Objective Patients who use substances (e.g. alcohol, illicit drugs, or non-prescribed medications) while in hospital present both medical and ethical challenges for healthcare management. However, little is known about the prevalence of this issue in Australia. This study aimed to quantify non-prescribed substance use among inpatients in a large teaching hospital. Methods A case file review was conducted using incident reports from a tertiary hospital in outer-metropolitan Sydney, Australia, covering the period between 2014 and 2021. Results Among 3775 reported critical incidents involving patients, substance use was identified in 99 (2.6%) over 7 years. Patient’s median age was 36 years, and 61 (62%) were male. Most admissions were for a substance use issue, and all involved withdrawal management. Notably, patients exhibited high levels of mental and physical health comorbidities, including depression (n = 79, 80%) and chronic pain (n = 24, 24%). Only eight patients (8%) were receiving opioid substitution therapy. Illicit substance use detected during hospitalisation involved various drug classes. Most of the substance use episodes (64%, n = 63) occurred outside regular hours, and fewer than half of the patients completed their admission. Conclusions Substance use in hospitals was detected infrequently and may be under-recognised. Inconsistent decisions regarding discharge contribute to discharged patients lacking ongoing health care, putting patients at risk of adverse outcomes. Clinicians and hospitals require further support to identify and address substance use within hospital settings. Clear policy guidance and improvements at multiple levels (policy, education, and clinical practice) are necessary to tackle this issue effectively.
Kardell et al. (Mon,) studied this question.