Consultation-Liaison Case Conference: Challenges of Managing Severe Opioid Use Disorder in the Hospital

Consultation-liaison psychiatrists are frequently consulted to assess and manage severe opioid use disorder in hospitalized patients requiring treatment for complications related to their opioid use disorder. We describe the case of a 43-year-old male with severe opioid use disorder who recently underwent bilateral amputations for his leg wounds at another hospital and left before medically advised. He subsequently presented to our hospital for pain and was admitted for ongoing infection. An understanding of the ethical considerations surrounding patient-directed discharge (previously referred to as "against medical advice"), appropriate opioid agonist dosing strategies, and postdischarge planning can improve outcomes for these patients, who often face significant stigma within the health care system.