Harm reduction in hospitals: is it time?

Rachlis, Beth; Montaner, Julio S. G.; Wood, Evan

doi:10.1186/1477-7517-6-19

Cited by 39 publications

(31 citation statements)

References 24 publications

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“…The Dr. Peter Centre in Vancouver, which was located in a hospital, offers one example where harm reduction has been successfully integrated with a medical facility [13]. Our research findings are consistent with previous recommendations that highlight the potential for harm reduction programs to minimise health‐related harms associated with drug use as PWUD recover from acute illnesses in hospital [11].…”

Section: Discussionsupporting

confidence: 87%

Illicit drug use in acute care settings

Grewal

Hayashi

et al. 2015

Drug and Alcohol Review

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Background While persons with addiction are often hospitalized, hospitals typically employ abstinence-based policies specific to illicit drug use. Although illicit drug use is known to occur within hospitals, this problem has not been well characterized. Therefore, we sought to investigate the prevalence of and factors associated with having ever used drugs in hospital among people who use drugs (PWUD) in Vancouver, Canada. Methods Data were derived from prospective cohort studies of PWUD between December 2012 and May 2013. Multivariable logistic regression was used to identify demographic and behavioural factors associated with having ever used illicit drugs in hospital. Results Among 1028 participants who had experienced ≥ 1 hospitalization, 43.9% reported having ever used drugs while hospitalized. In multivariable analyses, factors positively associated with having ever used drugs in hospital included: daily cocaine injection and daily crack non-injection (both p < 0.05). Factors negatively associated with the outcome included: older age and male gender (both p < 0.05). The most common reasons for drug use in hospital were “wanting to use” and “being in withdrawal”. Drugs were most commonly used in patient washrooms. Conclusions Our findings demonstrate that an abstinence-based approach to drug use in hospitals may be ineffective at prohibiting drug consumption. High-risk drug use behaviours arising from ongoing drug use may pose risks for further harm and illness. Efforts to minimize the harms associated with using drugs in hospital are urgently needed.

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Section: Discussionsupporting

confidence: 87%

Illicit drug use in acute care settings

Grewal

Hayashi

et al. 2015

Drug and Alcohol Review

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“…Specifically, nurses at the Dr. Peter Centre directly observe injections of preobtained illicit drugs for the purposes of preventing illness and promoting health. Our findings support recent calls to implement harm‐reduction services within hospital settings in an effort to minimize the harms associated with illicit drug use …”

Section: Discussionsupporting

confidence: 86%

Willingness to access an in‐hospital supervised injection facility among hospitalized people who use illicit drugs

Buxton

Harrison

et al. 2015

Journal of Hospital Medicine

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Background Despite the reliance on abstinence-based drug policies within hospital settings, illicit drug use is common among hospitalized patients with severe drug addiction. Hospitalized people who use illicit drugs (PWUD) have been known to resort to high-risk behaviours to conceal their drug use from healthcare providers. Novel interventions with potential to reduce high-risk behaviours among PWUD in hospital settings have not been well studied. Objective The objective of the study was to examine factors associated with willingness to access an in-hospital supervised injection facility (SIF). Design Data were derived from participants enrolled in two Canadian prospective cohort studies involving PWUD between June 2013 and November 2013. A cross-sectional study surveying various socio-demographic characteristics, drug use patterns and experiences was conducted. Setting Vancouver, Canada Measurements Bivariable and multivariable logistic regression analyses were used to explore factors significantly associated with willingness to access an in-hospital SIF. Results Among 732 participants, 499 (68.2%) would be willing to access an in-hospital SIF. In multivariable analyses, factors positively and significantly associated with willingness to access an in-hospital SIF included: daily heroin injection (adjusted odds ratio [AOR] = 1.90; 95% confidence interval [CI]: 1.20 – 3.11); having used illicit drugs in hospital (AOR = 1.63; 95%CI: 1.18 – 2.26); and having recently used a SIF (AOR = 1.53; 95%CI: 1.10 – 2.15). Conclusions Our findings highlight the potential of in-hospital SIFs to complement existing harm reduction programs that serve PWUD. Moreover, an in-hospital SIF may minimize the harms associated with high-risk illicit drug use in hospital.

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“…However, hospital policies, including those existing where the present research was conducted, continue to be primarily oriented toward promoting and, in some cases, enforcing drug abstinence. Against this backdrop, our findings lend support to the argument for integrating comprehensive harm reduction approaches, including supervised drug consumption services, into hospitals (Rachlis et al, 2009). While this approach is by no means a panacea, our findings suggest that this has the potential to reduce the deleterious effects of efforts to deter and limit drug use within hospital settings, and thus drug-related risks (e.g., injecting alone) and discharges from hospital against medical advice.…”

Section: Discussionsupporting

confidence: 71%

Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs

McNeil

Small

Wood

et al. 2014

Social Science & Medicine

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People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the `Risk Environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm reduction supports, including supervised drug consumption services.

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Harm reduction in hospitals: is it time?

Cited by 39 publications

References 24 publications

Illicit drug use in acute care settings

Illicit drug use in acute care settings

Willingness to access an in‐hospital supervised injection facility among hospitalized people who use illicit drugs

Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs

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