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ADAI Bibliography #MS-015

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ILLICIT DRUG USE IN HOSPITALS (BY INPATIENTS)

Updated June 2007

  1. Aveyard H. Is it ever permissible to discharge an illicit drug user from hospital? British J of Nursing 1996;5(4):234-236.

    Is it ever permissible to discharge a patient who uses illicit drugs on hospital premises? It is argued that there is nothing inherent in the use of illicit drugs by a patient which justifies his/her discharge. However, the implications of the drug use need to be examined. First, if a patient's activity presents a significant risk to others, the hospital may be in breach of safety regulations and may need to secure alternative provision of treatment. Second, if the continued use of drugs limits the benefits of treatment, this treatment may be considered an inappropriate use of resources.

  2. College of Pharmacists of British Columbia: Guidelines for Handling Suspected Illicit Substances in Hospitals: http://ww.bcpharmacists.org/resources/pdf/Suspected_Illicit_Substances_Guidelines.pdf

  3. Dolan M, Kirwan H. Survey of staff perceptions of illicit drug use among patients in a medium secure unit. Psychiatric Bulletin 2001;25:14-17.

    AIMS AND METHOD: A survey of staff perceptions of illicit drug use among in-patients in a medium secure unit. RESULTS: Sixty percent of staff were aware of drug misuse on the unit. While 82% commented on the potential adverse effects of illicit substances on patient psychopathology, 45% were also concerned about the negative impact on the staff-patient relationships. Most (82%) staff cite personal enjoyment as the main reason for drug-taking behaviour and perceive drug use on the unit as a form of antisocial behaviour. Less than one-third of staff were clear about the unit's policy for dealing with in-patient drug use and few have had adequate training in the management of patients with dual diagnoses. Strategies for dealing with drug misuse appear to focus on security rather than therapeutic issues. CLINICAL IMPLICATIONS: Services need to provide adequate training for staff on the management of patients with comorbid substance misuse, introduce patient education programmes and develop and disseminate clear policies that emphasise both therapy and security.

  4. Kendrick C, Basson J, Taylor PJ. Substance misuse in a high security hospital: period prevalence and an evaluation of screening. Crim Behav Ment Health 2002;12(2):123-34.

    BACKGROUND: Illicit drug misuse by people with mental disorder in the community has been associated with increased risk of violence but not tested among inpatients. AIMS: To evaluate screening for illicit drugs and determine the period prevalence of use in one high security hospital. METHOD: A records study six and 18 months after introduction of random ward urine testing was followed by a true random prospective study. A random sub-sample of these tests was checked in the laboratory. RESULTS: In the first period there were few tests and patchy recording; during the second, both improved, but testing was not random. In the third period there were 217 tests (65% of those requested) in 33 days; 116 tests requested were not carried out, of which 42 were due to patient refusals. Correlations between dipstick and laboratory results, and research and central recording of tests were high. The rate of drug detection was no higher with true randomization. The hospital's central record was confirmed as a reliable and valid research tool with respect to illicit substances. In the year 2000 the central record showed 12 definite cases of illicit substance use in 153,887 patient days, but some for test refusals. CONCLUSIONS: Random, reliable urine drug testing can be implemented, with generally good cooperation between patients and staff. Contrary to popular belief, in this setting there was little misuse. Further research might test whether current extensive preventive measures are cost effective. The methodology might be applied in less controlled settings to test inpatient violence and substance misuse associations.

  5. McKeown M, Liebling H. Staff perception of illicit drug use within a special hospital. J Psychiatr Ment Health Nurs 1992;2(6):343-50.

    This paper presents the results of a survey of staff perceptions of issues related to illicit drug use amongst patients within a UK Special (forensic) Hospital. The issues examined were: the nature and extent of drug-related problems; current management strategies and their perceived efficacy; suggestions for improved management strategy; and identification of staff training needs. Data were collected utilizing a questionnaire distributed all patient-care team members and representatives of disciplines working in off-ward areas (n = 311). The response rate was approximately 40%. Analysis of the returns suggests that staff concerns are largely focused on issues around the supply of drugs. A significant level of ignorance regarding illicit drugs and their usage was revealed, indicating a need for coordinated training. A review of literature suggests that future management strategies should not be solely directed towards supply restriction. A discussion of the results highlights parallels between Ashworth Hospital staff perceptions of illicit drug problems, media coverage of the same, and the findings of earlier sociological studies of deviance, subculture and moral panic.

  6. Pelletier LR, Poster EC, Kay K. Contraband: the hidden risk. QRB Qual Rev Bull 1990;16(1):9-14.

    In a 28-month retrospective study of contraband possession in an inpatient psychiatric setting, 54 incidents of contraband confiscation were identified. Incidents were analyzed according to day and shift of occurrence, nature of contraband, patient diagnoses and characteristics, and patient outcome of contraband possession. Study findings stress the importance of clearly stated contraband policies and procedures, especially in light of patient and staff rights and responsibilities.

  7. Tunis MT. Illicit drugs in hospitals. J Healthc Prot Manage 1991-1992;8(1):70-5.

    This article addresses some of the issues involved in developing a policy/procedure for handling patients who are found in possession of illicit drugs -- i.e., cocaine, crack, marijuana.


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