Meeting people where they are: implementing hospital-based substance use harm reduction

Rachel Perera,Ayesha Appa,Marlene Martin,Paula Lum,Louise Stephan,Robert Hoffman,Ro Giuliano

doi:10.1186/s12954-022-00594-9

Abstract

BackgroundHospital-based addiction care focuses on assessing and diagnosing substance use disorders, managing withdrawal, and initiating medications for addiction treatment. Hospital harm reduction is generally limited to prescribing naloxone. Hospitals can better serve individuals with substance use disorders by incorporating harm reduction education and equipment provision as essential addiction care. We describe the implementation of a hospital intervention that provides harm reduction education and equipment (e.g., syringes, pipes, and fentanyl test strips) to patients via an addiction consult team in an urban, safety-net hospital.MethodsWe performed a needs assessment to determine patient harm reduction needs. We partnered with a community-based organization who provided us harm reduction equipment and training. We engaged executive, regulatory, and nursing leadership to obtain support. After ensuring regulatory compliance, training our team, and developing a workflow, we implemented this harm reduction program that provides education and equipment to individuals whose substance use goals do not include abstinence.ResultsDuring a 12-month period we provided 195 individuals harm reduction kits.ConclusionsThis intervention allowed us to advance hospital-based addiction care, better educate and engage patients, staff, and clinicians, and reduce stigma. By establishing a community harm reduction partner, obtaining support from hospital leadership, and incorporating feedback from staff, clinicians, and patients, we successfully implemented harm reduction education and equipment provision in a hospital setting as part of evidence-based addiction care.Trial registration: Commentary, none.

Highlights

Hospital-based addiction care focuses on assessing and diagnosing substance use disorders, managing withdrawal, and initiating medications for addiction treatment
Hospital-based addiction care is focused on diagnosing Substance use disorder (SUD), treating withdrawal, initiating medications for SUD, and prescribing
We describe the implementation of harm reduction education and equipment provision in an urban, safety-net hospital

Summary

Introduction

Hospital-based addiction care focuses on assessing and diagnosing substance use disorders, managing withdrawal, and initiating medications for addiction treatment. Hospitals can better serve individuals with substance use disorders by incorporating harm reduction education and equipment provision as essential addiction care. We describe the implementation of a hospital intervention that provides harm reduction education and equipment (e.g., syringes, pipes, and fentanyl test strips) to patients via an addiction consult team in an urban, safety-net hospital. We describe the implementation of harm reduction education and equipment provision (e.g., syringes, pipes, fentanyl test strips, and other safe use supplies) in an urban, safety-net hospital. To our knowledge, this is the first published guideline of how to integrate harm reduction education and equipment distribution in a US hospital as part of evidencebased addiction care

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