Discriminatory Practice in Opioid Use Disorder: In a Post-X-Waiver Era, Barriers to Buprenorphine Persist.

Multiple court settlements established that it is a violation of the Americans with Disabilities Act (ADA) for skilled-nursing facilities (SNF) to refuse to care for patients with opioid use disorder (OUD) who are on medication for opioid use disorder (MOUD). Yet, this discriminatory practice persists. This perspective discusses the case of a patient with cirrhosis and OUD, who was not allowed to return to his SNF due to starting buprenorphine during a hospitalization, and highlights why stigma and knowledge deficits continue to be barriers to this mortality-reducing treatment resulting in increased length of stay and negative outcomes. Sublingual buprenorphine is a commonly utilized MOUD due to its safety profile as a partial µ-opioid agonist and was what this patient with cirrhosis received. Due to the patient's resilience in the face of discrimination, the hospital's advocacy efforts including clinician-to-clinician conversations and the SNF's willingness to learn about best practice clinical guidelines and align with the ADA, this patient was able to return to the SNF on buprenorphine, despite delays in care. This perspective outlines tools that hospitalists can use in advocacy efforts with SNFs to improve MOUD treatment adoption as they leave the acute hospital setting.