Acute secondary care settings provide intensive short-term care but also offer a complex environment and a range of challenges for the healthcare staff working in them (Giandinoto & Edward, 2014; SAMHSA, 2005). These challenges are only exacerbated when patients present with comorbid conditions such as substance abuse and mental illness.

The acute care facility is concerned with little more than detoxing the patient in a suboptimal setting and generally lacks the resources to provide any kind of care other than a momentary intervention (SAMHSA, 2005). For patients who have co-occurring disorders, in many cases, without a follow-up care plan that goes beyond simple recommendations to the individual, quickly releasing these patients back to a self-care environment does little more than contribute to the increasingly high mortality rate of persons with mental illness (Giandinoto & Edward, 2014).

In March of 2017, Rhode Island became the first electorate to enact legislation mandating treatment standards for the care of adult patients with opioid use disorder for all licensed acute care facilities in the state. The legislation required that regardless of the size or number of patients at the facility, a minimum of three levels of hospital and emergency department opioid use disorder care and mechanisms for referral to treatment services be in place (Samuels et al., 2019).

Initiatives and directives toward improving the health care of people experiencing mental health and substance use conditions is a priority worldwide, and the integration of treatment services with both primary and secondary medical care can provide advances toward moving the comorbid client to the next needed level of care (Giandinoto & Edward, 2014; SAMHSA, 2005).



Giandinoto, J., & Edward, K. (2014). Challenges in acute care of people with co-morbid mental illness. British Journal of Nursing, 23(13), 728-732. doi:10.12968/bjon.2014.23.13.728

SAMHSA. (2005). TIP 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders. Rockville, MD Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, DHHS Publication No. (SMA) 05-3922 Retrieved from

Samuels, E., McDonald, J., McCormick, M., Koziol, J., Friedman, C., & Alexander-Scott, N. (2019). Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017–2018. American Journal of Public Health, 109(2), 263-266.  Retrieved from



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