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

Abstract

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.

Willingness to use an in‐hospital supervised inhalation room among people who smoke crack cocaine in Vancouver, Canada

“…Our study also found that people who use non-injection crack cocaine daily were more likely to report willingness to use an in-hospital SIR. This is consistent with previous studies documenting associations between high-intensity drug use and willingness to use in-hospital supervised injection facilities [32]. Our finding of an association between daily crack use and willingness to use an in-hospital SIR is encouraging given that high-intensity use of crack cocaine has previously been linked to various high-risk sexual and drug use behaviours and harms [10] and that a key objective of supervised consumption facilities is to attract higher-risk PWUD [30].…”

“…The tendency for SIR-willing people who smoke crack cocaine to have ever used drugs in hospital is largely consistent with a previous study demonstrating that having a history of in-hospital drug use was positively associated with willingness to use an in-hospital supervised injection facility among people who inject drugs [32]. This finding likely reflects an appreciation for in-hospital SIRs based on prior difficult hospitalisation experiences [15,17], particularly given that the primary reasons cited for willingness to use an in-hospital SIR were based on the desire to remain in hospital and circumvent structural pressures that promote risky drug use practices and premature discharges.…”

“…If a participant had more than one observation of crack cocaine use in the previous six months during the study period, the most recent observation was included in the analyses. The primary outcome of this study was the willingness to access an in-hospital SIR (yes vs. no or unsure), ascertained by asking participants the following hypothetical question: “If you were admitted into a hospital, and if there was a safe place to smoke your drugs (ventilated inhalation room) in that hospital, would you use it?” Explanatory variables were selected on the basis of previous studies that examined acceptability or use of supervised consumption sites among PWUD [29,32,33]. These variables included: age (per year increase); gender (male vs. female or transgender); ancestry (Caucasian vs. other); HIV serostatus (positive vs. negative); homelessness (yes vs. no); DTES residency (yes vs. no); cocaine injection (≥ daily vs. <daily); heroin injection (≥ daily vs. <daily); non-injection crack use (≥ daily vs. <daily); binge non-injection drug use (yes vs. no); shared crack pipe (yes vs. no); difficulty accessing new crack pipes (yes vs. no); bought used crack pipe off the street (yes vs. no); smoked crack in public (yes vs. no); non-fatal overdose (yes vs. no); ever left hospital AMA (yes vs. no); ever used drugs in hospital (yes vs. no); ever treated poorly by healthcare professional (yes vs. no); enrolment in addiction treatment (yes vs. no); sex work involvement (yes vs. no); ‘jacked up’ by police (i.e.…”

Integrating harm reduction and clinical care: Lessons from Covid-19 respite and recuperation facilities

“…Covid-19 has focused a light on the counter-productivity of this mentality and highlighted the need for and feasibility of change. In-hospital overdose prevention or supervised injection facilities are available to patients in several hospitals in Canada and must be made available in the United States ( Dong, Brouwer, Johnston, & Hyshka, 2020 ; Ti et al, 2015 ). In response to Covid-19, the British Columbia Ministry of Health recommended additional harm reduction approaches.…”

Lewer, D; Copeland, C; Eastwood, B; Farrell, M; Petersen, I; White, M; (2020) Fatal opioid overdoses in healthcare settings in England: a case series analysis (PROTOCOL)

“…The risk of fatal overdose in these settings may be modifiable through more timely provision of opioid substitution therapies and/or naloxone, safer injecting spaces (which have been proposed in Canada 23 ), or improved protocols for management of people who are dependent on opioids. A study of hospital opioid substitution protocols is currently underway, led by Release and LSHTM, with early findings showing wide variation in protocols.…”