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. 2022 Oct 1:239:109608.
doi: 10.1016/j.drugalcdep.2022.109608. Epub 2022 Aug 25.

Harm reduction in the hospital: An overdose prevention site (OPS) at a Canadian hospital

Seonaid Nolan  1 , Salpy Kelian  2 , Thomas Kerr  2 , Samantha Young  3 , Isaac Malmgren  4 , Cher Ghafari  5 , Scott Harrison  6 , Evan Wood  2 , Mark Lysyshyn  7 , Elizabeth Holliday  8
Affiliations

Harm reduction in the hospital: An overdose prevention site (OPS) at a Canadian hospital

Seonaid Nolan et al. Drug Alcohol Depend. .

Abstract

Background: Substance use management in hospitals can be challenging. In response, a Canadian hospital opened an overdose prevention site (OPS) where community members and hospital inpatients can inject pre-obtained illicit drugs under supervision. This study aims to: (1) describe program utilization patterns; (2) characterize OPS visits; and (3) evaluate overdose events and related outcomes.

Methods: A retrospective chart review was completed at one hospital in Vancouver, Canada. All community members and hospital inpatients who visited the OPS between May 2018 and July 2019 were included. Client measures included: hospital inpatient status, use of intravenous access line for drug injection, and substances used. Program measures included: number of visits (daily/monthly), overdose (fatal/non-fatal) events and overdose-related outcomes.

Results: Overall, 11,673 OPS visits were recorded. Monthly visits increased from 306 to 1198 between May 2018 and July 2019 respectively. On average, 26 visits occurred daily. Among all visits, 20% reported being a hospital inpatient, and 5% reported using a hospital intravenous access line for drug injection. Opioids (56%) and stimulants (24%) were the most common substances used. Overall 39 overdose events occurred - 82% required naloxone reversal, 28% required transfer to the hospital's emergency department and none were fatal. Overdose events were more common among hospital inpatients compared to community clients (6.6 vs 2.2 per 1000 visits respectively; p value = 0.046).

Conclusions: This unique OPS is an example of a hospital-based harm reduction initiative. Use of the site increased over time among both groups with no fatal overdose events occurring.

Keywords: Harm reduction; Hospital; Injection drugs; Overdose prevention; Supervised consumption.

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Conflict of interest statement

Conflict of interest Evan Wood is the Chief Medical Officer of Numinus Wellness a mental health company focussed on psychedelic medicines.

Figures

Figure 1.
Figure 1.
Total number of monthly visits to the St. Paul’s Hospital’s Overdose Prevention Site (SPH OPS), Vancouver, Canada (May 2018 – July 2019).
Figure 2.
Figure 2.
Percentage of monthly visits to the St. Paul’s Hospital’s Overdose Prevention Site (SPH OPS) by hospital inpatients, Vancouver, Canada (May 2018 – July 2019).
Figure 3.
Figure 3.
Percentage of monthly visits where a hospital-issued intravenous access line was reported to have been used for the injection of drugs at the St. Paul’s Hospital’s Overdose Prevention Site (SPH OPS), Vancouver, Canada (May 2018 – July 2019).
Figure 4.
Figure 4.
Percentage of monthly visits resulting in an overdose event recorded at the St. Paul’s Hospital Overdose Prevention Site (SPH OPS) and responses taken, Vancouver, Canada (May 2018 – July 2019).
Figure 5.
Figure 5.
Substances Used at the St. Paul’s Hospital Overdose Prevention Site e (SPH OPS), VancouVancouver, Canada (May 2018 – May 2019). *mix: any drug mixture that was not solely opioid or stimulant.
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