In a recently published commentary for Annals of Internal Medicine, “Ending Medical Complicity with Skilled Nursing Facility Discrimination Against People with Opioid Use Disorder,” Shawn M. Cohen, MD, instructor (general medicine) and faculty in the Yale Program in Addiction Medicine, along with co-authors from the University of Washington, Boston Medical Center, and the Legal Action Center, describe discriminatory admissions practices in skilled nursing facilities (SNFs) limiting access to care for people with opioid use disorder.
It is a common practice among SNFs to deny admission to individuals receiving evidence-based medications for opioid use disorder (MOUD) such as methadone and buprenorphine. As the authors describe, doing so not only places undue limitations on access to life-saving medications (MOUD is demonstrated to reduce OUD mortality by over 50 percent), but violates federal law, specifically the Americans with Disabilities Act, Rehabilitation Act of 1973, and the Patient Protection and Affordable Care Act.
In drawing attention to this discriminatory, illegal practice, the authors hope to inform and empower healthcare providers to combat complicity in the medical community.
“I think most healthcare workers realize that this practice of SNFs declining admission to people on MOUD is wrong, but most don’t know that it’s an illegal discrimination. There are actions we can take to address it. Our role in healthcare is to help people and it must include doing everything we can to address this and other forms of discrimination that are impacting the health of the people we care for. There are already enough barriers to MOUD, we can’t accept more,” said Cohen.
Actions that health care providers can consider taking to address this issue include:
- Ensuring that all forms of MOUD are offered in their health care setting and that referrals to SNFs can be made without compromising optimal patient care
- Filing Department of Justice complaints when instances of discrimination occur
- Educating SNFs about their legal responsibility to nondiscriminatory in admissions policies and practices
The Legal Action Center offers further details in their press release, "New Annals of Internal Medicine Commentary Points to Critical Need to End Skilled Nursing Facilities' Discrimination Against People with Opioid Use Disorder."
Along with Cohen, other authors include Rebekah Joab, JD and Sally Friedman, JD, from the Legal Action Center; Kathryn Bolles, MD, from the University of Washington; and Simeon Kimmel, MD, from Boston University School of Medicine.
The Yale Program in Addiction Medicine seeks to expand access to and improve the effectiveness of prevention and treatment services for substance use. For more on their work, visit Yale Program in Addiction Medicine.