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
3 min

MDSpire News

Objective:

To advocate for a collaborative and dignifying approach to hospital discharge for patients with opioid use disorder (OUD), particularly when they leave before treatment completion.

Approach:

Key Findings:

Over 50% of postdischarge deaths in patients with OUD were attributed to overdose, not infection, when discharged against medical advice.
Oral antibiotic strategies are safe and effective for selected patients with barriers to prolonged intravenous therapy.
Stigmatizing language can undermine patient care and clinician engagement.

Interpretation:

The authors argue for a shift in discharge practices to prioritize patient dignity and safety, advocating for harm-reduction strategies and collaborative planning.

Limitations:

The fragmented healthcare system may lack support for intensive wraparound services.
There may be no perfect solution for managing early discharges in OUD patients.