Illicit drug use in acute care settings

Abstract

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.

Advancing patient‐centered care for structurally vulnerable drug‐using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals

“…We draw upon qualitative interviews conducted as part of an ethno-epidemiological study exploring social-structural influences on hospital care among structurally vulnerable PWUD (33,52,53), and their perspectives on hospital-based harm reduction services. Consistent with ethno-epidemiological methods (60,61), we deployed qualitative methods alongside an epidemiological research program to examine contextual influences on hospital outcomes to generate insights to inform more targeted interventions.…”

“…This increases their likelihood of hospital re-admission, longer hospital stays and premature mortality [45,[49][50][51]. Recent research characterizing hospitals as 'risk environments' has demonstrated that socialstructural forces in hospitals, such as abstinence-based drug policies and racial discrimination, drive adverse outcomes for PWUD [33,52,53]. Moreover, these contextual forces deny the subjective health experiences and agency of structurally vulnerable PWUD [33], and preclude the implementation of PCC models responsive to their needs.…”

Uptake into a bedside needle and syringe program for acute care inpatients who inject drugs

“…This gap in knowledge on NSPs is problematic because people who inject drugs (PWID) have high rates of hospitalisation . Hospitals typically have written or unwritten prohibitions on drug use and syringe possession, and healthcare providers may negatively sanction patients if they are caught or suspected of using drugs .…”

“…Hospitals typically have written or unwritten prohibitions on drug use and syringe possession, and healthcare providers may negatively sanction patients if they are caught or suspected of using drugs . However, longitudinal cohort data collected with PWID in Vancouver, Canada indicate that 44% of participants reported previously injecting drugs while hospitalised . PWID have reported participating in unsafe injection practices while hospitalised, including injecting alone and in unsanitary conditions, and reusing syringes .…”

Risk Factors Of Infective Endocarditis In Persons Who Inject Drugs

“…The literature primarily studies the clinical and epidemiological characteristics of PWID developing IE (3,7,(25)(26)(27). Some studies assessing injection practices of PWID are in relation to the development of skin and soft tissue infections (28) or infections in general (14,20,29). To our knowledge, this is the largest study (n=33) showcasing detailed survey data regarding injection practices of PWID with IE.…”