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Fabricant SA, Abramson EL, Hutchings K, Vien A, Scherer M, Kapadia SN. PICC Your Poison: Resident Beliefs and Attitudes Regarding Discharge Parenteral Antibiotics for Patients Who Inject Drugs. Open Forum Infect Dis 2024; 11:ofae364. [PMID: 38994443 PMCID: PMC11237634 DOI: 10.1093/ofid/ofae364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024] Open
Abstract
Background Serious injection-related infections (SIRIs) in people who inject drugs often lead to prolonged hospitalizations or premature discharges. This may be in part due to provider reluctance to place peripherally inserted central catheters (PICCs) for outpatient parenteral antibiotic therapy in this population. Because internal medicine (IM) residents are often frontline providers in academic centers, understanding their perspectives on SIRI care is important to improve outcomes. Methods We surveyed IM residents in a large urban multicenter hospital system about SIRI care with a novel case-based survey that elicited preferences, comfort, experience, and stigma. The survey was developed using expert review, cognitive interviewing, and pilot testing. Results are reported with descriptive statistics and linear regression. Results Of 116 respondents (response rate 34%), most (73%) were uncomfortable discharging a patient with active substance use home with a PICC, but comfortable (87%) with discharge to postacute facilities. Many (∼40%) endorsed high levels of concern for PICC misuse or secondary line infections, but larger numbers cited concerns about home environment (50%) or loss to follow-up (68%). While overall rates were low, higher stigma was associated with more concerns around PICC use (r = -0.3, P = .002). A majority (58%) believed hospital policies against PICC use in SIRI may act as a barrier to discharge, and 74% felt initiation of medications for opioid use disorder (MOUD) would increase their comfort discharging with a PICC. Conclusions Most IM residents endorsed high levels of concern about PICC use for SIRI, related to patient outcomes and perceived institutional barriers, but identified MOUD as a mitigating factor.
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Affiliation(s)
- Scott A Fabricant
- Department of Medicine, New York–Presbyterian, New York, New York, USA
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Kayla Hutchings
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Alexis Vien
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Scherer
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA
| | - Shashi N Kapadia
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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2
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Guta A, Gagnon M, German D, Buchman DZ, Strike CJ. Resisting Inadequate Care is Not Irrational, and Coercive Treatment is Not an Appropriate Response to the Drug Toxicity Crises. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:42-45. [PMID: 38635440 DOI: 10.1080/15265161.2024.2327287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Adrian Guta
- School of Social Work, University of Windsor
| | | | | | | | - Carol J Strike
- Dalla Lana School of Public Health, University of Toronto
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3
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Bardwell G, Ivsins A, Wallace JR, Mansoor M, Kerr T. "The machine doesn't judge": Counternarratives on surveillance among people accessing a safer opioid supply via biometric machines. Soc Sci Med 2024; 345:116683. [PMID: 38364722 DOI: 10.1016/j.socscimed.2024.116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
People who use illegal drugs experience routine surveillance, including in healthcare and harm reduction settings. The MySafe Project - a safer supply pilot project that dispenses prescription opioids via a biometric vending machine - exists in the Canadian province of British Columbia. The machine scans a participant's palmprint and has a built-in camera that records every machine interaction. The aim of this paper is to understand participants' experiences of surveillance, privacy, and personal security when accessing this novel program. An integrative case study and grounded theory methodology was employed. Qualitative one-to-one interviews were conducted with 46 MySafe participants across three different program sites in Vancouver. We used a team-based approach to code interview transcripts and utilized directed and conventional content analyses for deductive and inductive analyses. While participants described negative experiences of surveillance in other public and harm reduction settings, they did not have concerns regarding cameras, collection of personal information, tracking, nor staff issues associated with MySafe. Similarly, while some participants had privacy concerns in other settings, very few privacy and confidentiality concerns were expressed regarding accessing the machine in front of others. Lastly, while some participants reported being targeted by others when accessing the machines, most participants described how cameras, staff, and machine locations helped ensure a sense of safety. Despite negative experiences of surveillance and privacy issues elsewhere, participants largely lacked concern regarding the MySafe program and machines. The machine-human interaction was characterized as different than some human-human interactions as the machine is completing tasks in a manner that is acceptable and comfortable to participants, leading to a social preference toward the machines in comparison to other surveilled means of accessing medications. These findings provide an opportunity to rethink how we conceptualize surveillance, medication access, and harm reduction programs targeting people who use drugs.
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Affiliation(s)
- Geoff Bardwell
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - James R Wallace
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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4
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Michaud L, van der Meulen E, Guta A. Between Care and Control: Examining Surveillance Practices in Harm Reduction. CONTEMPORARY DRUG PROBLEMS 2023; 50:3-24. [PMID: 36733491 PMCID: PMC9885017 DOI: 10.1177/00914509221128598] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023]
Abstract
As harm reduction programs and services proliferate, people who use drugs (PWUD) are increasingly subjected to surveillance through the collection of their personal information, systematic observation, and other means. The data generated from these practices are frequently repurposed across various institutional sites for clinical, evaluative, epidemiological, and administrative uses. Rationales provided for increased surveillance include the more effective provision of care, service optimization, risk stratification, and efficiency in resource allocation. With this in mind, our reflective essay draws on empirical analysis of work within harm reduction services and movements to reflect critically on the impacts and implications of surveillance expansion. While we argue that many surveillance practices are not inherently problematic or harmful, the unchecked expansion of surveillance under a banner of health and harm reduction may contribute to decreased uptake of services, rationing and conditionalities tied to service access, the potential deepening of health disparities amongst some PWUD, and an overlay of health and criminal-legal systems. In this context, surveillance relies on the enlistment of a range of therapeutic actors and reflects the permeable boundary between care and control. We thus call for a broader critical dialogue within harm reduction on the problems and potential impacts posed by surveillance in service settings, the end to data sharing of health information with law enforcement and other criminal legal actors, and deference to the stated need among PWUD for meaningful anonymity when accessing harm reduction and health services.
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Affiliation(s)
- Liam Michaud
- Socio-Legal Studies Graduate Program, York University, Toronto,
Ontario, Canada,Liam Michaud, Socio-Legal Studies Graduate
Program, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
| | - Emily van der Meulen
- Department of Criminology, Toronto Metropolitan University, Toronto,
Ontario, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario,
Canada,Australian Research Centre in Sex, Health and Society, La Trobe
University, Melbourne, Victoria, Australia
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5
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Eckland A, Kohut M, Stoddard H, Burris D, Chessa F, Sikka MK, Solomon DA, Kershaw CM, Eaton EF, Hutchinson R, Friedmann PD, Stopka TJ, Fairfield KM, Thakarar K. "I know my body better than anyone else": a qualitative study of perspectives of people with lived experience on antimicrobial treatment decisions for injection drug use-associated infections. Ther Adv Infect Dis 2023; 10:20499361231197065. [PMID: 37693858 PMCID: PMC10492466 DOI: 10.1177/20499361231197065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background People who inject drugs (PWID) are at risk for severe bacterial and fungal infections including skin and soft tissue infections, endocarditis, and osteomyelitis. PWID have high rates of self-directed discharge and are often not offered outpatient antimicrobial therapies, despite studies showing their efficacy and safety in PWID. This study fills a gap in knowledge of patient and community partner perspectives on treatment and discharge decision making for injection drug use (IDU)-associated infections. Methods We conducted semi-structured interviews with patients (n = 10) hospitalized with IDU-associated infections and community partners (n = 6) in the Portland, Maine region. Community partners include peer support workers at syringe services programs (SSPs) and outreach specialists working with PWID. We transcribed and thematically analyzed interviews to explore perspectives on three domains: perspectives on long-term hospitalization, outpatient treatment options, and patient involvement in decision making. Results Participants noted that stigma and inadequate pain management created poor hospitalization experiences that contributed to self-directed discharge. On the other hand, patients reported hospitalization provided opportunities to connect to substance use disorder (SUD) treatment and protect them from outside substance use triggers. Many patients expressed interest in outpatient antimicrobial treatment options conditional upon perceived efficacy of the treatment, perceived ability to complete treatment, and available resources and social support. Finally, both patients and community partners emphasized the importance of autonomy and inclusion in medical decision making. Although some participants acknowledged their SUD, withdrawal symptoms, or undertreated pain might interfere with decision making, they felt these medical conditions were not justification for health care professionals withholding treatment options. They recommended open communication to build trust and reduce harms. Conclusion Patients with IDU-associated infections desire autonomy, respect, and patient-centered care from healthcare workers, and may self-discharge when needs or preferences are not met. Involving patients in treatment decisions and offering outpatient antimicrobial options may result in better outcomes. However, patient involvement in decision making may be complicated by many contextual factors unique to each patient, suggesting a need for shared decision making to meet the needs of hospitalized patients with IDU-associated infections.
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Affiliation(s)
- Amy Eckland
- Tufts University School of Medicine, Boston, MA, USA
| | - Michael Kohut
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
| | - Henry Stoddard
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
| | - Deb Burris
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
| | - Frank Chessa
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Center, Portland, ME, USA
| | - Monica K. Sikka
- Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Daniel A. Solomon
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA, USA
| | - Colleen M. Kershaw
- Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ellen F. Eaton
- Division of Infectious Disease, University of Alabama, Birmingham, AL, USA
| | - Rebecca Hutchinson
- Tufts University School of Medicine, Boston, MA, USA
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
- Maine Medical Center, Portland, ME, USA
| | - Peter D. Friedmann
- Office of Research, Baystate Health and UMass Chan Medical School—Baystate, Springfield, MA, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kathleen M. Fairfield
- Tufts University School of Medicine, Boston, MA, USA
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
- Maine Medical Center, South Portland, ME, USA
| | - Kinna Thakarar
- Maine Medical Center, 41 Donald B. Dean Drive, Suite B, South Portland, ME 04106, USA
- Tufts University School of Medicine, Boston MA, USA
- Maine Health Institute for Research, Center for Interdisciplinary Population and Health Research, Portland, ME, USA
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6
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Chase J, Nicholson M, Dogherty E, Garrod E, Hill J, Brar R, Weaver V, Connors WJ. Self-injecting non-prescribed substances into vascular access devices: a case study of one health system's ongoing journey from clinical concern to practice and policy response. Harm Reduct J 2022; 19:130. [PMID: 36424629 PMCID: PMC9694828 DOI: 10.1186/s12954-022-00707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Overdose-associated deaths and morbidity related to substance use is a global public health emergency with devastating social and economic costs. Complications of substance use are most pronounced among people who inject drugs (PWID), particularly infections, resulting in increased risk of hospitalization. PWID often require intravenous access for medical treatments such as antibiotics; however, vascular access may be limited due to the impacts of long-term self-venipuncture. While vascular access devices including peripherally inserted central catheters (PICCs) allow reliable and sustained routes of administration for indicated therapies, the use of PICCs among PWID presents unique challenges. The incidence and risks associated with self-injecting non-prescribed substances into vascular access devices (SIVAD) is one such concern for which there is limited evidence and absence of formal practice guidance. CASE PRESENTATION We report the experience of a multidisciplinary team at a health organization in Vancouver, Canada, working to characterize the incidence, patient and healthcare provider perspectives, and overall impact of SIVAD. The case study of SIVAD begins with a patient's perspective, including patient rationale for SIVAD, understanding of risks and the varying responses given by healthcare providers following disclosure of SIVAD. Using the limited literature available on the subject, we summarize the intersection of SIVAD and substance use and outline known and anticipated health risks. The case study is further contextualized by experience from a Vancouver in-hospital Overdose Prevention Site (OPS), where 37% of all individual visits involve SIVAD. The case study concludes by describing the systematic process by which local clinical guidance for SIVAD harm reduction was developed with stakeholder engagement, medical ethics consultation, expert consensus guideline development and implementation with staff education and planned research evaluation. CONCLUSION SIVAD is encountered with enough frequency in an urban healthcare setting in Vancouver, Canada, to warrant an organizational approach. This case study aims to enhance appreciation of SIVAD as a common and complex clinical issue with anticipated health risks. The authors conclude that using a harm reduction lens for SIVAD policy and research can provide benefit to clinicians and patients by offering a clear and a consistent healthcare response to this common issue.
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Affiliation(s)
- Jocelyn Chase
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.416553.00000 0000 8589 2327Division of Geriatric Medicine, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Melissa Nicholson
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Elizabeth Dogherty
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Emma Garrod
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre On Substance Use, Vancouver, Canada
| | - Jocelyn Hill
- grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada
| | - Rupinder Brar
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.498786.c0000 0001 0505 0734Vancouver Coastal Health, Vancouver, BC Canada ,grid.415289.30000 0004 0633 9101Inter-Department Division of Addiction Medicine, Providence Health Care, Vancouver, BC Canada
| | - Victoria Weaver
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre On Substance Use, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Inter-Department Division of Addiction Medicine, Providence Health Care, Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Division of Infectious Diseases, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada
| | - William J. Connors
- grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, Canada ,grid.415289.30000 0004 0633 9101Providence Health Care, Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Division of Infectious Diseases, St. Paul’s Hospital, Providence Health Care, Vancouver, BC Canada
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7
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Morales Y, Smyth E, Zubiago J, Bearnot B, Wurcel AG. "They Just Assume That We're All Going to Do the Wrong Thing With It. It's Just Not True": Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs. Open Forum Infect Dis 2022; 9:ofac364. [PMID: 36267246 PMCID: PMC9579457 DOI: 10.1093/ofid/ofac364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the absence of adequate harm reduction opportunities, people who inject drugs (PWID) are at increased risk for serious infections. Infectious diseases guidelines recommend extended periods of intravenous antibiotic treatment through peripherally inserted central catheters (PICCs), but PWID are often deemed unsuitable for this treatment. We conducted semi-structured interviews and focus groups to understand the perspectives and opinions of patients and clinicians on the use of PICCs for PWID. Methods We approached patients and clinicians (doctors, nurses, PICC nurses, social workers, and case workers) involved in patient care at Tufts Medical Center (Boston, Massachusetts) between August 2019 and April 2020 for semi-structured interviews and focus groups. Results Eleven of 14 (79%) patients agreed to participate in an in-depth interview, and 5 role-specific clinician focus groups (1 group consisting of infectious diseases, internal medicine, and addiction psychiatry doctors, 2 separate groups of floor nurses, 1 group of PICC nurses, and 1 group of social workers) were completed. Emergent themes included the overall agreement that PICCs improve healthcare, patients' feelings that their stage of recovery from addiction was not taken into consideration, and clinicians' anecdotal negative experiences driving decisions on PICCs. Conclusions When analyzed together, the experiences of PWID and clinicians shed light on ways the healthcare system can improve the quality of care for PWID hospitalized for infections. Further research is needed to develop a system of person-centered care for PWID that meets the specific needs of patients and improves the relationship between them and the healthcare system.
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Affiliation(s)
- Yoelkys Morales
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Emma Smyth
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Julia Zubiago
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Benjamin Bearnot
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Alysse G Wurcel
- Correspondence: Alysse G. Wurcel, MD, MS, Tufts Medical Center, Department of Geographic Medicine and Infectious Diseases, 800 Washington St, Boston MA 02111, USA ()
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8
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Abstract
Although many of the tenets of harm reduction have been around for centuries and more traditional harm reduction services such as syringe services programs have been in existence for decades, there has been a recent increase in interest and acceptance of harm reduction as an essential component of a public health approach to substance use. This article provides an overview of harm reduction and its application to alcohol, tobacco, and drug use. It discusses the importance of integrating harm reduction principles and services with traditional psychiatric, medical, and addiction treatment programs.
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Affiliation(s)
- Avinash Ramprashad
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt St, 2nd Floor Suite 289, Baltimore, MD 21201, USA
| | - Gregory Malik Burnett
- Center for Addiction Medicine, University of Maryland Midtown Campus, 827 Linden Avenue 4th Floor, Suite 405, Baltimore MD 21201 USA; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA.
| | - Christopher Welsh
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA
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9
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Brooks HL, Salvalaggio G, Pauly B, Dong K, Bubela T, Taylor M, Hyshka E. "I have such a hard time hitting myself, I thought it'd be easier": perspectives of hospitalized patients on injecting drugs into vascular access devices. Harm Reduct J 2022; 19:54. [PMID: 35619121 PMCID: PMC9137200 DOI: 10.1186/s12954-022-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians’ concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms. Methods Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually. Results A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms. Conclusions VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs.
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Affiliation(s)
- Hannah L Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.,Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.,Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Marliss Taylor
- Streetworks, Boyle Street Community Services, 10116 105 Ave NW, Edmonton, AB, T5H 0K2, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada. .,Inner City Health and Wellness Program, Royal Alexandra Hospital, B811 Women's Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
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10
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Guta A, Buchman DZ, Schmidt RA, Perri M, Strike C. Trauma-Informed Approaches in Healthcare Ethics Consultation: A Missing Element in Healthcare for People Who Use Drugs during the Overdose Crisis? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:68-70. [PMID: 35475957 DOI: 10.1080/15265161.2022.2055208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Adrian Guta
- School of Social Work, University of Windsor
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health
- Dalla Lana School of Public Health, University of Toronto
- Joint Centre for Bioethics, University of Toronto
| | - Rose A Schmidt
- Centre for Addiction and Mental Health
- Dalla Lana School of Public Health, University of Toronto
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto
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11
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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