Treatment of opioid use disorder in an innovative community-based setting after multiple treatment attempts in a woman with untreated HIV

A community-based innovative model of care for the management of severe bacterial infections in persons who use injection drugs

The opioid crisis and complications related to injection drug use are a public health emergency. The combination of addiction and injection drug use is a devastating double-edged sword: it predisposes patients to severe life-threatening infections like endocarditis, and epidural abscess, as well as to disorganized behaviour and impaired decision-making that interferes with the completion of prolonged courses of required antibiotic therapy. Poverty and stigma add further fuel to the fire. The Community Transitional Care Team (CTCT) is a revolutionary community-based short-term residence where people who inject drugs can stay to complete their course of antibiotics. We present the case of a young woman struggling with addiction, tremendous social barriers to health, and life threating Staphylococcus aureus infection that highlights the benefits of strong, community-based, and individualized models of patient care.

"Maybe if I stop the drugs, then maybe they'd care?"-hospital care experiences of people who use drugs

BACKGROUND

Drug use is associated with increased morbidity and mortality but people who use drugs experience significant barriers to care. Data are needed about the care experiences of people who use drugs to inform interventions and quality improvement initiatives. The objective of this study is to describe and characterize the experience of acute care for people who use drugs.

METHODS

We conducted a qualitative descriptive study. We recruited people with a history of active drug use at the time of an admission to an acute care hospital, who were living with HIV or hepatitis C, in Toronto and Ottawa, Canada. Data were collected in 2014 and 2015 through semi-structured interviews, audio-recorded and transcribed, and analyzed thematically.

RESULTS

Twenty-four adults (18 men, 6 women) participated. Participants predominantly recounted experiences of stigma and challenges accessing care. We present the identified themes in two overarching domains of interest: perceived effect of drug use on hospital care and impact of care experiences on future healthcare interactions. Participants described significant barriers to pain management, often resulting in inconsistent and inadequate pain management. They described various strategies to navigate access and receipt of healthcare from being "an easy patient" to self-advocacy. Negative experiences influenced their willingness to seek care, often resulting in delayed care seeking and targeting of certain hospitals.

CONCLUSION

Drug use was experienced as a barrier at all stages of hospital care. Interventions to decrease stigma and improve our consistency and approach to pain management are necessary to improve the quality of care and care experiences of those who use drugs.