Drug Use in Hospital Settings: Why it Happens and How We Respond

Unprescribed substance use during hospitalization is common among people with substance use disorders. It occurs for multiple reasons including inadequate pain control, self-management of withdrawal symptoms, and what can be a triggering environment. Potential negative medical outcomes associated with in-hospital drug use include overdose, infection, medication interactions, and cardiovascular, neurological, and respiratory events. Additionally, hospital response to drug use may further increase harm by causing patients to feel further stigmatized, creating mistrust, or limiting medical treatment offered to a patient. Law enforcement presence in hospitals may lead to criminal legal involvement when patients use substances due to undertreated symptoms. Most hospitals do not have in-hospital substance use policies. Without policies, staff and clinicians apply their individual perspectives about addiction to in-hospital substance use. They may respond with ignoring it, punishing, and stigmatizing patients resulting in worsened patient-clinician mistrust. Calling law enforcement could also lead to legal repercussions, especially for people of color who face disproportionately higher rates of substance-related incarceration. During this workshop session, presenters will describe the approaches to in-hospital substance use of their respective institutions. Subsequently, workshop participants will work in small groups to discuss potential best practices on in-hospital substance use, how their own institutions respond to in-hospital substance use and whether changes to the current approach are needed. Participants will consider steps that they can take on an individual and at a system level, and which stakeholders they should include. Small groups will be invited to share key points from their discussions with the broader audience.