A qualitative study exploring the feasibility and acceptability of embedding an overdose prevention sites in a U.S. hospital

Abstract

Introduction

Community-based overdose prevention sites (OPS) are recognized for reducing overdose deaths and the spread of HIV and hepatitis C among people who use drugs (PWUD). While some hospitals in Europe and Canada have successfully integrated OPS into their facilities, such integration remains illegal in the United States. This study explores the feasibility and acceptability of implementing an OPS at the Hospital of the University of Pennsylvania (HUP), situated in an urban area with high rates of overdose.

Methods

Using semi-structured interviews, we engaged 28 stakeholders, including clinicians, hospital leadership, security personnel, and PWUD. The study presented participants with a hypothetical scenario depicting a PWUD hospitalized multiple times for injection-related endocarditis to elicit nuanced responses.

Results

Thematic analysis of the qualitative data revealed a complex landscape of perceived benefits and challenges associated with embedding an OPS at HUP. Stakeholders acknowledged potential advantages, such as harm reduction, including patient and community safety, education, and stigma reduction. However, concerns were raised regarding acceptability among PWUD, hospital staff, leadership, and the broader Philadelphia community. Hesitancy stemmed from uncertainties about trust-building, safety protocols, clinician stigma, and institutional support. Feasibility concerns, including patient eligibility criteria, drug policy, staffing, and suitable location, were also highlighted.

Conclusions

Despite political and cultural barriers, participants proposed strategies to garner support for a hospital-based OPS, emphasizing clinical education, anti-stigma training, and community engagement. They discussed a vision for an OPS at HUP that could serve as a haven for PWUD during hospitalization, potentially reducing patient-directed discharges and improving adherence to medical treatments, thus decreasing morbidity and readmissions. This study underscores the need to address multifaceted concerns before implementing OPS within hospital settings. Once legal and cultural impediments are addressed, insights from this research can inform the design and operation of OPS at HUP and similar institutions, contributing to enhanced patient outcomes and community well-being.