Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital

Given the significant health risks associated with drug injecting, a growing body of research highlights the urgent need for harm reduction programs for people who inject drugs (PWID). Though proven effective in preventing disease and promoting health, research describing PWID experiences with in-hospital needle and syringe programs (NSPs) is limited.

Through a mixed-method study, we examined the implementation of an NSP in a large urban hospital in Western Canada. In the qualitative arm of the study, we conducted semi-structured interviews with 25 PWID who had been offered supplies from the NSP.

We found that participants reported accepting supplies to prevent harms from injecting and to have access to sterile injection equipment, but some reported hesitation or refusal due to fears of negative repercussions from hospital staff. Participants suggested that modifications to hospital policies may mitigate these fears, including changes to inpatient drug use policies or the creation of an inpatient supervised consumption service.

Our results indicate that NSPs within acute care settings may facilitate harm reduction and improve hospital outcomes. However, to realize these benefits fully, interventions to mitigate harms and optimize patient engagement are required.

This study highlights the relevance of contextual factors in implementation research and the importance of integrating program evaluation with ongoing operational adaptations to maximize benefits to patients.

Significance statement: People who inject drugs are a marginalized population experiencing significant health risks. In-hospital needle and syringe programs may reduce harms and improve outcomes but are limited in scope. We explored the implementation of an in-hospital needle and syringe program in a large urban hospital through qualitative interviews with patients who use the program. Patients reported accepting supplies to prevent harms from injecting and to have access to sterile injection equipment, but some reported hesitation or refusal due to fears of negative repercussions from hospital staff. Participants suggested that modifications to hospital policies may mitigate these fears, including changes to inpatient drug use policies or the creation of an inpatient supervised consumption service. Findings indicate that in-hospital needle and syringe programs may aid providers in reducing harms and improving hospital outcomes for people who inject drugs.

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