Is “Against Medical Advice” Still Defensible?

A Viewpoint calls for more dignifying, harm-reduction–oriented hospital discharges for patients with OUD.

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.

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.

Assess for opioid use disorder and associated complications during hospitalization.

Implement a collaborative discharge plan that includes medications like buprenorphine and naloxone.

Patients with opioid use disorder and invasive Staphylococcus aureus infections.

Utilize long-acting dalbavancin and oral antibiotics to facilitate early discharge.

Clinical Scorecard: Is “Against Medical Advice” Still Defensible?