Hospital-Based Harm Reduction Interventions: A Systematic Review

Abstract

Background: In the U.S., the number of hospitalized patients diagnosed with a substance use disorder (SUD; e.g., opioid use disorder, alcohol use disorder) is growing at an alarming rate. Often negatively impacted by stigma, homelessness and physical and mental comorbidities, this vulnerable patient population may benefit from the use of hospital-based harm reduction interventions (HHRIs) to improve overall hospital care experiences and negative health outcomes. Purpose: To examine how harm reduction principles have been successfully applied to HHRIs resulting in decreased negative health outcomes associated with SUD, improved healthcare provider-patient relationships, and reduced financial burden of healthcare systems. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and flow diagram were utilized for this systematic review. Nineteen studies met the eligibility criteria for inclusion in the review. Implications: Four consistent themes that either inhibit or facilitate the implementation of HHRIs (e.g., establishing specialized SUD hospital units, employing peer support specialists, utilizing the clinical opiate withdrawal scale) were identified: ethical responsibility, stigma, structural changes to hospital systems, and noted gaps associated with post-discharge care. Conclusion: HHRIs are a useful treatment option to manage the unique needs associated with the growing SUD patient population.