Some U.S. physicians would like hospitals to consider opening safe-injection sites on their campuses to reduce the chance of addicted patients overdosing on illicit drugs while receiving medical treatment, as two Canadian hospitals recently have done.
In May, St. Paul's Hospital in Vancouver opened what it calls an Overdose Prevention Site in a tent on the hospital grounds. Patients being treated for medical problems can leave the hospital unit with assistance, if needed, go to the site to inject and return. About 15 patients a day have been using the facility, said Scott Harrison, director of the hospital's substance abuse treatment program.
It offers clean needles, injection supplies and take-home kits of naloxone for reviving people who overdose, plus monitoring by peer workers and emergency care.
Advocates say the open approach of providing a supervised location with clean equipment to inject drugs enables providers to better treat both medical and addiction issues. Some U.S. doctors say they're willing to consider the approach to try to boost the chances of continuing treatment of infections associated with drug use and other conditions. “We've talked about it here,” said Dr. Timothy Lahey, an infectious disease specialist and clinical ethicist at Dartmouth-Hitchcock Medical Center, Lebanon, N.H. “Later conversations may come on whether a safe-injection facility would be wise.”
First, Lahey and his colleagues want to expand medication-assisted treatment. But many patients won't enter treatment, he said.
As a result, it's not uncommon to see patients choosing between getting medical treatment for a life-threatening condition or leaving the hospital to use drugs. “That's why in-hospital safe-injection sites should be explored,” he said.
The Trump administration has signaled that it considers safe-injection facilities illegal, but San Francisco, Seattle and Philadelphia are moving to open sites anyway.
No U.S. hospitals have opened such sites yet.
Since its site opened, St. Paul's has seen about a 25% decrease in patients leaving before their medical treatment is completed.
“We hope people will enter recovery, but until they do we have to acknowledge that they use substances,” said Harrison. “Providing a safe space prevents harm.”
Previously, Royal Alexandra Hospital in Edmonton in April became likely the first hospital in North America to open a supervised injection site for patients. Addicts can get sterile needles and self-inject from a supply they can store in a locked safe at the hospital.
Dr. Larry Graham, president of Mercy Health's Behavioral Health Institute in Ohio, said, “We've thought about it. I don't think there's an appetite in Ohio yet to let patients use. I'm not saying it's off the table, but you'd have to do a lot of groundwork to move forward with that.”
St. Paul's Harrison sees a safe-injection site as the obvious right thing to do.
“In an ideal world, we wouldn't have people using illicit drugs,” he said. “But people will continue to use. If we can prevent people from dying, that's a good thing.”