New project tests harm reduction strategies for methamphetamine use in hospitals

The Lawson Health Research Institute is launching a new project that will test harm reduction strategies for people who use methamphetamine in hospital settings.

Outside of the hospital, harm reduction strategies include needle/syringe services, as well as supervised injection sites and safe supplies such as one-time use sterile water.

Without those measures in place, intravenous drug use in hospitals poses a greater risk of infection than within the community.

Recent studies conducted in London, Ont. have found that substance use in hospitals is taking place.

Doctors in hospital wards search for sterile intravenous in patients as a quality metric. Dr. Michael Silverman, chief of Infectious Diseases for London Health Sciences Centre and St. Joseph's Health Care London, searched meticulously through patient charts and found those who injected drugs were more likely to have bloodstream infections from injecting into the intravenous.

That's when he realized drug-use is a problem in London hospitals, as well as others. 

"There's generally an assumption that when people are in the hospital they won't use, because we have a rule that you can't use," said Silverman, who is a co-principal investigator for the study. "But when people have a serious problem with addiction, just because they're in hospital doesn't mean their addiction problem goes away." 

Dr. Cheryl Forchuk, assistant scientific director at Lawson and another co-principal study investigator, said that hospital workers are often caught in a "Catch 22" because of this. 

Healthcare professionals are legally prevented from prescribing street drugs that may ease withdrawal symptoms, or from allowing patients to consume illegal substances in front of them. 

This causes patients to hide their drug use or even opt to leave the hospital early, only to eventually return because they have contracted a bad infection. 

"Imagine you're prescribing other medications and you're forcing people to hide [their drug use] or to lie in order to receive care, and then you don't really know what these other bad consequences could end up being," Forchuk said.

For the next four years, the Lawson research team will recruit up to 360 adults aged 16-35 years with past experience or current use of methamphetamine. 

'Opportunity to shift narrative around addiction'

Up to 180 healthcare and service providers will be recruited to share their perspectives on harm reduction strategies. Once the consultation phase of the project is complete, a set of strategies will be implemented within the LHSC and St. Joseph's hospital sites. 

"To our knowledge, there are only five supervised consumption services based in acute care hospitals in the world," said Forchuk. "Three of these sites are in Europe and there are two locations in Canada that have implemented a similar approach. London will be the second place in North America to implement harm reduction strategies for substance users within hospital walls." 

Sonja Burke, director of Harm Reduction Service for Regional HIV/AIDS Connection, said that the project is an opportunity to shift the narrative around addiction. 

"The million dollar piece is we need to stop making assumptions about what people need in their healthcare, and we need to start asking people what they need," Burke said. 

"Our experience in the supervised consumption services proves that once a person is able to use their pre-obtained substances, they will engage in further supports for their health care. We have to change how the supports are being provided within the system to ensure we are reducing health risks and death."