In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care

Martin, Marlene; Snyder, Hannah; Otway, Gillian; Holpit, Leslie; Day, Lukejohn W.; Seidman, Dominika

doi:10.1097/adm.0000000000001046

Cited by 9 publications

(16 citation statements)

References 14 publications

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“…This study begins to characterize policies and practices in US hospitals that address the use of substances during hospitalization. Hospitals in the United States have begun to implement new, increasingly patient‐centered policies, but in the absence of agreed upon best practices 21 . Future directions include the development of best practices for teaching and nonteaching hospitals to guide policies addressing the use of nonprescribed substances during hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…Future directions include the development of best practices for teaching and nonteaching hospitals to guide policies addressing the use of nonprescribed substances during hospitalizations. These policies should be developed collaboratively with multiple stakeholders, including people who use substances, medical staff (physicians, nurses, social workers), and hospital administration 21 . The absence of such policies are a missed opportunity to partner with patients, increase access to harm reduction and other treatment services, reduce the stigma of substance use, reduce risk for inpatient overdose, reduce self‐directed discharges, and connect individuals to addiction care during and following hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…medical staff (physicians, nurses, social workers), and hospital administration. 21 The absence of such policies are a missed opportunity to partner with patients, increase access to harm reduction and other treatment services, reduce the stigma of substance use, reduce risk for inpatient overdose, reduce selfdirected discharges, and connect individuals to addiction care during and following hospitalization.…”

Section: Conflict Of Interest Statementmentioning

confidence: 99%

See 2 more Smart Citations

Response to substance use during hospitalization: A survey study of current and ideal policies and practices

Huxley‐Reicher,

Puglisi,

Tetrault

et al. 2023

Journal of Hospital Medicine

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People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient‐directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross‐sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)‐accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME‐addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient‐centered policies to address this.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Conflict Of Interest Statementmentioning

confidence: 99%

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Response to substance use during hospitalization: A survey study of current and ideal policies and practices

Huxley‐Reicher,

Puglisi,

Tetrault

et al. 2023

Journal of Hospital Medicine

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“…Having clear hospital policies, goals and supervision of peer support workers could help mitigate against these issues or concerns. Including PWUD in the formulation of this policy would further add trust and agency into this support system [10].…”

Section: Role Of Specialist Teamsmentioning

confidence: 99%

“…There is the challenge of providing good quality health care in the presence of behaviours potentially at odds with good health outcomes set against the seeming stigma underlying current hospital practices [2]. Drafting formal policies and including PWUDs within the drafting of these policies is as a necessary first step in the engagement and retention of PWUDs in treatment [10].…”

Section: Hospital Policy Impacting Person-centred Care For Pwudmentioning

confidence: 99%

People who use drugs in hospital settings: ‘Moving towards a person‐centred harm reduction model’

Naren,

MacCartney,

Crawford

et al. 2023

Drug and Alcohol Review

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People who use drugs often continue to use drugs while in hospital. However, health‐care systems often expect abstinence from drugs as a condition of engagement in various services. This commentary piece proposes that this approach is inconsistent with the principles of person‐centred care. A harm reduction‐based approach in conjunction with collaboration of people who use drugs is proposed as a model for providing person‐centred care to people who use drugs during hospital‐based treatment.

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Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl

Englander,

Thakrar,

Bagley

et al. 2024

JAMA Intern Med

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ImportanceThe rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions.ObservationsClinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl’s high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl’s unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians’ understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing.Conclusions and RelevanceThe findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.

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In-hospital Substance Use Policies: An Opportunity to Advance Equity, Reduce Stigma, and Offer Evidence-based Addiction Care

Cited by 9 publications

References 14 publications

Response to substance use during hospitalization: A survey study of current and ideal policies and practices

Response to substance use during hospitalization: A survey study of current and ideal policies and practices

People who use drugs in hospital settings: ‘Moving towards a person‐centred harm reduction model’

Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl

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