Hospital policies put the lives of people who inject drugs at risk, say experts

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  1. Wip Lamba

    Thank you for bringing this topic to the forefront. When a patient leaves AMA due to withdrawal it is a sign that the system failed. We need the attitude shift that Dr. Selby was talking about and access to supplies, harm reduction principles and access to active addiction treatment within the hospital setting. I look forward to see how this attitude shift occurs and the addiction team at St. Mikes would be happy to help in any way possible.

    Offering Buprenorphine, methadone, alcohol withdrawal treatment, anti craving Meds, harm reduction tools/kits and psychosocial interventions would be a great place to start and anyone is welcome to contact us if they want to build capacity in those areas – Wip Lamba, addiction physician St. Mikes , toronto.

  2. Kenneth Lam

    This is a great topic that doesn’t get enough attention in the hospital.

    The bad relations between health care providers and drug users stem from a lot of assumptions made by both parties. As the article suggests, drug users are likely to have bad experiences with health care providers, and sometimes just one experience is all it takes for them to lose faith in the system and start seeing doctors and nurses as uncaring and stingy. For health care providers, we are scared of being held responsible for over-prescribing opiates, but I think we are made even more hesitant from experiences with shrewd and misleading requests for drugs in hospital: I believe we are more averse to the idea of being taken advantage of than of the risk of over-prescribing.

    For health care providers to become less judgmental, there needs to be a change in attitudes about drug use and the long road to recovery as the articles suggests, perhaps made explicit through some re-assurance from regulatory bodies about what actually constitutes egregious prescribing practices in hospital. But we also need a strategy to deal with that feeling we get when we find out someone has lied to us – that mixture of anger, betrayal and humiliation – which colours so many of our encounters with this marginalized population.

  3. Lisa Bromley

    In addition to offering harm reduction services, hospitals should be prepared to offer pharmacologic treatment for people with substance use disorders (SUD). Specifically, contrary to popular perception, Opioid Use Disorder (OUD) is a highly treatable illness. It often responds spectacularly well to pharmacologic treatment with methadone or buprenorphine-naloxone. Methadone and bup-nx are gold standard treatments with incontrovertible scientific evidence behind them. Methadone treatment for OUD is over fifty years old: talk about a gap between evidence and practice. Not offering treatment for OUD in hospital is akin to not starting treatment for a newly diagnosed diabetic in hospital. It is a combination of attitude gap and knowledge gap. Hospitalization with a serious illness can be a major motivation for change for someone who is injecting, a window of opportunity. If a hospital is to offer harm reduction services, it makes the most sense to offer the full spectrum of harm reduction, namely, offer proven medication treatment for Opioid Use Disorder *in addition to* safer injection support. Without it, patients who are interested in treatment and who would benefit from methadone or bup-nx would miss a precious opportunity. The gains in health and cost savings would be massive if even a small proportion of injection drug using patients were captured into methadone or bup-nx treatment during a hospitalization. -Lisa Bromley, family physician with focused practice in addiction, Ottawa

    • Wip Lamba

      Lisa’s comment on in-hospital treatment is so true. Many hospitals do not have a regular prescriber who can initiate and continue buprenorphine-naloxone or methadone. Harm reduction works best when we are in environments where there is a saturation of treatment options.

      Hopefully there will be a shift in hospital policy so all patients have access to these treatments when indicated.

  4. Kimberly Wintemute

    Thanks for bringing this issue to light. One of the hardest things to do in life – and as a care provider – is to put yourself in someone else’s shoes. This piece helps me do that.

  5. Elliott Coronado

    I had pleaded with the hospital not to take any decisions without first speaking to me, but they ignored me, as they had done since she was admitted as an emergency six days earlier.

  6. Richard Gould

    I understand that Health Canada has recently classified heroin in such a way that physicians can legally prescribe it. So perhaps this is another option available to hospitals. A hospital could possibly try methadone or suboxzone first but if that doesn’t work then injectable options could be available for the patient.

  7. Carrie H

    Heroin has been legal for a very long time. Many patients in Hospital (especially cardiac patients) are give it for pain on a routine basis. It is safer for the hear than the alternative, Morphine.

    It is labeled as “Diamorphine” it is, esentially, more refined heroin. I bet at least 1/3 or more of elderly patients in hospital have recieved it on a routine basis. (Not available in many countries but luckily Canada allows it).

    If you havent already and have an interest in the subject, please check out Johann Hari and listen to his Ted talk. If you want to explore further, he as a superb book out about everything anyone should know about it and many of its Opiate/oid relatives.

    Being informed and knowledgable, especially in the Healtcare field, about something that affect a huge percentage of patients can only make you a better provider. Knowledge is power.

    One cannot truly have an opinion on a subject that he/she know little about. Who know, it just might change perceptions, opinions, and help you save someone who would otherwise be lost to the tradgedy of addiction.

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