The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders

Chau, Leena W.; Erickson, Margaret; Vigo, Daniel; Lou, Hayami; Pakhomova, Tatiana E.; Winston, Mark L.; MacPherson, Donald; Thomson, Erica; Small, Will

doi:10.1016/j.drugpo.2021.103208

Cited by 10 publications

(7 citation statements)

References 60 publications

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“…Work to increase the attractiveness of treatment to potential consumers, and to diversify treatment options, is also necessary. This also accords with the views of people who use drugs [24].…”

Section: Discussionsupporting

confidence: 86%

The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls

et al. 2021

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Background and aims Many nations have provisions for involuntary treatment of alcohol dependence where the person is at serious risk of harm to themselves. To date, there has been little thorough evaluation of its effectiveness. This study aimed to determine if there were differences between involuntary and voluntary treatment for alcohol dependence on subsequent emergency and hospital care. Design A retrospective cohort design using linked routinely collected administrative data on health‐care utilization. Setting Hospital and community‐based alcohol treatment, New South Wales, Australia. Participants A total of 231 patients who were involuntarily treated for alcohol dependence and 231 matched controls who received treatment as usual within the period May 2012 to April 2018. Intervention and comparator Involuntary treatment comprised a 28‐day mandated hospital admission which included supervised withdrawal, comprehensive assessment, rehabilitation and support followed by voluntary aftercare support for up to 6 months. Treatment as usual comprised three not mutually exclusive forms of intensive voluntary alcohol treatment: withdrawal management, rehabilitation and pharmacotherapies for alcohol dependence. Measurements Outcome measures: changes in the number of emergency department (ED) visits and number of unplanned hospital admissions 12 months before and 12 months after completion of index treatment. Findings Both groups showed a reduction in ED visits (incidence rate ratio (IRR) = 0.56, 95% credible intervals (CrI) = 0.39–0.78) and unplanned hospital admissions (IRR = 0.49, 95% CrI = 0.37–0.65). There was no statistically significant difference between the two groups (IRR = 0.77, 95% CrI = 0.58–1.03 for ED visits and IRR = 0.79, 95% CrI = 0.62–1.01 for hospital admissions). The Bayes factors were 0.925 and 0.936 for ED visits and unplanned hospital admissions, respectively, interpreted as weak evidence in support of the null hypothesis of no difference between the interventions. Conclusions Involuntary treatment of alcohol dependence was associated with reduced health service utilization in the year following treatment, and the outcomes did not differ from those of a matched control group.

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Section: Discussionsupporting

confidence: 86%

The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls

et al. 2021

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“…18 However, some research suggests instances of involuntary hospitalization for substance use alone. 22,23 Thus, observed trends may also indicate cases of involuntary hospitalization of people with a primary substance use disorder, particularly among youth given documented involuntary admission of youth for stabilization care. 18 Increases may be a consequence of the unmet need for people with substance use disorders, 36 and concurrent disorders, 37 such as limited access to treatment for medical and psychiatric comorbidities among people who use drugs.…”

Section: Discussionmentioning

confidence: 99%

“…[64][65][66] Given the association between stimulant use and involuntary hospitalization, 67 growing use of stimulants may be contributing to the rise in involuntary hospitalizations for substance use. 67 Increasing admissions for substance use is concerning given the absence of treatment guidelines and legal frameworks surrounding involuntary treatment of substance use in BC, 22 and the limited evidence of the benefits of involuntary care for substance use. 68 Indeed, people who use drugs and advocates have argued against involuntary care for substance use in BC, highlighting the need to enhance the voluntary systems of care and address structural and systemic issues that influence high-risk drug use, before expanding the scope of BC's MHA, as was proposed with the introduction of Bill 22.…”

Section: Discussionmentioning

confidence: 99%

“…68 Indeed, people who use drugs and advocates have argued against involuntary care for substance use in BC, highlighting the need to enhance the voluntary systems of care and address structural and systemic issues that influence high-risk drug use, before expanding the scope of BC's MHA, as was proposed with the introduction of Bill 22. 18,22,69…”

Section: Discussionmentioning

confidence: 99%

“…21 Involuntary hospitalization for substance use may only occur in the presence of a concurrent mental disorder, 18 however, some research suggests instances of involuntary hospitalization for substance use alone. 18,22,23 Section 28 of the BC MHA permits police to apprehend and take a person believed to have a mental disorder to a physician for examination. 21 If deemed to require involuntary treatment, the physician completes a medical certificate (Form 4) which permits the patient to be admitted for up to 48 h. A second examination by another physician must be completed within this 48 h period to extend the involuntary admission up to 1 month (see Supplementary 1 for a breakdown of detention periods).…”

Section: Methodsmentioning

confidence: 99%

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Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018

et al. 2022

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Introduction Involuntary psychiatric hospitalization occurs when someone with a serious mental disorder requires treatment without their consent. Trends vary globally, and currently, there is limited data on involuntary hospitalization in Canada. We examine involuntary hospitalization trends in British Columbia, Canada, and describe the social and clinical characteristics of people ages 15 and older who were involuntarily hospitalized between 2008/2009 and 2017/2018. Method We used population-based linked administrative data to examine and compare trends in involuntary and voluntary hospitalizations for mental and substance use disorders. We described patient characteristics (sex/gender, age, health authority, income, urbanity/rurality, and primary diagnosis) and tracked the count of involuntarily hospitalized people over time by diagnosis. Finally, we examined population-based prevalence over time by age and sex/gender. Results Involuntary hospitalizations among British Columbians ages 15 and older rose from 14,195 to 23,531 (65.7%) between 2008/2009 and 2017/2018. Apprehensions involving police increased from 3,502 to 8,009 (128.7%). Meanwhile, voluntary admissions remained relatively stable, with a minimal increase from 17,651 in 2008/2009 to 17,751 in 2017/2018 (0.5%). The most common diagnosis for involuntary patients in 2017/2018 was mood disorders (25.1%), followed by schizophrenia (22.3%), and substance use disorders (18.8%). From 2008/2009 to 2017/2018, the greatest increase was observed for substance use disorders (139%). Over time, population-based prevalence increased most rapidly among women ages 15–24 (162%) and men ages 15–34 (81%) and 85 and older (106%). Conclusion Findings highlight the need to strengthen the voluntary care system for mental health and substance use, especially for younger adults, and people who use substances. They also signal a need for closer examination of the use of involuntary treatment for substance use disorders, as well as further research exploring forces driving police involvement and its implications.

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A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services

Knaub

Evans

Yang

et al. 2022

Drug and Alcohol Dependence

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The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders

Cited by 10 publications

References 60 publications

The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls

The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls

Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018

A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services

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