ASAM Consensus Standards for Substance Use Disorder Care Capabilities in Hospitals and Emergency Departments

IMPORTANCE: The morbidity, mortality, and costs associated with untreated substance use disorder (SUD) in hospitals are substantial. In 2017 alone, $13 billion was spent on medical costs associated with SUD care in hospitals and emergency departments (EDs). However, SUD often goes unaddressed during hospital and ED encounters despite the existence of effective treatments. METHODS: In 2024, the American Society for Addiction Medicine (ASAM) initiated a consensus development process to update The ASAM Criteria standards for general hospital settings. These standards outline the capabilities all hospitals are recommended to meet to enable effective care for SUD. The development process included convening an expert Task Force, evidence review and synthesis, formal consensus development, field review, and approval through ASAM's Quality Improvement Council. RESULTS: The Task Force defined 7 core competencies for hospital and ED-based SUD care: (1) identification, engagement, and approach to patient care, (2) intoxication and withdrawal management, (3) overdose and post-overdose care, (4) initiation and continuation of addiction medications, (5) assessment and management of common co-occurring conditions, (6) linkage to ongoing SUD care, and (7) risk reduction. The Task Force used these competencies to define consensus standards within The ASAM Criteria service characteristic domains including setting, staff, support systems, assessment and treatment planning, services, and documentation. CONCLUSIONS: Rapidly evolving evidence demonstrates the importance and feasibility of providing SUD care in hospitals. These consensus standards aim to coalesce the field around a common set of expectations for meeting the needs of patients with SUD.