The Effect of Incorporating Addiction Medicine Consults on Medical Toxicology Service Volume

Document Type

Conference Proceeding

Publication Date

3-18-2026

Publication Title

J Med Toxicol

Keywords

clonidine, addiction medicine, adult, alcohol withdrawal syndrome, alcoholism, cocaine dependence, conference abstract, consultation, coronavirus disease 2019, drug dependence, drug therapy, female, follow up, hospital planning, human, intensive care unit, major clinical study, male, opioid use disorder, pandemic, patient volume, sedation, toxicology, ventilator weaning

Abstract

Background: A portion of Medical Toxicology services have incorporated Addiction Medicine (AM) consultations into their practice. Most-if not all-AM consults fall within the purview of Medical Toxicology. Our group began performing AM consults in 2019. Hypothesis or Research Question: AM consultations increase overall Medical Toxicology service volume and do not affect “traditional” toxicology consult volume. Methods: This was a retrospective analysis of our consult list from 2015 to 2025 based on billing descriptions entered by attending toxicologists (e.g., “clonidine toxicity requiring IMV” or “OUD, BUP micro”). Average volumes were calculated over the 5 years prior to service initiation and 5 years since (2015 – 2019 and 2020- 2024). We counted only new consult encounters; follow-up evaluations were removed. Consults were divided by year and by type: “TOX” and substance use disorders (SUD) were subdivided into opioid use disorder (OUD), alcohol use disorder (AUD), OUD + AUD, OUD + substance use disorder (SUD), SUD, cocaine use disorder (CUD), and “wean/sedation”. “Wean/Sedation” are consultations we perform to help sedate patients with high tolerances and/or facilitate ventilator liberation. All consults prior to 2019 were considered TOX. Total ED volume for the hospitals where we see >95% consults added for context to help interpret changes in overall patient volume due to COVID pandemic. Simple counts and percentages were used to document results. Results: Despite an average reduction in ED volume by 24% from 2015-2019 and 2020-2024, addition of AM consultations resulted in a marked increase in volume by 71%. Consult volume in 2024 alone was triple the average volume in 2015-2019. Over time, types of SUD and polysubstance use consultations also increased but may reflect more complex descriptions of reason for consultation. Apparent TOX volume decreased slightly and was likely due to change in diagnosis description by attendings over time (e.g., evaluations for AUD in 2020-2024 cohort often include treatment of alcohol withdrawal that were coded as “TOX” in 2015-2019 cohort), but may be related to a non-specific “post COVID effect”. Consultations for ICU sedation and ventilator weaning have increased consistently since initiation of that service component. Conclusion: The addition of AM consultations to a medical toxicology service greatly increased overall Medical Toxicology Service volume and the apparent decrease in “traditional” medical toxicology service volume likely reflected changes in coding for reason for evaluation. This suggests that Medical Toxicologists fill a need for acute treatment of patients with SUDs in the hospital system where no established AM service exists.

Volume

22

Issue

2

First Page

127

Find It @ Sladen

Share

COinS