Teryl Nuckols remembers the frustration of seeing patients with opioid use disorder cycle through Cedars-Sinai Medical Center in Los Angeles—treated for infections or withdrawal, then discharged without the care that could break the cycle. Now, a new study co-led by Nuckols offers a clear path forward: the START program, a hospital-based addiction consultation service, not only increases treatment initiation but does so at a cost so low it redefines what’s possible in addiction medicine. For just $162 more per patient, those enrolled in START were significantly more likely to begin medication for opioid use disorder and connect with ongoing care after leaving the hospital—a shift that translates to an estimated $15,750 per additional year of healthy life, well under the $50,000 to $100,000 threshold typically considered cost-effective in U.S. health care.
This isn’t just about saving lives—it’s about smart spending. Using data from a prior randomized trial, researchers built a computer simulation to model outcomes and costs over one year, comparing START to standard care. The results, published in JAMA Network Open, show that 47% of patients in the START group began treatment during hospitalization, compared to just 16% in the usual care group. Even more striking, 68% of START patients were linked to follow-up care after discharge, versus 32% in the control group. These aren’t abstract gains: they represent real people stabilizing their health, reducing overdose risk, and rebuilding their lives.
The Substance Use Treatment and Recovery Team—START—works by embedding addiction specialists directly into hospital units. Nurses, social workers, and physicians trained in addiction medicine meet patients at their most vulnerable moment: during a hospital stay. They offer buprenorphine, counseling, and discharge planning tailored to each individual. "Hospitalization is a critical opportunity to begin treatment for opioid use disorder, yet most patients are discharged without it," said Dr. Nuckols, director of the Division of Internal Medicine at Cedars-Sinai and senior author of the study. "Our findings suggest START delivers meaningful health benefits for a relatively modest additional investment."
With over 100,000 overdose deaths annually in the U.S., mostly involving opioids, the need for scalable, effective interventions has never been greater. The START model offers a blueprint—one that costs less than a high-end laptop per patient but could yield years of healthier life. While barriers to implementation remain, from staffing to stigma, the data make a compelling case. As hospital leaders and policymakers weigh priorities, the message is clear: treating addiction during hospitalization isn’t a luxury. It’s a high-value, life-changing standard of care waiting to be adopted.
The next step? Expanding access. With evidence of both clinical and economic benefit, programs like START could become a routine part of hospital care, turning a missed opportunity into a turning point—for patients, families, and the health system alike.