In-Hospital Substance Use and Possession: A Study of Events From 38 Acute Care Hospitals in Pennsylvania

Abstract

Patients’ substance use and possession at acute care hospitals is an understudied topic. To learn more about this topic, we queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) for events that occurred during calendar year 2018. We identified 106 reports from 38 acute care hospitals (excluding psychiatric, detox, and behavioral health units and facilities) where a patient possessed and/or misused a substance (e.g., heroin, oxycodone, liquor). We analyzed these reports to better understand how hospital personnel attempt to prevent in-hospital substance use and manage patients who are at risk for using a substance. We explored a range of variables, including antecedent conditions and hospital personnel’s actions post- detection of a patient’s substance use or possession. We found that a relatively low percentage of patients (26%) were identified as having a prior history of substance use, despite later using or being in possession of a substance in hospital. In our sample, patients frequently acquired the substances from visitors, more than half of the substances were consumed intravenously, and opioids were the most common substance. The most prevalent actions taken by hospital personnel were conducting searches for substances and paraphernalia, use of a patient sitter or video monitor, moving patients to a different room, and implementing visitor restrictions. Based on our findings and previous research, hospitals should consider increasing their use of substance use disorder (SUD) screening tools, pharmacotherapy, and referring patients to treatment. Overall, our results can help personnel better understand the nature of and strategies that may reduce the likelihood of in-hospital substance use. Keywords: substance use, paraphernalia, substance use disorder, in-hospital, addiction, opioid, risk mitigation, patient safety