Multiple court settlements established that it is a violation of the Americans with Disabilities Act (ADA) for skilled-nursing facilities (SNF) to refuse to care for patients with opioid use disorder (OUD) who are on medication for opioid use disorder (MOUD). Yet, this discriminatory practice persists. This perspective discusses the case of a patient with cirrhosis and OUD, who was not allowed to return to his SNF due to starting buprenorphine during a hospitalization, and highlights why stigma and knowledge deficits continue to be barriers to this mortality-reducing treatment resulting in increased length of stay and negative outcomes. Sublingual buprenorphine is a commonly utilized MOUD due to its safety profile as a partial µ-opioid agonist and was what this patient with cirrhosis received. Due to the patient's resilience in the face of discrimination, the hospital's advocacy efforts including clinician-to-clinician conversations and the SNF's willingness to learn about best practice clinical guidelines and align with the ADA, this patient was able to return to the SNF on buprenorphine, despite delays in care. This perspective outlines tools that hospitalists can use in advocacy efforts with SNFs to improve MOUD treatment adoption as they leave the acute hospital setting.

Barriers to ideal equitable patient experience typically involve some level of prejudice. In the past 15 years, global migration rates have steadily risen, creating a trail of unfamiliarity that can motivate ignorance (and, in graver instances, hatred). Our focus in this perspective is on anti-Muslim racism, which has spilled into the world of medicine, harming Muslim women in particular, especially those who wear the hijab-the Muslim headscarf. In this paper, we examine many of the prejudices surrounding the hijab that arise in areas where the Muslim faith is not well understood, particularly through ignorance, indifference, and the epidemic of Islamophobia. In doing so, we argue that the violation of the dignity of women who wear hijab may occur more often than is realized by practicing clinicians, leading to our recommendation of increased education about cultural humility. Our dignity-based claims in support of our call for greater cultural humility are rooted in an understanding of that concept, which prohibits humiliating[1] treatment of persons, all of whom possess dignity. It is an ethical obligation, we argue, that clinicians preserve dignity by avoiding placing patients in humiliating situations, and without greater education around diverse cultural practices, this obligation cannot be satisfied.