In-Hospital Substance Use and Possession

A Study of Events From 38 Acute Care Hospitals in Pennsylvania

  • Matthew A. Taylor, PhD Patient Safety Authority
  • Alexandra Nowalk, MPH School of Pharmacy, University of Pittsburgh
  • Alex Falk, BS School of Pharmacy, University of Pittsburgh
Keywords: substance use, paraphernalia, substance use disorder, in-hospital, addiction, opioid, risk mitigation, patient safety

Abstract

Patients’ substance use and possession at acute care hospitals is an understudied topic. To learn more about this topic, we queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) for events that occurred during calendar year 2018. We identified 106 reports from 38 acute care hospitals (excluding psychiatric, detox, and behavioral health units and facilities) where a patient possessed and/or misused a substance (e.g., heroin, oxycodone, liquor). We analyzed these reports to better understand how hospital personnel attempt to prevent in-hospital substance use and manage patients who are at risk for using a substance. We explored a range of variables, including antecedent conditions and hospital personnel’s actions post-detection of a patient’s substance use or possession. We found that a relatively low percentage of patients (26%) were identified as having a prior history of substance use, despite later using or being in possession of a substance in hospital. In our sample, patients frequently acquired the substances from visitors, more than half of the substances were consumed intravenously, and opioids were the most common substance. The most prevalent actions taken by hospital personnel were conducting searches for substances and paraphernalia, use of a patient sitter or video monitor, moving patients to a different room, and implementing visitor restrictions. Based on our findings and previous research, hospitals should consider increasing their use of substance use disorder (SUD) screening tools, pharmacotherapy, and referring patients to treatment. Overall, our results can help personnel better understand the nature of and strategies that may reduce the likelihood of in-hospital substance use.  

Author Biographies

Matthew A. Taylor, PhD, Patient Safety Authority

Matthew A. Taylor (MattTaylor@pa.gov) is a patient safety analyst at the Patient Safety Authority.

Alexandra Nowalk, MPH, School of Pharmacy, University of Pittsburgh

Alexandra Nowalk is a program manager in the Program Evaluation and Research Unit at the University of Pittsburgh School of Pharmacy.

Alex Falk, BS, School of Pharmacy, University of Pittsburgh

Alex Falk is a research specialist and data analyst at the Program Evaluation and Research Unit at the University of Pittsburgh School of Pharmacy.

References

Lipari RN, Van Horn SL. Trends in Substance Use Disorders Among Adults Aged 18 or Older. The CBHSQ report: Substance Abuse and Mental Health Services Administration (US); 2017.

Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, et al. Acute Care Hospital Utilization Among Medical Inpatients Discharged With a Substance Use Disorder Diagnosis. J Addict Med. 2012;6(1):50.

Geller AI, Dowell D, Lovegrove MC, McAninch JK, Goring SK, Rose KO, et al. US Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016. Am J Prev Med. 2019;56(5):639-47.

Rockett IR, Putnam SL, Jia H, Chang CF, Smith GS. Unmet Substance Abuse Treatment Need, Health Services Utilization, and Cost: A Population-Based Emergency Department Study. Ann Emerg Med. 2005;45(2):118-27.

Weiss A, Barrett M, Heslin K, Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. Statistical brief. 2016;216.

Vivolo-Kantor AM, Hoots BE, Scholl L, Pickens C, Roehler DR, Board A, et al. Nonfatal Drug Overdoses Treated in Emergency Departments—United States, 2016–2017. Morb Mort Wkly Rep. 2020;69(13):371-6.

Babatunde VD, Menendez ME, Ring D. Does Illicit Drug Use Influence Inpatient Adverse Events, Death, Length of Stay and Discharge After Orthopaedic Trauma? J Surg Orthop Adv. 2016;25(1):41-8.

Haber PS, Demirkol A, Lange K, Murnion B. Management of Injecting Drug Users Admitted to Hospital. The Lancet. 2009;374(9697):1284-93.

Jewell CE, Tomlinson J, Weaver M. Identification and Management of Prescription Opioid Abuse in Hospitalized Patients. J Addict Nurs. 2011;22(1-2):32-8.

Fanucchi LC, Lofwall MR, Nuzzo PA, Walsh SL. In-Hospital Illicit Drug Use, Substance Use Disorders, and Acceptance of Residential Treatment in a Prospective Pilot Needs Assessment of Hospitalized Adults With Severe Infections From Injecting Drugs. J Subst Abuse Treat. 2018;92:64-9.

Grewal HK, Ti L, Hayashi K, Dobrer S, Wood E, Kerr T. Illicit Drug Use in Acute Care Settings. Drug Alcohol Rev. 2015;34(5):499-502.

McNeil R, Small W, Wood E, Kerr T. Hospitals as a “Risk Environment”: An Ethno-Epidemiological Study of Voluntary and Involuntary Discharge From Hospital Against Medical Advice Among People Who Inject Drugs. Soc Sci Med. 2014;105:59-66.

Medical Care Availability and Reduction of Error (MCARE) Act, Pub. L. No. 154 Stat. 13 (2002).

Ashford RD, Brown AM, McDaniel J, Curtis B. Biased Labels: An Experimental Study of Language and Stigma Among Individuals in Recovery and Health Professionals. Subst Use Misuse. 2019;54(8):1376-84.

Saitz R. Misperceptions and the Misused Language of Addiction: Words Matter. National Network of Libraries of Medicine New England Region (NNLM NER); 2017.

Magura S, Achtyes ED, Batts K, Platt T, Moore TL. Adding Urine and Saliva Toxicology to SBIRT for Drug Screening of New Patients. Am J Addict. 2015;24(5):396-9.

Polydorou S, Gunderson EW, Levin FR. Training Physicians to Treat Substance Use Disorders. Curr Psychiatry Rep. 2008;10(5):399-404.

Schottenfeld JR, Waldman SA, Gluck AR, Tobin DG. Law and the Opioid Crisis: An Inter-Disciplinary Examination: Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis. J Law Med Ethics. 2018;46(2):220-37. doi: 10.1177/1073110518782923 PubMed Central PMCID: PMC30146986

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35(2):253-9.

Theisen-Toupal J, Ronan MV, Moore A, Rosenthal ES. Inpatient Management of Opioid Use Disorder: A Review for Hospitalists. J Hosp Med. 2017;12(5):369-74.

Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary Care Validation Of A Single-Question Alcohol Screening Test. J Gen Intern Med. 2009;24(7):783-8.

Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A Single-Question Screening Test for Drug Use in Primary Care. Arch Intern Med. 2010;170(13):1155-60.

Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups. J Gen Intern Med. 2008;23(6):781-7.

McRee B, Babor TF, Lynch ML, Vendetti JA. Reliability and Validity of a Two-Question Version of the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test: The ASSIST-FC. J Stud Alcohol Drugs. 2018;79(4):649-57.

Johnson JA, Woychek A, Vaughan D, Seale JP. Screening for At-Risk Alcohol Use and Drug Use in an Emergency Department: Integration of Screening Questions Into Electronic Triage Forms Achieves High Screening Rates. Ann Emerg Med. 2013;62(3):262-6.

Slain T, Rickard-Aasen S, Pringle JL, Hegde GG, Shang J, Johnjulio W, et al. Incorporating Screening, Brief Intervention, and Referral to Treatment Into Emergency Nursing Workflow Using an Existing Computerized Physician Order Entry/Clinical Decision Support System. J Emerg Nurs. 2014;40(6):568-74.

Mitchell AM, Kane I, Lindsay DL, Hagle H, Puskar K, Aiello J, et al. Educating Emergency Department Registered Nurses (EDRNs) in Screening, Brief Intervention, and Referral To Treatment (SBIRT): Changes in Attitudes and Knowledge Over Time. Int Emerg Nurs. 2017;33:32-6.

Burnette AT. Searches of Hospital Patients, Their Rooms and Belongings. Health Care Law Mon. 2012;Oct:2-9.

Tsimtsiou Z, Kirana P, Hatzimouratidis K, Hatzichristou D. What is the Profile of Patients Thinking of Litigation? Results From the Hospitalized and Outpatients’ Profile and Expectations Study. Hippokratia. 2014;18(2):139-43.

Simon R, Snow R, Wakeman S. Understanding Why Patients With Substance Use Disorders Leave the Hospital Against Medical Advice: A Qualitative Study. Subst Abuse. 2019;Oct 22:1-7.

Ti L, Milloy M-J, Turje RB, Montaner J, Wood E, Kerr T. The Impact of an HIV/AIDS Adult Integrated Health Program on Leaving Hospital Against Medical Advice Among HIV-Positive People Who Use Illicit Drugs. J Pub Health. 2016;39(2):e33-e9.

Alfandre DJ. “I’m Going Home”: Discharges Against Medical Advice. Mayo Clin Proc. 2009;84(3):255-60.

Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press; 2013.

D’Onofrio G, Chawarski MC, O’Connor PG, Pantalon MV, Busch SH, Owens PH, et al. Emergency Department-Initiated Buprenorphine for Opioid Dependence With Continuation in Primary Care: Outcomes During and After Intervention. J Gen Int Med. 2017;32(6):660-6.

Busko J. The Slippery Slope of ED Buprenorphine. Emergency Medicine News. 2018;40(12):6-7.

Babor TF, Del Boca F, Bray JW. Screening, Brief Intervention and Referral to Treatment: Implications of SAMHSA’s SBIRT Initiative for Substance Abuse Policy and Practice. Addiction. 2017;112:110-7.

Pringle JL, Kelley DK, Kearney SM, Aldridge A, Dowd W, Johnjulio W, et al. Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Examination of Health Care Utilization and Costs. Med Care. 2018;56(2):146-52.

Mussulman LM, Faseru B, Fitzgerald S, Nazir N, Patel V, Richter KP. A Randomized, Controlled Pilot Study of Warm Handoff Versus Fax Referral for Hospital-Initiated Smoking Cessation Among People Living With HIV/AIDS. Addict Behav. 2018;78:205-8.

Pace CA, Gergen-Barnett K, Veidis A, D’Afflitti J, Worcester J, Fernandez P, et al. Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments. Ann Fam Med. 2018;16(4):346-8.

Hawk K, D’Onofrio G. Emergency Department Screening and Interventions for Substance Use Disorders. Addict Sci Clin Pract. 2018;13(1):1-6.

Selby S, Wang D, Murray E, Lang E. Emergency Departments as the Health Safety Nets of Society: A Descriptive and Multicenter Analysis of Social Worker Support in the Emergency Room. Cureus. 2018;10(9).

Ashford RD, Meeks M, Curtis B, Brown AM. Utilization of Peer-Based Substance Use Disorder and Recovery Interventions in Rural Emergency Departments: Patient Characteristics and Exploratory Analysis. J Rural Mental Health. 2019;43(1):17-29.

Smith JS, Levine RL. Warm Hand-Off: PA Dept of Drug and Alcohol Programs & PA Dept of Health; 2019 [February 28, 2020]. Available from: https://www.ddap.pa.gov/Pages/Warm-Hand-Off.aspx.

Blanchard J, Weiss AJ, Barrett ML, Stocks C, Owens PL, Coffey R, et al. Readmissions Following Inpatient Treatment for Opioid-Related Conditions. Subst Use Misuse. 2019;54(3):473-81.

Marks LR, Munigala S, Warren DK, Liang SY, Schwarz ES, Durkin MJ. Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder. Clin Infect Dis. 2018;68(11):1935-7.

Hirshfield S, Remien RH, Humberstone M, Walavalkar I, Chiasson MA. Substance Use and High-Risk Sex Among Men Who Have Sex With Men: A National Online Study in the USA. AIDS Care. 2004;16(8):1036-47.

Miller KA, Stanley LR, Beauvais F. Regional differences in Drug Use Rates Among American Indian Youth. Drug Alcohol Depend. 2012;126(1-2):35-41.

McAuliffe WE, Dunn R. Substance Abuse Treatment Needs and Access in yhe USA: Interstate Variations. Addiction. 2004;99(8):999-1014.

Pill bottle tipped over on table with pills spilling out.
Published
2020-06-17
How to Cite
Taylor, M., Nowalk, A., & Falk, A. (2020). In-Hospital Substance Use and Possession: A Study of Events From 38 Acute Care Hospitals in Pennsylvania. Patient Safety , 2(2), 13. https://doi.org/10.33940/data/2020.6.6
Section
Original Research and Articles
Bookmark and Share