Intravenous Drug Use in the Hospital Setting: Advancing Reconciliation for Indigenous Canadians Using In-Hospital Harm Reduction and Culturally Safe Care.

Abstract: People who inject drugs are likely to end up admitted to a hospital due to complications associated with substance use. While in hospital, many of these patients will continue the self-administration of nonprescribed drugs. When implemented without a harm reduction approach, self-administration can lead to an increase in the acquisition of infectious diseases, injection-related infections, and fatal and nonfatal overdoses. Often, administrators and providers use punitive approaches to manage this behavior among patients and providers. This abstinence-based approach has, and continues to, disproportionally impact structurally vulnerable communities. To mobilize the Truth and Reconciliation Commission's Calls to Action, Canadian hospitals must respond transparently and urgently to Indigenous peoples, patients, and communities. For example, First Nations, Inuit, and Metis people and communities living in Canada are significantly affected by the opioid epidemic, which can be traced back to the legacy of and continued colonialism and systemic discrimination in health care. Colonial policies and systems manifest as Indigenous populations experiencing a high prevalence of socioeconomic disadvantage and poor access to quality health and social services, on- and off-reserve. Clinicians must understand and receive cultural safety training to adequately care for Indigenous patient populations, as well as other structurally vulnerable populations. Additionally, Canadian hospitals should acknowledge and measure intravenous drug use in their organizations and take a harm reduction approach to mitigate associated adverse outcomes. Finally, hospitals should work with academic institutions to train, recruit, and retain Indigenous clinicians from diverse sociocultural backgrounds.