Implementation of a Naloxone Distribution Program in an Inpatient Addiction Service: A Case Study

Johnson, Cheyenne; Buxton, Jane A.; Harrison, Scott; Ahamad, Keith; Nolan, Seonaid; Lappalainen, Leslie; Mead, Annabel; McLean, Mark; Wood, Evan

doi:10.1097/02024458-201602000-00005

Cited by 1 publication

(4 citation statements)

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“…Included studies utilized a range of study designs with retrospective chart reviews (n = 14) [23][24][25][26][27][28][29][30][31][32][33][34][35][36] being the most common, followed by randomized controlled trials (n = 10) [37][38][39][40][41][42][43][44][45][46], cross-sectional designs (n = 10) [47][48][49][50][51][52][53][54][55][56], case reports (n = 9) [57][58][59][60][61][62][63][64][65], qualitative studies (n = 5) [66-70], mixed methods studies (n = 5) [71][72][73][74][75], prospective cohort design (n = 2) [76,…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

“…The reported sample size across studies ranged from 1 to 30,263. The majority of studies targeted patient populations alone (n = 46) [23-28, 30, 32-42, 44-52, 55, 56, 58-60, 62-68, 74-79, 81], followed by both patients and health care providers (HCPs) (n = 8) [31,43,54,61,[69][70][71]80], patients and caregivers (n = 3) [29,57,73] and HCPs alone (n = 2) [53,72].…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

“…• Lack of case management when addressing complex psychosocial illnesses [29] • Insurance status [30,66] • Lack of organizational prioritization [70] • Unengaged and remote hospital leadership [70] • Poor interdepartmental communication, collaboration, and coordination [70] • Poor community-hospital partnerships [70] • Absence of local champion [70] • Rural and community hospitals had structural barriers to follow-up treatments [29,32] • COVID 19 initiated closures and decreased intakes to addiction treatment programs creating barriers to care for treatment seeking patients [32] • Screening impacted by patient trauma [80] • Timely identification of patients [62,69] • No systematic approach to selecting clients for program and inability to select clients based on potential future alcohol/drug use [64] • Phones not available in in all treatment areas [81] • Adaptability of intervention [70] • Trained patients forgetting naloxone kits at discharge; only patient who received training used their kits [49,57] • Covering the cost of and sourcing naloxone kits [54,66,70] • Challenges related to documenting the prescribing, dispensing, and training of naloxone distribution [48,53,54,57].…”

Section: System and Organizational Factors: Reported Barriers Of Impl...mentioning

confidence: 99%

“…While this review identified a diverse range of harm reduction strategies, additional strategies currently being used in other settings were notably absent. Managing and providing nutrition for PWUAD [88], providing housing resources [89], drug checking technology to allow PWUAD to ascertain unknown chemicals in their street drugs [90,91], and providing off label prescriptions (i.e., safe supply) to PWUAD [92] are all increasingly being considered as • Patient distrust of healthcare services [23,67] • Patient fear of being stigmatized by HCPs [67] • Lack of trust that the hospital SCS would provide adequate protection from criminalization and surveillance [67] Patient Perceptions: Reported Enablers of Implementation • Increased patient awareness of high risk alcohol consumption [69] Provider Perceptions: Reported Barriers of Implementation • Doubt related to policy changes efficacy, screening/treatment efficacy and patient adherence [70,71] • The perception that psychosocial interventions are not the responsibility of ED HCPs [71] • HCP resistance to changes in practice [54,66] • HCP resistance due to belief that they are encouraging drug use and increasing harms [56,66] • HCPs bias and stigma toward drug using patients [54,70,72] • Lack of understanding of who would benefit from naloxone kits [53] • Difficulty motivating HCPs to buy in [57,69,71] • HCP opposition to harm reduction strategies and associated resource allocation [64] Provider Perceptions: Reported Enablers of Implementation • Belief in effectiveness of policy changes [70] • Increased provider awareness of high risk alcohol consumption [69] • Staff acceptance [73] https://doi.org/10.1371/journal.pone.0294804.t004 Table 5. Summary of partner reflections on gaps in the literature.…”

Section: Plos Onementioning

confidence: 99%

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Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Crowther,

Curran,

Somerville

et al. 2023

PLoS ONE

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Background People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. Methods A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. Findings The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. Conclusion This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.

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