In some hospitals in the United States, doctors will send people home with prescriptions for opioid use disorder medications like methadone and buprenorphine after they are discharged. But there is a severe general lack of harm reduction services in health care settings. A team of researchers and harm reduction advocates have been piloting a project at the San Francisco General Hospital in an attempt to address this.
“We hope [we can] change that going forward,” Marlene Martin, MD, associate professor of clinical medicine at the University of California San Francisco and director of the hospital’s Addiction Care Team (ACT), told Filter.
The hospital is providing harm reduction kits to people who come in to receive medical attention—for any reason—and who say that they use drugs and don’t plan to quit. Dr. Martin said that as well as helping former patients to use drugs more safely, the practice can build much-needed trust between health care workers and people who use drugs. The team published their findings so far in Harm Reduction Journal this month.
“We think of it as part of evidence-based addiction care,” Martin said. “Traditionally, the medical system has not … provided evidence-based addictions care in hospital settings.”
The kits have included syringes, pipes, fentanyl test strips and written educational materials.
In May 2020, ACT members spoke with 30 patents at the hospital whose “substance use goal was not abstinence.” The team asked them about what knowledge and supplies would be useful, and whether or not they wanted to receive them after they were discharged. They also asked if the patients had already been in contact with harm reduction organizations out in the community. This process was “just to assess what the role of the hospital could be, and if there was a need for this intervention,” Martin said, adding that the idea was well received by the patients.
The researchers also partnered with the San Francisco AIDS Foundation, which provided ACT with some educational sessions and created a video for team members to learn about the supplies. One foundation staff member was a co-author of the report—and Martin noted that some of the original patients during the assessment process had made use of the foundation’s services, including its syringe service program. The San Francisco AIDS Foundation has also been supplying the project with the harm reduction tools it hands out to patients at discharge.
From August 2020 to July 2021, the program (then a pilot) handed out 195 harm reduction kits to people who use drugs, whether they came in for a broken bone or to deal with an injection-related infection. The kits have included syringes, pipes, fentanyl test strips and written educational materials. In the pilot, ACT members also spoke with the patients about safe drug-use practices—better injection techniques, for instance—and tried to connect them with community harm reduction groups, if they were interested.
“For so many years, health care has had an antagonistic, a very abstinence-based approach.”
According to Martin, the program faced some challenges—there was institutional stigma and hesitancy around it, and ACT is a small team. But the project moved on from being a pilot, and is still ongoing, with the San Francisco AIDS Foundation’s support. She added that the program’s success might help encourage other hospitals to adopt similar measures.
Going forward, the team hopes to look into the longer-term impacts of the program, including for both patients and medical staff. For example, it might reduce the number of times a person comes into the hospital with an infection at a site of injection. Martin said that it could also help make people who use drugs feel more comfortable accessing health care generally. In many cases, health care institutions have stigmatized drug use and erected barriers, effectively excluding people who use drugs from medical care.
“For so many years, health care has had an antagonistic, a very abstinence-based approach to addiction. I think the harm reduction kit is one way to build trust,” Martin said.