Addressing in-hospital illicit substance use

Barnett, Brian S.; Morris, Nathaniel P.; Suzuki, Joji

doi:10.1016/s2215-0366(20)30487-9

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…Current guidelines recommend the use of methadone, buprenorphine, and non-opioids for managing opioid withdrawal, however, these medications can often be insufficient in alleviating withdrawal among patient using fentanyl (63)(64)(65). Patients with undertreated withdrawal may use their illicit substances and selfdischarge against medical advice, which are strongly associated with adverse outcomes and mortality (66)(67)(68). Some physicians have employed the use of short-acting opioids, like IV hydromorphone and fentanyl, to support patients to stay in hospital and initiate them on OAT (60,65).…”

Section: Discussionmentioning

confidence: 99%

Systematic review on intentional non-medical fentanyl use among people who use drugs

Tsang,

Wong,

Westenberg

et al. 2024

Front. Psychiatry

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ObjectivesFentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use.MethodsThe search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included.ResultsThe search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability.ConclusionsAmong PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.

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Section: Discussionmentioning

confidence: 99%

Systematic review on intentional non-medical fentanyl use among people who use drugs

Tsang,

Wong,

Westenberg

et al. 2024

Front. Psychiatry

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“…We report higher rates of in-hospital substance use among this population than previously seen. This demonstrates the need to address this issue, as ignoring these behaviors can lead to adverse health outcomes, 40 and abstinence-based policies have been shown not to prevent substance use during hospitalizations. Findings from this study provide a holistic understanding of people who use methamphetamine.…”

Section: Discussionmentioning

confidence: 99%

Characterization of a Cohort of Persons Who Use Methamphetamines in London, Ontario, and In-hospital Substance Use

Kim,

Silverman,

Anderson

et al. 2023

Canadian Journal of Addiction

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Our objective was to describe the sociodemographic characteristics of a cohort of people who use methamphetamine with a history of hospitalizations in London, Ontario, including their substance use patterns, health and social service use patterns, and self-perceived quality of life. Participants were recruited from community and hospital settings in Southwest Ontario, and survey data were collected between October 2020 and May 2021. A total of 109 individuals were recruited in the study, of whom 32.1% reported a hospitalization directly related to methamphetamine use and 55.0% reported using substances during a hospitalization. The survey participants had high rates of health and social service use, as well as emergency department visits. Scores for quality of life and community integration were lower for the study participants compared with general population scores. We found that in-hospital substance use was higher than reported previously, highlighting the need to address this issue to support people who use methamphetamine in the hospital setting. Notre objectif était de décrire les caractéristiques sociodémographiques d’une cohorte de personnes consommant de la méthamphétamine et ayant des antécédents d’hospitalisation à London, en Ontario, incluant leurs habitudes de consommation de substances, leurs habitudes d’utilisation des services sociaux et de santé et leur perception de leur qualité de vie. Les participants ont été recrutés dans les milieux communautaires et hospitaliers du sud-ouest de l’Ontario, et les données de l’enquête ont été recueillies entre octobre 2020 et mai 2021. Au total, 109 personnes ont été recrutées dans l'étude. 32,1% ont déclaré une hospitalisation directement liée à la consommation de méthamphétamine, et 55,0% ont déclaré avoir consommé des substances pendant une hospitalisation. Les participants à l’enquête présentaient des taux élevés d’utilisation des services sociaux et de santé, ainsi que de visites aux urgences. Les scores de qualité de vie et d’intégration dans la communauté étaient inférieurs pour les participants à l'étude par rapport aux scores de la population générale. Nous avons constaté que la consommation de substances à l’hôpital était plus élevée que ce qui avait été rapporté précédemment, ce qui souligne la nécessité d’aborder cette question pour soutenir les personnes qui consomment de la méthamphétamine en milieu hospitalier.

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“…In completing an assessment, it becomes clear that while there are risks to the patient and staff of ongoing substance use, in many cases these risks can be mitigated by practices which will improve patient care and reduce the serious impact of stigmatised care [3]. Harm reduction interventions as those detailed in Table 1 have been advocated before [12] and also implemented in some hospital settings [13]. PWUDs have been given harm reduction education and 'harm reductions kits' containing sharps containers, sterile injecting equipment, tourniquets, etc., with reports of better education and engagement of patients, staff and clinicians though further evaluation is required [13].…”

Section: Risk Assessments For Drug Use In Hospitalsmentioning

confidence: 99%

“…The role of substance use in hospitals and advocating for a harm reduction model [11] has been discussed previously with recommendations made for changes in both hospital policy, staff training and further research into people using drugs in hospital settings [12]. This article hopes to complement these earlier works by providing practical strategies and a template in how to achieve this and how it may be possible for hospitals to provide a model for harm reduction which can result in improvements in outcomes.…”

Section: A Proposal For Hospitals To Move Past Abstinence‐based Appro...mentioning

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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Addressing in-hospital illicit substance use

Cited by 9 publications

References 5 publications

Systematic review on intentional non-medical fentanyl use among people who use drugs

Systematic review on intentional non-medical fentanyl use among people who use drugs

Characterization of a Cohort of Persons Who Use Methamphetamines in London, Ontario, and In-hospital Substance Use

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

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