When Should Harm-Reduction Strategies Be Used for Inpatients with Opioid Misuse?

Back to the Case

The case involves an individual who has already had at least two complications of his IV heroin use, including cellulitis and opioid overdose. Ideally, this individual would be willing to see an addiction specialist and start medication-assisted treatment. Unfortunately, he is unwilling to be further evaluated by a specialist at this time. Regardless, he remains at risk of future complications, and it is the hospitalist’s responsibility to intervene with a goal of reducing future harm that may result from his IV heroin use.

The hospitalist in this case advises the patient to abstain from heroin and IDU, encourages him to seek treatment for his opioid use disorder, and gives him resources for linkage to care if he becomes interested. In addition, the hospitalist educates the patient on safe injection practices and provides a list of local syringe exchange programs to decrease future risk of viral, bacterial, and fungal infections. Furthermore, the hospitalist provides opioid overdose education and distributes naloxone to the patient, along with friends and family of the patient, to reduce the risk of death related to opioid overdose.

Bottom Line

Hospitalists should utilize harm-reduction interventions in individuals hospitalized with opioid misuse. TH

Dr. Theisen-Toupal is a hospitalist at the Veterans Affairs Medical Center and assistant professor of medicine at the George Washington University School of Medicine & Health Sciences, both in Washington, D.C.

References

1. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm. Published November 4, 2011.
2. Drug abuse warning network, 2011: national estimates of drug-related emergency department visits. Substance Abuse and Mental Health Services Administration website. Available at: https://www.samhsa.gov/data/2k13/DAWN2k11ED/DAWN2k11ED.htm#5. Accessed July 29, 2015.
3. Hedergaard H, Chen LH, Warner M. Drug-poisoning deaths involving heroin: United States, 2000–2013. National Center for Health Statistics Data Brief. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/nchs/data/databriefs/db190.htm. Published March 2015.
4. Getting off right: a safety manual for injection drug users. Harm Reduction Coalition website. Available at: https://harmreduction.org/wp-content/uploads/2011/12/getting-off-right.pdf.
5. Syringe exchange programs—United States, 2008. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5945a4.htm/Syringe-Exchange-Programs-United-States-2008. Published November 19, 2010.
6. Wodak A, Conney A. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. World Health Organization website. Available at: https://apps.who.int/iris/bitstream/10665/43107/1/9241591641.pdf. Published 2004.
7. Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.
8. Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm. Published June 19, 2015.