Harm Reduction in the ED
Special Populations, Substance Use, Toxicology
- Opioid-related overdoses and deaths continue to rise in British Columbia and across North America.
- Injection drug use increases the risk of blood-borne infections — such as HIV and hepatitis C — and bacterial infections.
- Safer injection and inhalation supplies decrease the risk of transmission of blood-borne and bacterial infections.
- Patients who use substances and patients with substance use disorders often visit emergency departments (ED), making this a critical setting for harm reduction. Harm reduction aims to reduce the risks associated with substance use.
- Patients who are in withdrawal when discharged from the ED are at increased risk of non-sterile supply use.
- ED-based harm reduction is a key component of the ED approach to opioid use disorder and substance use in general. See how harm reduction can be incorporated into an ED care pathway here.
- People who use drugs are at higher risk of leaving before their visit is complete. Address harm reduction and provide resources and supplies early in the visit.
Foster a Non-Judgemental ED Environment and Screen for Substance Use
- Let patients know it is an ED best practice to ask all patients about any potential substance use in order to improve their care. Ask permission to have a conversation about their substance use.
- Use person-first language. For example, “person who uses drugs” instead of “drug user” or “addict.”
- Screening identifies patients who may benefit from harm reduction education and safer injection and inhalation supplies. Screen all patients for current substance use, even those without the more easily recognized risk factors (prior substance use or injection drug use history, positive drug screen results, or complications associated with substance use).
- “How many times in the past year have you used a street drug or a prescription medication for non-medical reasons?” is an effective single-question screening tool.
Provide Take Home Naloxone Kits
- BCCDC’s Take Home Naloxone Program has reduced overdose-related deaths.
- Confirm if your ED is registered as a Take Home Naloxone distribution site and receiving naloxone kits. If not, register your ED (or email firstname.lastname@example.org) as a Take Home Naloxone distribution site.
- If your ED is a Take Home Naloxone distribution site, kits can be ordered and delivered directly to your site for free.
- Provide resources for patients and providers to review how to use naloxone kits and respond to opioid and polysubstance overdoses.
- Familiarize patients with how the Good Samaritan Drug Overdose Act may protect them. (Download: Printable Good Samaritan Pocket Card)
Provide Safer Injection and Inhalation Supplies
- Provide patients with resources on how to inject and smoke more safely and how to use safer injection and inhalation supplies.
- Stock ready-made safer injection and inhalation supplies kits in your department to distribute to patients. Use posters or other non-profiling means to let patients know you have supplies.
- To obtain free safer injection and inhalation supplies and seek guidance on kit composition, contact the BCCDC Toward the Heart Program.
- Contact the BCCDC Towards the Heart Program via email@example.com (or find your Regional Harm Reduction Coordinator contact), or access the Toward the Heart Harm Reduction Sites webpage, and the BCCDC Harm Reduction Program Supply Requisition Form. If other departments in your hospital are already ordering safer injection and inhalation supplies, coordinate ordering with them.
Review Safer Drug Use Tips
- Ask what strategies patients are currently using to keep themselves safe when they are using substances.
- Encourage using small drug amounts as “test doses,” going slowly, and using one drug at a time.
- Recommend using with a friend, rather than alone.
- Supervised consumption sites and overdose prevention services decrease the risk of overdoses, over-dose related deaths, and blood-borne infections. Help connect your patient to local supervised consumption sites and community partners that can provide safer injection and inhalation supplies, drug testing, and other supports. Use the site finder to find local supervised consumption sites and sites where patients can access replacement naloxone kits and more safe injection and inhalation supplies.
- Recommend using the Lifeguard App or BeSafe App if using alone. The Lifeguard App contacts emergency services when patients are unable to turn off a 1-minute timer. The BeSafe App allows patients to create an individualized Rescue Plan outlining when the supporter should call for help and who should be called for help—a friend or emergency services.
OTHER RELEVANT INFORMATION
Addiction Medicine. What Can You Do To Help?
How to Engage and Provide Care for People with Substance Use Disorder. Created By: Jade Zhong & Raman Dhillon in collaboration with the Fraser Health Department of Addiction Medicine and Substance Use Services.
Koh, J., Klaiman, M., Miles, I., Cook, J., Kumar, T., Sheikh, H., Dong, K., Orkin, A., Ali, S., & Shouldice, E. (2020). CAEP Position Statement: Emergency department management of people with opioid use disorder. Canadian Journal of Emergency Medicine, 22(6), 768–771.
Irvine, M., Buxton, J., Otterstatter, M., Balshaw, R., Gustafson, R., Tyndall, M., Kendall, P., Kerr, T., Gilbert, M., & Coombs, D. (2018). Distribution of take-home opioid antagonist kits during a synthetic opioid epidemic in British Columbia, Canada: a modelling study. The Lancet. Public Health, 3(5), e218–e225.
Fernandes, R., Cary, M., Duarte, G., Jesus, G., Alarcão, J., Torre, C., Costa, S., Costa, J., & Carneiro, A. (2017). Effectiveness of needle and syringe Programmes in people who inject drugs – An overview of systematic reviews. BMC Public Health, 17(1), 309–309.
Macias-Konstantopoulos, W., Heins, A., Sachs, C., Whiteman, P., Wingkun, N., & Riviello, R. (2021). Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use. Annals of Emergency Medicine, 77(5), 479–492.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by the BC Emergency Medicine Network and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Jun 22, 2021
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