Is “Against Medical Advice” Still Defensible?
A Viewpoint calls for more dignifying, harm-reduction–oriented hospital discharges for patients with OUD.
By
Kerri Miller
April 14, 2026
Clinical Scorecard: Is “Against Medical Advice” Still Defensible?
At a Glance
Category Detail
Condition Opioid Use Disorder (OUD) Key Mechanisms Harm-reduction principles, collaborative discharge planning, and proactive treatment strategies. Target Population Patients with opioid use disorder hospitalized with invasive Staphylococcus aureus infections. Care Setting Hospital and substance use disorder clinics.
Key Highlights
Collaborative discharge plans can reduce stigma and improve patient outcomes. Avoiding the term 'Against Medical Advice' can enhance patient-clinician relationships. Over 50% of postdischarge deaths in OUD patients were due to overdose, not infection. Oral antibiotics can be a safe and effective alternative to prolonged intravenous therapy. Proactive planning for early discharge can maintain care continuity. Guideline-Based Recommendations
Diagnosis
Assess for opioid use disorder and associated complications during hospitalization. Management
Implement a collaborative discharge plan that includes medications like buprenorphine and naloxone. Monitoring & Follow-up
Follow up with patients in substance use disorder clinics post-discharge. Risks
Recognize the risk of overdose in patients leaving against medical advice. Patient & Prescribing Data
Patients with opioid use disorder and invasive Staphylococcus aureus infections.
Utilize long-acting dalbavancin and oral antibiotics to facilitate early discharge.
Clinical Best Practices
Treat withdrawal symptoms proactively. Document barriers to treatment clearly. Ensure medications and follow-up appointments are arranged before discharge. Use non-stigmatizing language in clinical documentation. References
