Substance Use Harm Reduction Approach Provides Support for Patients

A harm reduction approach to substance use provides realistic support for patients who are hospitalized for other medical reasons, according to a Psychiatric News article.

Many individuals with substance use disorders continue to use illicit substances during hospitalization for medical conditions, posing ethical challenges for physicians. This issue was discussed at the 2023 Academy of Consultation-Liaison Psychiatry annual meeting, emphasizing harm reduction strategies for managing in-hospital substance use, particularly regarding opioid use disorders.

“It’s normal for a lot of physicians to be very surprised and have an intense reaction when a patient is found using in the hospital,” said Samantha Zwiebel, MD, MA, an assistant professor of clinical psychiatry at the University of Pennsylvania Perelman School of Medicine. “For those of us who do addiction psychiatry in the hospital, it’s just another day at the office. It’s not surprising.”

The concept of harm reduction is not about enabling drug use but recognizing the difficulties of achieving abstinence and aiming to minimize the negative effects of substance use. In the context of hospital care, this can mean acknowledging that patients might bring substances into the facility to avoid withdrawal or discomfort. Strategies discussed include the controversial topics of searching patients' belongings for drugs and the potential for safe injection sites within hospitals.

A January 2023 commentary in the Journal of Addiction Medicine calls for nonpunitive in-hospital substance use policies, recognizing the commonality and adverse outcomes associated with in-hospital substance use. The APA Board of Trustees, in December 2023, supported harm reduction in a position statement, advocating for the discussion of medications like buprenorphine for patients admitted with opioid use disorder.

Hospitals are encouraged to develop patient-centered policies that balance between monitoring patients and respecting their dignity, including education on substance use signs, naloxone training, and offering treatment for withdrawal symptoms, regardless of a patient's abstinence goal. This approach aims to provide compassionate care that addresses both the medical and psychological needs of patients with substance use disorders. “At my hospital we try to offer aggressive treatment for OUD. I can have a conversation with the patient and say, ‘Our goal is that you do not suffer and that you do not have to use. I know that some patients bring substances into the hospital. I do not assume that you have, but I do know you may be going through withdrawal. If you are, please tell your nurse that we should be offering you more medication,” said Dr Zwiebel.

Reference

Moran M. Harm reduction approach to substance use provides realistic support for patients. PsychiatricNews. Published online February 26, 2024. Accessed March 8, 2024. https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2024.03.3.12