Jordan Ellis
Hospitals have a responsibility to provide effective care to people with substance use disorders (SUDs). However, people with SUDs often face significant barriers to accessing healthcare and experience stigma and discrimination when they do access it. This stigma is perpetuated by healthcare workers' personal beliefs about addiction, which may result in punitive responses to patients with SUDs. To address this issue, hospitals need to develop and implement in-hospital substance use policies that are patient-centered, stigma-free, evidence-based, and non-punitive. These policies should be coupled with addiction education for healthcare workers to ensure that patients with SUDs receive compassionate and equitable care.
| Characteristics | Values |
|---|---|
| Hospitals' responsibility | Hospitals are legally responsible for providing effective care to people with substance use disorder. |
| Hospitals' failure | Many emergency departments discharge patients with substance use disorders without offering recommended and lifesaving care. |
| Hospitals' discrimination | Hospitals may be liable for “disparate treatment” discrimination if their emergency departments fail to offer evidence-based practices because of generalizations and stereotypes about people with substance use disorders. |
| Hospitals' violation | Hospitals can violate federal law by denying necessary care for substance use disorders in emergency departments. |
| Hospitals' challenges | People who use drugs experience significant barriers to care, including stigma and challenges accessing care. |
| Hospitals' policies | In-hospital substance use policies could facilitate therapeutic responses instead of leaving health care workers to apply potentially stigmatizing beliefs about addiction. |
| Hospitals' policy gaps | There are gaps in addiction treatment: Black, Indigenous, and Latinx individuals have lower access to treatment than White individuals. |
| Hospitals' policy recommendations | In-hospital substance use policies must be patient-centered, stigma-free, evidence-based, non-punitive, and coupled with addiction education for the health care workforce. |
| Hospitals' policy alternatives | Hospitals can promote health and advance equity and anti-racism by revising or developing policies to address in-hospital substance use. |
| Hospitals' treatment alternatives | Treatments for drug addiction include counseling, medicines, or both. |
| Hospitals' treatment challenges | In the absence of formal policies, responses to observed or suspected illicit drug use were determined by individual health care providers. |
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What You'll Learn
- Hospitals are legally responsible for treating patients with substance use disorder
- In-hospital substance use policies should be patient-centred, stigma-free, and evidence-based
- Drug addiction is a relapsing disease that changes the brain
- Drug use is associated with increased morbidity and mortality
- Treatment for drug addiction includes counselling, medicines, or both
Hospitals are legally responsible for treating patients with substance use disorder
In the United States, hospitals are legally obligated to provide effective care to individuals with SUD under federal laws. The Legal Action Center (LAC) has emphasised that hospital emergency departments must adhere to evidence-based practices when treating patients with SUD. Failure to do so could violate patients' legal rights and expose the hospital to liability for "disparate treatment" discrimination. This discrimination can occur if the emergency department's methods of administration or generalizations and stereotypes about people with SUD result in discriminatory treatment.
Additionally, hospitals have a responsibility to address the stigma associated with SUD and ensure their policies and practices are patient-centred, stigma-free, evidence-based, and non-punitive. Historically, healthcare workers have been undertrained to care for individuals with SUD, and their personal beliefs about addiction have influenced their responses, often resulting in punitive measures and increased patient surveillance. To promote equity and anti-racism, hospitals should revise their policies to dismantle stigma and punitive practices and provide compassionate, evidence-based addiction care.
Furthermore, hospitals should have specific policies in place regarding substance use to guide consistent responses from healthcare providers. In the absence of such policies, responses to observed or suspected illicit drug use during hospital admissions can vary, leading to inconsistent care. Some physicians may focus on enforcing abstinence, while others may prioritise preventing withdrawal, managing cravings, and reducing patient and provider conflict.
Hospitals can utilise screening tools and standard diagnostic criteria to identify patients with SUD and provide appropriate treatment. This may include medications to manage withdrawal and prevent overdose, as well as referrals to addiction treatment facilities to ensure continued care. By addressing SUD comprehensively and compassionately, hospitals can improve patient outcomes and reduce the harm associated with substance use.
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In-hospital substance use policies should be patient-centred, stigma-free, and evidence-based
Hospitals have a responsibility to provide care for people with substance use disorders (SUDs). However, individuals with SUDs often face significant barriers to accessing care and experience stigma and discrimination during their interactions with healthcare providers. This stigma is perpetuated by the racist War on Drugs, which has long criminalized and stigmatized people with addiction.
In-hospital substance use policies are essential to ensuring that patients with SUDs receive equitable, non-discriminatory, and evidence-based care. These policies should be patient-centred, stigma-free, and based on the latest research and best practices in addiction treatment.
Without clear policies, healthcare workers may rely on personal beliefs about addiction, which can be rooted in stigma and lead to punitive responses. Punitive measures, such as increased patient surveillance, restricting visitors, or threatening discharge, are harmful and ineffective in addressing SUDs. Instead, policies should facilitate therapeutic responses that address the underlying causes of substance use and provide compassionate care.
Effective in-hospital substance use policies should include evidence-based practices such as screening and diagnostic tools, medication-assisted treatment, and warm handoffs to ensure continued care after discharge. Additionally, policies should address addiction education for healthcare workers, ensuring they are equipped with the knowledge and skills to provide non-judgmental and individualized care.
By implementing patient-centred, stigma-free, and evidence-based policies, hospitals can improve outcomes for patients with SUDs, reduce harm, and advance equity and anti-racism in healthcare. Further research and practice recommendations are needed to guide hospitals in developing and refining their policies.
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Drug addiction is a relapsing disease that changes the brain
Drug addiction is a complex condition that has long been misunderstood and stigmatized. It is defined as a chronic, relapsing disorder characterized by compulsive drug-seeking behavior and continued substance use despite adverse consequences. This compulsivity is driven by changes in the brain's structure and function, which can be long-lasting and contribute to the high risk of relapse.
Research has shown that drug use can lead to physical changes in areas of the brain that are critical for judgment, decision-making, learning, memory, and behavior control. These changes can endure long after an individual stops using substances, and they may produce continued, periodic cravings that can lead to relapse. More than 60% of people treated for substance use disorders experience relapse within the first year after discharge from treatment, and they may remain at increased risk for many years.
The transition from initial drug use to addiction involves a shift from impulsivity to compulsivity. Initially, drug use is driven by positive reinforcement, as individuals seek the pleasure or euphoria associated with substance use. However, as use becomes ingrained, the primary driver shifts to negative reinforcement, where individuals seek to escape negative feelings and physical illness associated with withdrawal. This compulsive substance-seeking behavior is a key characteristic of addiction, and it is driven by changes in the brain's reward, stress, and self-control circuits.
The risk of developing an addiction differs from person to person and is influenced by various factors, including genetic, environmental, and developmental factors. Early drug use is a strong indicator of future problems, as it can have a more harmful effect on the developing brain. Additionally, the method of drug administration, such as smoking or injecting, increases the potential for addiction due to the rapid onset of intense effects.
Understanding drug addiction as a relapsing disease that alters the brain is crucial for developing effective treatment approaches. Hospitals and healthcare systems are responsible for providing evidence-based, compassionate care to individuals with substance use disorders, free from stigma and punitive practices. This includes offering adequate pain control, addiction treatment, and supportive services to address the complex needs of patients struggling with addiction.
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Drug use is associated with increased morbidity and mortality
Drug use is dangerous and is associated with increased morbidity and mortality. Drug addiction is a chronic brain disease that causes a person to take drugs repeatedly, despite the harm they cause. Repeated drug use can lead to addiction and cause lasting changes in the brain. These changes can make people in recovery vulnerable to relapses, even after long periods of abstinence.
Drug use can harm not only the user but also those around them, including friends, family, and children. If the user is pregnant, it can also harm the fetus. Drug use can lead to substance use disorders, which are among the leading causes of premature mortality and disability. In the Region of the Americas, drug use disorders were responsible for a significant number of disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to premature mortality.
The impact of drug use on mortality is evident in the rising number of drug overdose deaths. In the United States, drug overdose deaths have risen over the past several decades, with a significant increase in deaths involving synthetic opioids, stimulants, cocaine, and psychostimulants. Adults aged 65 and older experienced the largest percentage increase in drug overdose deaths from 2021 to 2022. Overall, drug overdose deaths declined slightly from 107,941 in 2022 to 105,007 in 2023.
The relationship between drug use and mortality is further complicated by the stigma and criminalization associated with addiction. Historically, healthcare workers have been undertrained to care for people with substance use disorders (SUDs), often responding to in-hospital substance use with punitive measures rooted in stigma. This has led to discriminatory practices and a lack of evidence-based care, perpetuating criminalization and inequities, especially for marginalized individuals.
To address these issues, hospitals are legally responsible for providing effective, non-discriminatory care to patients with substance use disorders. This includes implementing patient-centered, stigma-free, and evidence-based policies that facilitate compassionate addiction treatment. By offering adequate pain control, evidence-based addiction treatments, and supportive services, hospitals can help reduce the morbidity and mortality associated with drug use and provide equitable care to all patients struggling with addiction.
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Treatment for drug addiction includes counselling, medicines, or both
Hospitals are legally responsible for providing effective care to people with substance use disorders. In-hospital substance use policies can facilitate therapeutic responses instead of leaving health care workers to apply potentially stigmatizing beliefs about addiction. These policies must be patient-centred, stigma-free, evidence-based, non-punitive, and coupled with addiction education for the health care workforce.
There are FDA-approved medications proven to help treat or avert opioid withdrawal, suppress opioid cravings and prevent opioid overdose. Buprenorphine, in particular, has been demonstrated to be administered effectively in the emergency department. For people with addictions to drugs like stimulants or cannabis, no medications are currently available to assist in treatment, so treatment consists of behavioural therapies. Treatment should be tailored to address each patient's drug use patterns and drug-related medical, mental, and social problems.
Drug addiction is a chronic brain disease that causes a person to take drugs repeatedly, despite the harm they cause. Repeated drug use can change the brain and lead to addiction. The brain changes from addiction can be lasting, so drug addiction is considered a "relapsing" disease. This means that people in recovery are at risk of taking drugs again, even after years of not taking them. Not everyone who uses drugs becomes addicted. Everyone's bodies and brains are different, so their reactions to drugs can also be different. Various risk factors can make a person more likely to become addicted to drugs, including genetic, environmental, and developmental factors.
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Frequently asked questions
Hospitals are legally responsible for providing effective care to people with substance use disorders. Treatments for drug addiction include counseling, medicines, or both. Research shows that combining medicines with counseling gives most people the best chance of success.
Substance use disorder (SUD) is a problematic pattern of substance use that affects your health and quality of life. It can range from mild to severe (addiction). SUD is a treatable and chronic mental health condition. Not everyone who uses drugs becomes addicted.
Treatments for drug addiction include counseling, medicines, or both. There are several types of counseling, including individual, family, and group therapy. There are also FDA-approved medications that can help treat or avert opioid withdrawal, suppress opioid cravings, and prevent opioid overdose.
