Drug Hospitalization: Patient Treatment And Care

Patients with drug addictions are often treated with stigma and discrimination in hospitals. This is due in part to the personal beliefs of healthcare workers, who may view addiction as a moral failing and a criminal act. This can lead to punitive measures such as increased patient surveillance, restricted access to visitors and medication, and even arrest. In addition, hospitals often lack clear policies on how to handle in-hospital drug use, and healthcare workers are often undertrained in dealing with patients with substance use disorders (SUDs). As a result, patients with SUDs may be reluctant to disclose their drug use, which can complicate their treatment and put their health at risk. To improve the care of patients with drug addictions, hospitals should implement patient-centred, stigma-free, and evidence-based policies that focus on harm reduction and provide proper training for healthcare workers.

Patients face judgement and negative stereotypes from doctors and nurses

Patients with substance use disorders often face judgement and negative stereotypes from doctors and nurses. This stigma can create barriers to treatment and negatively impact their health and well-being. Studies have shown that health professionals often perceive people with substance use disorders as lacking motivation, being manipulative, aggressive, and unmotivated. Some patients are labelled as "drug-seeking" or believed to be selling their prescription opioids, leading to reluctance in prescribing medication. Additionally, there is a misconception that drug use is a choice rather than a compulsion, placing blame on the individual. Language plays a significant role in perpetuating stigma, with terms like "junkie" and "addict" contributing to negative biases and dehumanization.

Healthcare professionals' negative attitudes and stereotypes towards patients with substance use disorders can lead to discrimination and subpar treatment. Patients have reported being ignored, neglected, and judged by doctors and nurses, who may hold preconceived notions about their diagnosis and worthiness of care. This judgement can lead to a lack of attention and support, as well as delayed treatment. Some patients feel they need to be "easy patients" and "go with the flow" to avoid conflict and ensure they receive the care they need.

Furthermore, hospitals often lack clear policies regarding in-hospital illicit substance use, leaving clinicians uncertain about how to respond. Confronting patients suspected of substance use can be challenging, as it may trigger explosive encounters, foster mistrust, and disrupt medical care. As a result, patients may be met with punitive measures or be encouraged to abstain from substances during hospitalization, which can lead to delayed care, discharge, and increased mortality.

The stigma and negative stereotypes faced by patients with substance use disorders are not limited to hospitals but are also prevalent in society. The stress of feeling discriminated against can increase the likelihood of substance use. Additionally, systemic racism, sexism, and other forms of discrimination layer additional stigma, particularly for marginalized groups. This stigma often prevents individuals who need help from seeking treatment, as they fear judgement and negative consequences.

To address these issues, hospitals should implement comprehensive harm reduction strategies, including supporting inpatient addiction consultation services, providing safe disposal of injection equipment, expanding access to overdose reversal medications, and training staff on responding to suspected substance use in a structured and empathetic manner. Additionally, educating healthcare professionals about the compulsive nature of substance use disorders and promoting trauma-informed care can help reduce stigma and improve patient outcomes.

Patients are often ignored, forgotten, or left untreated

Patients with drug addictions are often ignored, forgotten, or left untreated due to the lack of proper protocols and training in hospitals. This results in inconsistent treatment and a lack of understanding of the underlying issues. Many hospitals are ill-prepared to meet the needs of patients with drug addictions, leading to inadequate care and potential harm.

One of the main issues is the lack of standardised policies and protocols for dealing with in-hospital drug use. Patients attempt to conceal their illicit drug use due to the absence of clear institutional policies, which then leads to varied responses from healthcare providers. These responses are often based on personal beliefs rather than patient-centred care, and can include ignoring the issue, increasing surveillance, or even threatening discharge. The lack of consistent guidelines leaves patients vulnerable to discrimination and inconsistent treatment.

Furthermore, healthcare providers may lack the necessary training and understanding to effectively address drug addiction. This can result in patients' self-reported levels of pain being disbelieved or their tolerance to opioids being ignored. Requests for higher doses of pain medication may be denied or labelled as drug-seeking behaviour. Without proper training, healthcare providers may struggle to balance patient safety with the need to address addiction, leading to patients feeling ignored or dismissed.

The consequences of this inadequate treatment can be severe. Patients may be discouraged from seeking timely healthcare, leading to a cycle of untreated pain and continued drug use. In some cases, patients may even leave the hospital against medical advice, putting their health at further risk. The lack of trust between patients and healthcare providers can hinder effective treatment and recovery.

To address these issues, hospitals need to implement comprehensive harm reduction strategies. This includes improving addiction consultation services, providing safe disposal methods for injection equipment, and increasing the availability of overdose reversal medications like naloxone. Additionally, educating staff about objective indicators of in-hospital drug use and promoting empathic communication with patients can help reduce stigma and improve patient welfare.

Patients are pressured to be easy or good to avoid subpar treatment

People with substance use disorders (SUDs) often face negative perceptions and stigmatization from healthcare providers, which can lead to delayed or inadequate treatment. This stigma is deeply rooted in the racist "War on Drugs," perpetuating criminalization, racism, and inequities, especially for Black, Indigenous, and Latinx individuals. Healthcare providers may hold beliefs that patients with SUDs are "drug-seeking," leading to reluctance in prescribing certain medications and increased surveillance. These attitudes can result in punitive responses, such as increased patient monitoring, restricted privileges, and involvement of law enforcement, further exacerbating stigma and mistrust.

To avoid such subpar treatment and potential harm, patients are often pressured to be "easy" or "good." They may feel compelled to conform to the expectations of healthcare providers, avoiding arguments or confrontations. This dynamic was evident in the experiences of patients in drug treatment hospitals, who felt they had to be "easy patients," not asking "too many questions" and "going with the flow" to ensure they received adequate care.

The pressure to be compliant can be a strategy for patients to navigate a healthcare system that often fails to address their complex needs comprehensively. By presenting themselves as cooperative, patients hope to obtain their required treatment without facing discrimination or judgment. This dynamic underscores the power imbalance in the patient-provider relationship, where patients feel they must conform to avoid further marginalization.

However, this pressure to conform can also deter patients from advocating for their needs and expressing their concerns. It can create an environment where patients feel they must tolerate rude or inappropriate behavior from healthcare providers. This dynamic can hinder honest conversations about drug use and treatment, impeding opportunities for holistic care and long-term behavior change.

To address these issues, hospitals and healthcare systems should implement comprehensive harm reduction strategies and trauma-informed care. Policies should be patient-centered, stigma-free, evidence-based, and non-punitive, focusing on supporting patients rather than criminalizing them. Educating healthcare workers about addiction and providing them with tools like the Hospital Misuse Checklist can help mitigate stigma and improve patient welfare. By addressing these systemic issues, hospitals can create a more supportive and effective environment for patients struggling with substance use disorders.

Patients fear stigmatization and traumatizing experiences, delaying care

Patients who use drugs often face stigmatization and traumatizing experiences in hospitals, which can delay their care and recovery. This can be attributed to the negative perceptions and stereotypes that healthcare providers may hold about such patients, leading to discrimination and mistrust. Some doctors and nurses are reported to have spoken negatively about their patients directly to them or to other staff or patients. For instance, a patient recounted a story where a doctor, unaware that the patient understood French, complained to a nurse about having to work with "these type of junkie people", wishing that they did not come to the hospital.

Past studies have also shown that providers often label such patients as "drug-seeking" and believe they will sell their prescription opioids, resulting in a reluctance to prescribe medications. This perception can lead to a cycle of stigmatization, where patients internalize these negative experiences, leading to low self-esteem, reduced healthcare utilization, and a lower quality of life. Additionally, patients who use drugs may be reluctant to seek treatment due to the fear of being judged, blamed, or stereotyped. They may also face challenges in emergency departments, with some believing that their needs are addressed more slowly than those of other patients.

Furthermore, hospitals often lack clear policies regarding in-hospital illicit substance use, and when they do, clinicians may be unaware of them. This can result in inconsistent approaches by physicians, confusion about how to address substance use disorders (SUD), and a fear of manipulation, further contributing to the stigmatization of patients. In some cases, patients who use drugs may be forced into abstinence during hospitalization, which can lead to delayed care, discharge, and increased mistrust. Instead, a spectrum of harm reduction strategies, such as facilitating safer use or substitution therapy, may be more effective in retaining patients in care and creating opportunities for drug treatment discussions on the patient's terms.

To address these issues, hospitals should implement comprehensive harm reduction strategies, including supporting inpatient addiction consultation services (ACS), providing evidence-based medications, and using non-stigmatizing language in medical documentation. By addressing the root contributors to stigma, such as fear, lack of awareness, and social judgment, hospitals can reduce the negative impact of stigmatization on the healthcare experiences and overall health of patients with SUD. Additionally, educating staff about objective signs of in-hospital illicit substance use and empathetic approaches can help mitigate associated health risks and stigma when responding to suspected cases.

Patients may not disclose drug use, complicating treatment and diagnosis

Patients may not disclose their drug use for various reasons, including the fear of discrimination, shame, and the difficulties associated with illicit substance use. This non-disclosure can negatively impact the quality of care and compromise accurate diagnoses, treatment, and management of health. For example, patients who do not disclose their drug use may be misdiagnosed or not receive the necessary treatment for substance use disorders.

In a Canadian study, it was found that 43.9% of drug users admitted to a hospital had used illicit drugs while hospitalized. US studies have also shown that 34-41% of patients used illicit substances during their hospital stay for injection-related infections. This in-hospital illicit drug use puts patients at risk of adverse health outcomes, including overdose, infection, medication interactions, delirium, and cardiovascular events.

The stigma associated with drug use and negative perceptions of people who use drugs (PWUD) can further complicate the issue. Healthcare providers may hold negative beliefs about PWUD, such as labelling them as "drug-seeking" or believing they will sell their prescription medications. This can result in reluctance to prescribe certain medications and a lack of trust between patients and providers. Additionally, patients may face internal struggles, such as shame and the fear of judgement, which can deter them from disclosing their drug use.

To address this issue, hospitals should implement comprehensive harm reduction strategies, including supporting inpatient addiction consultation services, providing safe disposal methods for injection equipment, expanding access to overdose reversal medications, and training staff on overdose response. Additionally, educating healthcare providers about structured and objective approaches, such as the Hospital Misuse Checklist, can help standardize responses to suspected in-hospital illicit substance use and reduce stigma.

Furthermore, adopting trauma-informed care and policies that are sensitive to the needs and realities of PWUD can create a non-judgmental environment and encourage disclosure. By prioritizing patient safety and well-being, hospitals can improve engagement in treatment and promote better health outcomes for this vulnerable population.

Frequently asked questions