatments and these medications should be on formulary and available for all types of SUD that have FDA-approved treatments. Patients should be linked to ongoing medication treatment after discharge and provided with enough medication until follow-up.
  5. Assessment and management of common co-occurring conditions: SUD frequently co-occurs with other psychiatric illnesses and pain. Providers should screen patients with SUD for suicide risk, utilize trauma-informed care, and have staff who are capable of assessing and stabilizing co-occurring psychiatric illnesses. Patients with acute or chronic pain and SUD should have their pain assessed and managed with multimodal pain interventions.
  6. Linkage to ongoing SUD care: Patients should not only be initiated on SUD treatment in the hospital or ED, but they should also be linked directly to care after discharge.
  7. Risk reduction: Providers should employ a person-centered care approach that is nonjudgmental, empathetic, and recognizes the autonomy and dignity of all people who use substances. Patients should be offered a range of services to improve their health and quality of life, and all patients at risk for overdose should be offered naloxone and overdose prevention education.

In addition to detailing the necessary elements for meeting each competency, the guide also describes clinical models, such as addiction consult services, hospital-based opioid treatment (HBOT), and bridge clinics, which can facilitate ensuring these services are readily available. While all EDs and hospitals should meet these basic standards, centers that manage a high volume of patients with complex conditions that frequently co-occur with SUD, such as trauma centers, transplant centers, or cardiac surgery centers, should have interdisciplinary, interprofessional addiction consult services staffed by addiction specialists. This is how hospitals approach other common conditions and patient needs. For example, all hospitals have protocols for addressing end-of-life care, however some deploy palliative care consult services to address more complex needs.

Treating SUD in hospital and ED settings is feasible, rewarding, and improves outcomes. It is long overdue for SUD care to be considered a routine element of medical care for all hospitals and EDs. By detailing these care standards and competencies, along with implementation steps and clinical models, this guide aims to help all hospitals effectively achieve them.

About the Author

Dr. Wakeman is the senior medical director for substance use disorder at Mass General Brigham in the Office of the Chief Medical Officer, director for the Mass General Brigham Program for Substance Use & Addiction Services, program director of the Mass General Addiction Medicine fellowship, and an associate professor of medicine at Harvard Medical School. She received her AB from Brown University and her MD from Brown Medical School. She completed residency training in internal medicine and served as chief medical resident at Mass General Hospital. Dr. Wakeman is a diplomate and fellow of the American Board of Addiction Medicine and board certified in addiction medicine by the American Board of Preventive Medicine.

References

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