Opioid-specific harm reduction in the emergency department: how staff provide harm reduction and contextual factors that impact their capacity to engage in harm reduction practice.
Acute care
Case study
Complex adaptive systems
Emergency department
Harm reduction
Mixed methods
Nurses
Physicians
Unregulated substance use
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
18 Sep 2024
18 Sep 2024
Historique:
received:
29
06
2024
accepted:
07
09
2024
medline:
19
9
2024
pubmed:
19
9
2024
entrez:
18
9
2024
Statut:
epublish
Résumé
Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement. Using a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (n = 99) and one-on-one semi-structured interviews (n = 15). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes. Study findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care. There is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.
Sections du résumé
BACKGROUND
BACKGROUND
Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement.
METHODS
METHODS
Using a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (n = 99) and one-on-one semi-structured interviews (n = 15). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes.
RESULTS
RESULTS
Study findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care.
CONCLUSIONS
CONCLUSIONS
There is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.
Identifiants
pubmed: 39294704
doi: 10.1186/s12954-024-01088-6
pii: 10.1186/s12954-024-01088-6
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
171Informations de copyright
© 2024. The Author(s).
Références
CATIE, Unit. 2: Harm reduction principles and practices. What is harm reduction? [Internet]. Toronto (CA): CATIE; 2022 [cited 2024 Feb 12]. https://elearning.catie.ca/HRTOOLKIT/unit2/content/#/lessons/sGlrFs517B6OlQ2pnE4gl0NgZHHOewvC
Harm Reduction International. What is harm reduction? [Internet]. London (UK): Harm Reduction International; 2022 [cited 2024 Feb 12]. https://hri.global/what-is-harm-reduction/
Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database of Systematic Reviews [Internet]. 2013 [cited 2024 Feb 12]; Issue 2. Art. No.: CD003409. Available from: https://doi.org/10.1002/14651858.CD003409.pub4
Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, et al. Overdose and take-home naloxone in emergency settings: a pilot study examining feasibility of delivering brief interventions addressing overdose prevention with ‘take-home naloxone’ in emergency departments. Emerg Med Australas. 2022;34(4):509–18. https://doi.org/10.1111/1742-6723.13925 .
doi: 10.1111/1742-6723.13925
pubmed: 35021268
Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database of Systematic Reviews [Internet]. 2011 [cited 2024 Feb 12]; Issue 8. Art. No.: CD003410. Available from: https://doi.org/10.1002/14651858.CD003410.pub3
Ferri M, Minozzi S, Bo A, Amato L. Slow-release oral morphine as maintenance therapy for opioid dependence. Cochrane Database of Systematic Reviews [Internet]. 2013 [cited 2024 Feb 12]; Issue 6. Art. No.: CD009879. Available from: https://doi.org/10.1002/14651858.CD009879.pub2
Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study. Drug Alcohol Depend. 2020;216:108202. https://doi.org/10.1016/j.drugalcdep.2020.108202 .
doi: 10.1016/j.drugalcdep.2020.108202
pubmed: 32948372
pmcid: 7490624
Karamouzian M, Dohoo C, Forsting S, McNeil R, Kerr T, Lysyshyn M. Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada. Harm Reduct J. 2018;15:46. https://doi.org/10.1186/s12954-018-0252-8 .
doi: 10.1186/s12954-018-0252-8
pubmed: 30200991
pmcid: 6131768
Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm Reduct J. 2017;14:28. https://doi.org/10.1186/s12954-017-0154-1 .
doi: 10.1186/s12954-017-0154-1
pubmed: 28521829
pmcid: 5437687
Strike C, Miskovic M. Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm Reduct J. 2018;15:6. https://doi.org/10.1186/s12954-018-0212-3 .
doi: 10.1186/s12954-018-0212-3
pubmed: 29422042
pmcid: 5806231
Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, et al. Effectiveness of needle and syringe programmes in people who inject drugs – an overview of systematic reviews. BMC Public Health. 2017;17:309. https://doi.org/10.1186/s12889-017-4210-2 .
doi: 10.1186/s12889-017-4210-2
pubmed: 28399843
pmcid: 5387338
Lightfoot B, Panessa C, Hayden S, Thumath M, Goldstone I, Pauly B. (2009). Gaining Insite: harm reduction in nursing practice. Can Nurse. 2009:105(4):19–22.
Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429–37. https://doi.org/10.1016/S0140-6736(10)62353-7 .
doi: 10.1016/S0140-6736(10)62353-7
pubmed: 21497898
McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177–87. https://doi.org/10.1111/add.13326 .
doi: 10.1111/add.13326
pubmed: 27028542
pmcid: 5071734
Hope VD, Ncube F, Parry JV, Hickman M. Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England. Epidemiol Infect. 2015;143(1):120–31. https://doi.org/10.1017/S0950268814000284 .
doi: 10.1017/S0950268814000284
pubmed: 24568684
Kerr T, Wood E, Grafstein E, Ishida T, Shannon K, Lai C, et al. High rates of primary care and emergency department use among injection drug users in Vancouver. J Public Health. 2005;27(1):62–6. https://doi.org/10.1093/pubmed/fdh189 .
doi: 10.1093/pubmed/fdh189
Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, et al. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction. 2020;115(6):1011–23. https://doi.org/10.1111/add.14892 .
doi: 10.1111/add.14892
pubmed: 31705770
pmcid: 7210080
Neale J, Sheard L, Tompkins CN. Factors that help injecting drug users to access and benefit from services: a qualitative study. Subst Abuse Treat Prev Policy. 2007;2:31. https://doi.org/10.1186/1747-597X-2-31 .
doi: 10.1186/1747-597X-2-31
pubmed: 17971204
pmcid: 2169215
Summers PJ, Hellman JL, MacLean MR, Rees VW, Wilkes MS. Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. Drug Alcohol Depend. 2018;190:200–8. https://doi.org/10.1016/j.drugalcdep.2018.06.010 .
doi: 10.1016/j.drugalcdep.2018.06.010
pubmed: 30055424
Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J. 2017;14:16. https://doi.org/10.1186/s12954-017-0143-4 .
doi: 10.1186/s12954-017-0143-4
pubmed: 28494791
pmcid: 5427560
Weiner SG, Baker O, Bernson D, Schuur JD. One-year mortality of patients after emergency department treatment for nonfatal opioid overdose. Ann Emerg Med. 2020;75(1):13–7. https://doi.org/10.1016/j.annemergmed.2019.04.020 .
doi: 10.1016/j.annemergmed.2019.04.020
pubmed: 31229387
Hawk K, Grau LE, Fiellin DA, Chawarski M, O’Connor PG, Cirillo N, et al. A qualitative study of emergency department patients who survived an opioid overdose: perspectives on treatment and unmet needs. Acad Emerg Med. 2021;28(5):542–52. https://doi.org/10.1111/acem.14197 .
doi: 10.1111/acem.14197
pubmed: 33346926
pmcid: 8281441
Moe J, Chong M, Zhao B, Scheuermeyer FX, Purssell R, Slaunwhite A. Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis. CMAJ Open. 2021;9(1):E242–51. https://doi.org/10.9778/cmajo.20200169 .
doi: 10.9778/cmajo.20200169
pubmed: 33731425
pmcid: 8096380
Cao SS, Dunham SI, Simpson SA. Prescribing buprenorphine for opioid use disorders in the ED: a review of best practices, barriers, and future directions. Open Access Emerg Med. 2020;12:261–74. https://doi.org/10.2147/OAEM.S267416 .
doi: 10.2147/OAEM.S267416
pubmed: 33116962
pmcid: 7569244
Dwyer K, Walley AY, Langlois BK, Mitchell PM, Nelson KP, Cromwell J, et al. Opioid education and nasal naloxone rescue kits in the emergency department. West J Emerg Med. 2015;16(3):381–4. https://doi.org/10.5811/westjem.2015.2.24909 .
doi: 10.5811/westjem.2015.2.24909
pubmed: 25987910
pmcid: 4427207
Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. The emergency department as an opportunity for naloxone distribution. West J Emerg Med. 2018;19(6):1036–42. https://doi.org/10.5811/westjem.2018.8.38829 .
doi: 10.5811/westjem.2018.8.38829
pubmed: 30429939
pmcid: 6225944
Holland TJ, Penm J, Dinh M, Aran S, Chaar B. Emergency department physicians’ and pharmacists’ perspectives on take-home naloxone. Drug Alcohol Rev. 2019;38(2):169–76. https://doi.org/10.1111/dar.12894 .
doi: 10.1111/dar.12894
pubmed: 30697852
Im DD, Chary A, Condella AL, Vongsachang H, Carlson LC, Vogel L, et al. Emergency department clinicians’ attitudes toward opioid use disorder and emergency department-initiated buprenorphine treatment: a mixed-methods study. West J Emerg Med. 2020;21(2):261–71. https://doi.org/10.5811/westjem.2019.11.44382 .
doi: 10.5811/westjem.2019.11.44382
pubmed: 32191184
pmcid: 7081867
Kestler A, Giesler A, Buxton J, Meckling G, Lee M, Hunte G, et al. Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone. CJEM. 2019;21(2):226–34. https://doi.org/10.1017/cem.2018.368 .
doi: 10.1017/cem.2018.368
pubmed: 29789030
Kestler A, Wale J, Allan M. The time for emergency department opioid agonist therapy is now: a BC perspective. CJEM. 2019;21(4):443–5. https://doi.org/10.1017/cem.2019.368 .
doi: 10.1017/cem.2019.368
pubmed: 31333150
Lacroix L, Thurgur L, Orkin AM, Perry JJ, Stiell IG. Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments. CJEM. 2018;20(1):46–52. https://doi.org/10.1017/cem.2017.390 .
doi: 10.1017/cem.2017.390
pubmed: 28918769
Wiercigroch D, Hoyeck P, Sheikh H, Hulme J. A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department. BMC Emerg Med. 2021;21:48. https://doi.org/10.1186/s12873-021-00443-1 .
doi: 10.1186/s12873-021-00443-1
pubmed: 33858328
pmcid: 8051038
Dekker SW. We have Newton on a retainer: reductionism when we need systems thinking. Jt Comm J Qual Patient Saf. 2010;36(4):147–9. https://doi.org/10.1016/s1553-7250(10)36024-7 .
doi: 10.1016/s1553-7250(10)36024-7
pubmed: 20402369
Widmer MA, Swanson RC, Zink BJ, Pines JM. Complex systems thinking in emergency medicine: a novel paradigm for a rapidly changing and interconnected health care landscape. J Eval Clin Pract. 2018;24(3):629–34. https://doi.org/10.1111/jep.12862 .
doi: 10.1111/jep.12862
pubmed: 29280244
Jiao S, Bungay V, Jenkins E, Gagnon M. How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective. Harm Reduct J. 2023;20:139. https://doi.org/10.1186/s12954-023-00871-1 .
doi: 10.1186/s12954-023-00871-1
pubmed: 37735432
pmcid: 10515241
Canadian Nurses Association, Canadian Association of Nurses in HIV/AIDS Care, Harm Reduction Nurses Association. Joint position statement: harm reduction and substance use [Internet]. Ottawa: Canadian Nurses Association; 2018 [cited 2024 Feb 12]. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/Joint_Position_Statement_Harm_Reduction_and_Substance_Use.pdf
British Columbia Nurses’ Union. Position statement: harm reduction [Internet]. Burnaby: British Columbia Nurses’ Union; 2011 [cited 2024 Feb 12]. https://www.bcnu.org/AboutBcnu/Documents/position-statement-harm-reduction.pdf
Doctors of British Columbia. Illicit drugs toxicity / overdose crisis [Internet]. Vancouver: Doctors of British Columbia; 2021 [cited 2024 Feb 12]. https://www.doctorsofbc.ca/file/30207/download?token=H94KWgaS
Cisewski DH, Santos C, Koyfman A, Long B. Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting. Am J Emerg Med. 2019;37(1):143–50. https://doi.org/10.1016/j.ajem.2018.10.013 .
doi: 10.1016/j.ajem.2018.10.013
pubmed: 30355476
Drainoni ML, Koppelman EA, Feldman JA, Walley AY, Mitchell PM, Ellison J, et al. Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment. BMC Res Notes. 2016;9:465. https://doi.org/10.1186/s13104-016-2268-z .
doi: 10.1186/s13104-016-2268-z
pubmed: 27756427
pmcid: 5070095
Allred CA, Burns BJ, Phillips SD. The assertive community treatment team as a complex dynamic system of care. Adm Policy Ment Health. 2005;32(3):211–20. https://doi.org/10.1007/s10488-004-0841-6 .
doi: 10.1007/s10488-004-0841-6
pubmed: 15844845
de Bock BA, Willems DL, Weinstein HC. Complexity perspectives on clinical decision making in an intensive care unit. J Eval Clin Pract. 2018;24(1):308–13. https://doi.org/10.1111/jep.12794 .
doi: 10.1111/jep.12794
pubmed: 28762632
Kuziemsky C. Decision-making in healthcare as a complex adaptive system. Healthc Manage Forum. 2016;29(1):4–7. doi: s10.1177/0840470415614842.
doi: 10.1177/0840470415614842
pubmed: 26656389
Nugus P, Carroll K, Hewett DG, Short A, Forero R, Braithwaite J. Integrated care in the emergency department: a complex adaptive systems perspective. Soc Sci Med. 2010;71(11):1997–2004. https://doi.org/10.1016/j.socscimed.2010.08.013 .
doi: 10.1016/j.socscimed.2010.08.013
pubmed: 20947232
McDaniel RR, Driebe DJ. Complexity science and health care management. Advances in health care management. Emerald Group Publishing Limited; 2001. pp. 11–36. https://doi.org/10.1016/S1474-8231(01)02021-3 .
Swanson RC, Cattaneo A, Bradley E, Chunharas S, Atun R, Abbas KM, et al. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan. 2012;27(Suppl 4):iv54–61. https://doi.org/10.1093/heapol/czs090 .
doi: 10.1093/heapol/czs090
pubmed: 23014154
pmcid: 3529625
Providence Health Care. Our populations of emphasis [Internet]. Vancouver: Providence Health Care; 2019 [cited 2024 Feb 12]. https://www.providencehealthcare.org/about-providence/who-we-serve/our-populations-emphasis
Providence Health Care. About St. Paul’s Hospital [Internet]. Vancouver: Providence Health Care; 2016 [cited 2024 Feb 12]. https://thenewstpauls.ca/app/uploads/2016/06/FS-About-St.-Pauls-21-June-2016.pdf
Watson H, Maclaren W, Shaw F, Nolan A. Measuring staff attitudes to people with drug problems: The development of a tool [Internet]. Glasgow (SCT): Scottish Executive Drug Misuse Research Programme; 2003 [cited 2024 Feb 12]. https://www.gov.scot/Publications /2003/08/17735/23454.
Williams KT, Baron KA, Gee JP, Chan J. Educating students about opioid use disorder and treatments in the community using an educational video. Nurse Educ. 2020;45(6):326–30. https://doi.org/10.1097/NNE.0000000000000793 .
doi: 10.1097/NNE.0000000000000793
pubmed: 31972841
Kelly P, Gotham HJ, Knopf-Amelung S, Kohnle K, Kuofie A. Distance versus on-site educational strategies for competency-based screening, brief intervention, and referral to treatment education. J Addict Nurs. 2018;29(4):E1–8. https://doi.org/10.1097/JAN.0000000000000247 .
doi: 10.1097/JAN.0000000000000247
pubmed: 30507825
Knopf-Amelung S, Gotham H, Kuofie A, Young P, Manney Stinson R, Lynn J, et al. Comparison of instructional methods for screening, brief intervention, and referral to treatment for substance use in nursing education. Nurse Educ. 2018;43(3):123–7. https://doi.org/10.1097/NNE.0000000000000439s .
doi: 10.1097/NNE.0000000000000439s
pubmed: 28817479
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa .
doi: 10.1191/1478088706qp063oa
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589–97. https://doi.org/10.1080/2159676X.2019.1628806 .
doi: 10.1080/2159676X.2019.1628806
Jiao S. Harm reduction: philosophical drivers of conceptual tensions and ways forward. Nurs Inq. 2019;26(2):e12286. https://doi.org/10.1111/nin.12286 .
doi: 10.1111/nin.12286
pubmed: 30773745
Onwuegbuzie AJ, Combs JP. Emergent data analysis techniques in mixed methods research: a synthesis. In: Tashakkori A, Teddlie C, editors. SAGE handbook of mixed methods in social and behavioural research. 2nd ed. Thousand Oaks: SAGE Publications, Inc; 2015. pp. 1–51.
Collins KMT, Onwuegbuzie AJ, Sutton IL. A model incorporating the rationale and purpose for conducting mixed-methods research in special education and beyond. Learn Disabil Contemp J. 2006;4(1):67–100.
Providence Health Care. Harm reduction and managing substance use – Acute care [Internet]. Vancouver: Providence Health Care. 2021 [cited 2024 Feb 12]. http://shop.healthcarebc.ca/phc/PHCDSTs/B-00-07-10096.pdf
Hemmons P, Bach P, Colizza K, Nolan S. Initiation and rapid titration of methadone in an acute care setting for the treatment of opioid use disorder: a case report. J Addict Med. 2019;13(5):408–11. https://doi.org/10.1097/ADM.0000000000000507 .
doi: 10.1097/ADM.0000000000000507
pubmed: 30741835
pmcid: 6682456
Khan GK, Harvey L, Johnson S, Long P, Kimmel S, Pierre C, et al. Integration of a community-based harm reduction program into a safety net hospital: a qualitative study. Harm Reduct J. 2022;19:35. https://doi.org/10.1186/s12954-022-00622-8 .
doi: 10.1186/s12954-022-00622-8
pubmed: 35414072
pmcid: 9002225
Calcaterra SL, Lockhart S, Callister C, Hoover K, Binswanger IA. Opioid use disorder treatment initiation and continuation: a qualitative study of patients who received addiction consultation and hospital-based providers. J Gen Intern Med. 2022;37(11):2786–94. https://doi.org/10.1007/s11606-021-07305-3 .
doi: 10.1007/s11606-021-07305-3
pubmed: 34981359
pmcid: 8722657
Collins AB, Beaudoin FL, Samuels EA, Wightman R, Baird J. Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: a qualitative evaluation. J Subst Abuse Treat. 2021;130:108411. https://doi.org/10.1016/j.jsat.2021.108411 .
doi: 10.1016/j.jsat.2021.108411
pubmed: 34118703
The Health Foundation. Evidence scan: complex adaptive systems [Internet]. London: The Health Foundation. 2010 [cited 2024 Feb 12]. https://www.health.org.uk/sites/default/files/ComplexAdaptiveSystems.pdf
Gagnon M, Payne A, Denis-Lalonde D, Wilbur K, Pauly B. Substance use education in Canadian nursing programs: a student survey. J Nurs Educ. 2020;59(9):510–3. https://doi.org/10.3928/01484834-20200817-06 .
doi: 10.3928/01484834-20200817-06
pubmed: 32865584
Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Acad Med. 2001;76(5):410–8. https://doi.org/10.1097/00001888-200105000-00007 .
doi: 10.1097/00001888-200105000-00007
pubmed: 11346513
Kothari D, Gourevitch MN, Lee JD, Grossman E, Truncali A, Ark TK, et al. Undergraduate medical education in substance abuse: a review of the quality of the literature. Acad Med. 2011;86(1):98–112. https://doi.org/10.1097/ACM.0b013e3181ff92cf .
doi: 10.1097/ACM.0b013e3181ff92cf
pubmed: 21099395
pmcid: 3148085
Rasyidi E, Wilkins JN, Danovitch I. Training the next generation of providers in addiction medicine. Psychiatr Clin North Am. 2012;35(2):461–80. https://doi.org/10.1016/j.psc.2012.04.001 .
doi: 10.1016/j.psc.2012.04.001
pubmed: 22640766
Ratycz MC, Papadimos TJ, Vanderbilt AA. Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. Med Educ Online. 2018;23s:1466574. https://doi.org/10.1080/10872981.2018.1466574 .
doi: 10.1080/10872981.2018.1466574
Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. J Gen Intern Med. 2017;32(8):909–16. https://doi.org/10.1007/s11606-017-4077-z .
doi: 10.1007/s11606-017-4077-z
pubmed: 28526932
pmcid: 5515798
Ram A, Chisolm MS. The time is now: improving substance abuse training in medical schools. Acad Psychiatry. 2016;40(3):454–60. https://doi.org/10.1007/s40596-015-0314-0 .
doi: 10.1007/s40596-015-0314-0
pubmed: 25749922
Finnell DS, Savage CL, Hansen BR, Sanchez M, White KM, Johnson JA, et al. Integrating substance use content in an overcrowded nursing curriculum. Nurse Educ. 2018;43(3):128–31. https://doi.org/10.1097/NNE.0000000000000438 .
doi: 10.1097/NNE.0000000000000438
pubmed: 28857953
Clancy C, Kelly P, Loth C. State of the art in European addictions nursing: perspectives from the United Kingdom, Ireland, and the Netherlands. J Addict Nurs. 2019;30(3):139–48. https://doi.org/10.1097/JAN.0000000000000293 .
doi: 10.1097/JAN.0000000000000293
pubmed: 31478961
Funke M, Kaplan MC, Glover H, Schramm-Sapyta N, Muzyk A, Mando-Vandrick J, et al. Increasing naloxone prescribing in the emergency department through education and electronic medical record work-aids. Jt Comm J Qual Patient Saf. 2021;47(6):364–75. https://doi.org/10.1016/j.jcjq.2021.03.002 .
doi: 10.1016/j.jcjq.2021.03.002
pubmed: 33811002
pmcid: 8924938
Winetsky D, Weinrieb RM, Perrone J. Expanding treatment opportunities for hospitalized patients with opioid use disorders. J Hosp Med. 2018;13(1):62–4. https://doi.org/10.12788/jhm.2861 .
doi: 10.12788/jhm.2861
pubmed: 29073311
Lowenstein M, Kilaru A, Perrone J, Hemmons J, Abdel-Rahman D, Meisel ZF, et al. Barriers and facilitators for emergency department initiation of buprenorphine: a physician survey. Am J Emerg Med. 2019;37(9):1787–90. https://doi.org/10.1016/j.ajem.2019.02.025 .
doi: 10.1016/j.ajem.2019.02.025
pubmed: 30803850
pmcid: 7556325
Duber HC, Barata IA, Cioè-Peña E, Liang SY, Ketcham E, Macias-Konstantopoulos W, et al. Identification, management, and transition of care for patients with opioid use disorder in the emergency department. Ann Emerg Med. 2018;72(4):420–31. https://doi.org/10.1016/j.annemergmed.2018.04.007 .
doi: 10.1016/j.annemergmed.2018.04.007
pubmed: 29880438
pmcid: 6613583
Fanucchi L, Lofwall MR. Putting parity into practice – integrating opioid-use disorder treatment into the hospital setting. N Engl J Med. 2016;375(9):811–3. https://doi.org/10.1056/NEJMp1606157 .
doi: 10.1056/NEJMp1606157
pubmed: 27579631