Substance use during hospitalisation requiring an urgent clinical response: an opportunity for intervention

BackgroundThere are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes.AimsTo describe cases of drug use by inpatients requiring an urgent clinical response.MethodsWe retrospectively reviewed cases at a teaching hospital in Sydney, Australia, from February 2019 to March 2021.ResultsThirty cases were identified, with no deaths. Two patient groups were identified: (i) substance use disorders, using illicit drugs and (ii) self-harm history, using prescribed or over-the-counter drugs. Management involved cardiac monitoring (40%), intensive care (30%), charcoal (20%), antidotes (20%) and intubation (13%). Discharge was planned in 22 of 30 patients, against medical advice in four and directed by medical staff in four.ConclusionsInpatient drug use requiring an urgent clinical response was infrequently recognised but presents a risk of harm to patients and staff and increases service utilisation and costs. Both harm reduction and systematic approaches guided by institutional policy are recommended. Using these events as reachable moments to address driving factors may modify patients' risk from future events.