Key challenges in providing services to people who use drugs: The perspectives of people working in emergency departments and shelters in Atlantic Canada

Abstract

AimsMany people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision.MethodsEDs and shelters were conceptualized as ‘micro environments’ with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada.FindingsThe social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges.ConclusionsStructural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.

Buprenorphine–naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey

“…26,27,29 Our finding that physicians valued addictions-trained ancillary staff and locally developed pathways is consistent with the findings of other North American studies. [25][26][27]29 Although our study physicians' self-efficacy score in treating PWUD was higher than previously reported elsewhere, 3 the low proportion of physicians scoring highly is discouraging and may reflect the lack of PWUD treatment resources identified by some of our ED groups, frustration with ED care of PWUD, 40 lower clinical regard for PWUD than for people with other conditions 41 and persistent stigma toward people with OUD and OUD-related medications. 20 Time constraints in the ED may be alleviated by easy-touse, locally appropriate clinical pathways and the availability Research of ED-based specialized staff to help with ED BUP.…”

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

“…To our knowledge, this is the first systematic review on harm reduction approaches and pharmacological interventions for this population. While our review did not focus exclusively on studies among populations experiencing homelessness, people experiencing homelessness and people who use substances both face considerable social marginalization, multiple physical and/or mental health concerns, and high rates of premature morbidity [79]. Our review found that these interventions reduce harms associated with substance use and mitigate morbidity and mortality [41,44,45,50,51,53,57,58,60,65,66].…”

A latent class approach to identify multi‐risk profiles associated with phylogenetic clustering of recent hepatitis C virus infection in Australia and New Zealand from 2004 to 2015

“…Those not sampled in this study were people with chronic HCV infection, and potentially people who are less likely to attend tertiary clinics or hospitals where participants in these studies were recruited. People who may be less likely to attend such settings are marginalized people or those not engaged in the healthcare system, particularly PWID . This highlights the need to provide HCV testing and treatment in non‐tertiary clinics and other places where the people who need to access these services are most likely to visit.…”