Attitudes Toward Injection Practices Among People Who Inject Drugs Utilizing Medical Services: Opportunities for Harm Reduction Counseling in Health Care Settings.

Hospitals are an important setting to provide harm reduction services to people who inject drugs (PWID). This study aimed to characterize PWID's injection practices, the perceived risk and benefits of those practices, and the immediate IDU risk environment among individuals seeking medical care. Surveys were administered to 120 PWID seeking medical services at an urban hospital. Poisson regression was used to examine the effect of perceived risk or importance of injection practices on the rate of engaging in those practices. The mean participant reported "often" reusing syringes and "occasionally" cleaning their hands or skin prior to injection. 78% of participants reported that syringes were extremely risky to share, which was associated with lower likelihood of sharing them (ARR: 0.59; 95% CI: 0.36-0.95). 38% of participants reported it was extremely important to use a new syringe for each injection, and these participants were more likely to report never reusing syringes >5 times (ARR: 1.62, 95% CI: 1.11-2.35). Other factors that may influence injection practices-including fear of arrest, withdrawal, lack of access to supplies, and injecting outdoors-were common among participants. In conclusion, practices that place PWID at risk of injury and infection are common, and risk-benefit perception is associated with some, but not all, injection practices. Injecting in challenging environments and conditions is common. Therefore, harm reduction counseling in medical settings must be accompanied by other strategies to reduce risk, including facilitating access to supplies. Ultimately, structural interventions, such as affordable housing, are needed to address the risk environment.

Emergency Department-initiated Buprenorphine and Referral to Follow-up Addiction Care: A Program Description.

INTRODUCTION: Emergency department (ED) initiated opioid use disorder (OUD) care is effective; however, real-world predictors of patient engagement are lacking. OBJECTIVE: This program evaluation examined predictors of ED-based OUD treatment and subsequent engagement. METHOD: Program evaluation in Boston, MA. Adult patients who met criteria for OUD during an ED visit in 2019 were included. Patients were included if a diagnosis of OUD or opioid-related overdose was associated with the ED visit or if they met previously validated criteria for OUD within the previous 12 months. We assessed predictors of ED-OUD treatment receipt and subsequent engagement, using Healthcare Effectiveness Data and Information Set definition of initial encounter within 14 days of discharge and either 2 subsequent encounters or a subsequent buprenorphine prescription within 34 days of the initial encounter. We used generalized estimating equations for panel data. RESULTS: During 2019, 1946 patients met criteria for OUD. Referrals to Bridge Clinic were made for 207 (11%), buprenorphine initiated for 106 (5%), and home induction buprenorphine kits given to 56 (3%). Following ED discharge, 237 patients (12%) had a visit within 14 days, 122 (6%) had ≥2 additional visits, and 207 (11%) received a subsequent buprenorphine prescription. Young, White, male patients were most likely to receive ED-OUD care. Patients who received ED-OUD care were more likely to have subsequent treatment engagement (adjusted rate ratio: 2.30, 95% confidence intervals: 1.62-3.27). Referrals were made less often than predicted for Black (-49%) or Hispanic/Latinx (-25%) patients. CONCLUSIONS: Initiating treatment for OUD in the ED was associated with increased engagement in outpatient addiction care.

Intervention to decrease leaving without treatment among intoxicated emergency department patients.

OBJECTIVE: Approximately 15% of the >4000 patients presenting each year to our emergency department (ED) with a chief complaint or discharge diagnosis related to alcohol were leaving without treatment (LWT). If they are not clinically sober at the time of departure, these patients are at risk for falls or other injury. Our goal was to create an intervention to decrease this rate of early departure. METHODS: A stakeholder group identified the reasons why intoxicated patients were leaving without treatment, concluding that the primary reason patients left was there was no process in place for evaluating and caring for these patients who potentially had impaired decision-making capacity. The group created a worksheet for the triage nurse to identify and manage patients presenting with intoxication and impaired decision-making or ambulation, with protocols to keep the patient in a supervised area. We performed a before and after analysis, evaluating 12 months before and 12 months after the protocol was initiated, with the primary outcome being the rate of intoxicated patients who left without treatment. We also measured the recidivism rate (the rate of return to the ED within 24 h after departure) and the ED length of stay (LOS). RESULTS: After the intervention was initiated, the percentage of intoxicated patients who left without treatment decreased from 15.0% to 7.4% LWT (p < 0.001). Among patients who stayed until discharge during the intervention period, the 24-hour recidivism was 9.4%, compared to 22.6% for those who left without treatment (p < 0.001). This difference in recidivism rates for each group was the same before and after the intervention, but fewer patients left without treatment after. For those patients with alcohol-related visits, the ED LOS was statistically significantly longer in the intervention phase, by a mean of 42 min for all patients (p < 0.001), as well as by a mean of 24 min for those who stayed to be dispositioned (p = 0.031). CONCLUSION: Providing a standardized process for caring for acutely intoxicated patients leads to fewer patients leaving the ED before discharge. Patients who stay to the completion of treatment have a lower recidivism rate within 24 h after leaving than those in the leaving without treatment category.

Effectiveness of Providing Education About Alcohol Use Disorders and Compassion Fatigue for Emergency Department Nurses.

BACKGROUND: Emergency departments (EDs) treat over 20,000 patients daily with alcohol use disorders (AUDs). However, nurses receive limited education about AUDs. Studies have shown that ED nurses have negative attitudes about patients with AUDs. Negativity can contribute to the symptoms of compassion fatigue (CF) and to dissatisfaction with work. PURPOSE: The aim of this study was to design, implement, and evaluate education about AUDs and CF for ED nurses. DESIGN: This study used a quasi-experimental pretest-posttest within-subjects design. SAMPLE: A convenience sample of 44 nurses was recruited at a large urban ED. METHODS: Nurses completed demographics, Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL), and Short Alcohol and Alcohol Problems Perceptions Questionnaire. Then, the nurses participated in 5 hours of an online educational program and a 1-hour live class about AUDs and CF. The surveys were readministered. RESULTS: The difference in pretest and posttest Short Alcohol and Alcohol Problems Perceptions Questionnaire subscales of role security (expected value = 8.5, p < .006) and therapeutic commitment (expected value = 7.50, p = .018) was statistically significant. For ProQOL constructs, no statistical significance was found. The ProQOL subscales were compared with norms and were statistically significantly different. CONCLUSION: Nurses' attitudes about patients with AUDs improved after completing the curriculum. Studied nurses had higher levels of professional satisfaction at baseline.