Harm Reduction in Hospital: Safe and compassionate care for IV drug users in hospital

Dr. Tommy Brothers with Natasha Touesnard
Dr. Tommy Brothers works closely with Natasha Touesnard of HANDUP (Halifax Area Network for Drug Using People) to develop harm reduction approaches to health care.

When a person who is addicted to intravenous drugs lands in hospital with a serious health issue, staff have a double-barrelled crisis on their hands: now, they have a patient who is medically unstable due to illness and also at risk of life-threatening opioid withdrawal.

Dr. Tommy Brothers, a second-year resident in internal medicine, is leading a new NSHA Research Fundsupported study to examine how such cases have been handled in the past. This is the crucial first step toward developing a plan to provide the best patientcentred, evidence-based care to patients in this perilous situation.

“There’s some consternation about how to manage IV-drug-using patients in hospital for a serious illness,” Dr. Brothers notes. “Health care professionals may feel it’s enabling someone’s addiction to provide them with clean needles and a safe place to inject, for example, and/or to provide them with an opioid-replacement like methadone or buprenorphine, to prevent a withdrawal crisis. But the evidence is clear— these interventions prevent infections and save lives.”

Dr. Brothers is reviewing the charts of all the people who’ve been treated for endocarditis who inject drugs at the QEII Health Sciences Centre over the past five years.

“About 40 per cent of people who develop endocarditis are IV drug users,” he explains, noting that the use of dirty needles allows bacteria to travel through the bloodstream and lodge in the heart valves, which become infected. Intravenous antibiotics are required to halt the infection; in some cases, the valves are so damaged by the infection, they must be replaced to save the person’s life.

“I want to know what happened with these patients,” he says. “Who had opioid withdrawal and how was that managed? Was anyone found injecting in the bathroom? Were people tested for HIV and hepatitis? Offered methadone? Referred to psych?”

Once he has a clear picture of how these patients were managed, Dr. Brothers plans to interview former patients and clinicians about their perception of the problem and how solutions might best be introduced. His aim is to introduce harm reduction protocols for all people who use IV drugs, complete with education for clinicians, to ensure the best outcomes for patients.

“If these patients are approached with compassion and offered a way to manage their withdrawal symptoms, a stay in the hospital could be a positive turning point in their lives,” says Dr. Brothers, who is collaborating with HANDUP on the project. “If not, their condition could easily worsen.”