Brynn Kosteniuk1, Ginetta Salvalaggio2, Ryan McNeil3, Hannah L Brooks1, Kathryn Dong2, Shanell Twan4, Jennifer Brouwer5, Elaine Hyshka6. 1. School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AL, T6G 1C9, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada. 2. Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada; Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112St. NW, Edmonton, AL, T6G 2R7, Canada. 3. School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, USA. 4. Streetworks, 10116-105 Ave, Edmonton, AL, T5H 0K2, Canada. 5. Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada. 6. School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AL, T6G 1C9, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, B818 Women's Centre, 10240 Kingsway Ave, Edmonton, AL, T5H 3V9, Canada. Electronic address: ehyshka@ualberta.ca.
Abstract
BACKGROUND: Acute care hospitals have been described as a high risk environment for people who use drugs (PWUD). Formal and informal bans on drug use can lead patients to conceal their use and consume under unsafe circumstances. Provision of hospital-based supervised consumption services (SCS) could help reduce drug-related harms and improve patient care. However, no peer-reviewed research documents patient experiences with attending SCS in this setting. To address this gap, the present study examines key factors that shape patients' decisions to attend or not attend a novel SCS embedded within a large, urban acute care hospital in Western Canada. METHODS: We adopted a focused ethnographic design and conducted 28 semi-structured interviews with SCS-eligible patients. We examined participant accounts thematically, and Rhodes' "Risk Environment" framework helped guide our analysis. RESULTS: Most participants perceived the SCS as a safer environment that made it possible to reduce drug-related risks and avoid using in unsafe areas of the hospital where they could be caught by staff, security, or police. However, some participants did not trust that the SCS would provide adequate protection from criminalization, which motivated them to avoid the site. Several participants also worried about the potential for unwanted changes to their patient care following SCS use. Physical site and policy limitations, such as eligibility requirements and a lack of infrastructure to support supervised inhalation, were additional reasons for not attending the SCS. CONCLUSION: PWUD in this study attended the hospital-based SCS in an attempt to reduce risks associated with their hospital stay. However, we note a number of access barriers that should be addressed to ensure optimal uptake. Wider provision of SCS in acute care requires both changes to the hospital environment and broader drug policy reform.
BACKGROUND: Acute care hospitals have been described as a high risk environment for people who use drugs (PWUD). Formal and informal bans on drug use can lead patients to conceal their use and consume under unsafe circumstances. Provision of hospital-based supervised consumption services (SCS) could help reduce drug-related harms and improve patient care. However, no peer-reviewed research documents patient experiences with attending SCS in this setting. To address this gap, the present study examines key factors that shape patients' decisions to attend or not attend a novel SCS embedded within a large, urban acute care hospital in Western Canada. METHODS: We adopted a focused ethnographic design and conducted 28 semi-structured interviews with SCS-eligible patients. We examined participant accounts thematically, and Rhodes' "Risk Environment" framework helped guide our analysis. RESULTS: Most participants perceived the SCS as a safer environment that made it possible to reduce drug-related risks and avoid using in unsafe areas of the hospital where they could be caught by staff, security, or police. However, some participants did not trust that the SCS would provide adequate protection from criminalization, which motivated them to avoid the site. Several participants also worried about the potential for unwanted changes to their patient care following SCS use. Physical site and policy limitations, such as eligibility requirements and a lack of infrastructure to support supervised inhalation, were additional reasons for not attending the SCS. CONCLUSION: PWUD in this study attended the hospital-based SCS in an attempt to reduce risks associated with their hospital stay. However, we note a number of access barriers that should be addressed to ensure optimal uptake. Wider provision of SCS in acute care requires both changes to the hospital environment and broader drug policy reform.
Authors: Elizabeth Dogherty; Carlin Patterson; Marilou Gagnon; Scott Harrison; Jocelyn Chase; Jill Boerstler; Jennifer Gibson; Sam Gill; Seonaid Nolan; Andy Ryan Journal: Harm Reduct J Date: 2022-02-05