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NH docs debate safe drug-use rooms in hospitals


A New Hampshire physician is encouraging health care professionals to consider a unique approach to helping patients by establishing safe drug-use rooms inside of hospitals.

Allowing patients to inject heroin in a hospital will understandably raise some red flags, but Dr. Tim Lahey, a physician, ethicist and director of education at the Dartmouth Institute for Health Policy and Clinical Practice, says thinking outside of the box could ultimately help fight the opioid crisis.

Safe injection rooms in hospitals would not be his first option, but Lahey said it should be explored further - a view not shared by some New Hampshire health experts.

Lahey has patients suffering from life-threatening illnesses that are currently hospitalized and struggling with addiction. Addicts could harm their health, or lose their lives, by leaving the hospital to get drugs, said Lahey.

The first goal should be the administration of methadone or other substances to help with cravings, followed by psychiatric services, he said. But even with the best care, some patients decline those measures, he said.

"I think the evidence is clear that safe injection facilities improve outcomes in people with addiction, and do not have the harms that people imagine," said Lahey. "I encourage these debates so that we can weigh the pros and cons."

While Lahey would not support safe injection rooms for addicts seeking rehabilitation or treatment, he does believe that if health professionals are attempting to save a patient's life and nothing else is working, the rooms could be an option.

He acknowledges that there are many cons to this proposal, but referred to studies suggesting that there are better outcomes for select patients using this model.

The opposition

Not everyone is on board with Lahey's recommendation, which he highlighted earlier this month in an op-ed piece published in The New York Times.

"I don't think this is even particularly controversial - I just don't think it is a good idea," said Dr. Chris Slusher, an urgent care physician who resides in Bedford and works in Manchester.

Slusher argued that heroin is still an illicit substance, and that it would be difficult to monitor what patients are actually injecting in safe, drug-use rooms.

"My concern is that this would become the practice, and that the public is going to look at this and if they are on the border of using, they will just use because it is allowed in the hospital," he said. "It will give them legitimacy."

Slusher stressed that there are numerous treatments available for addicts while hospitalized that will help with withdrawal symptoms, specifically methadone. Patients are not allowed to smoke or drink in hospitals, and they shouldn't be permitted to shoot heroin, he said.

He said the concept of in-hospital injection rooms is a terrible message to send to New Hampshire's at-risk population, and it is a slap in the face to officials working to fight the opioid crisis.

"We are trying to reduce heroin use in the state, not increase it," he wrote in response to Lahey's New York Times op-ed.

Lahey said he received many emails following the publication of the op-ed, which maintains that a safe place to inject for addicted patients in the hospital could reduce conflict with staff, protect patients and providers from dirty needles and other drug hazards and enable patients to receive respectful, high-quality care when back in their hospital beds.

The use of safe injection rooms could also offer treatment for addiction, a step often neglected in hospitals, according to Lahey.

"We want to save their lives," he said, adding a thoughtful and balanced approach must be taken to study all alternatives to fight the drug crisis. He stressed that the standard of care in New Hampshire hospitals must first be improved, and that the use of methadone must also be increased as a first step before safe drug-use rooms are considered.

Opioid-agonist therapy

Dr. Seddon Savage, an addiction medicine specialist and adviser to Dartmouth-Hitchcock's Substance Use and Mental Health Initiative, said she shares Lahey's goals of reducing opioid-related harm, but believes that patients should not be injecting drugs in hospitals.

Opioids can be given as a part of intensive care for treatment, and there are some initiatives that have been piloted throughout the country and are having great success at keeping patients struggling with addiction in the hospital, according to Savage.

"Many clinicians are hesitant about opioid-agonist therapy treatment of morphine and methadone, but both of these are options. I think there is some misunderstanding about the legality of doing that," she said.

Opioid-agonist therapy uses synthetic opiates like methadone and others to help prevent cravings and withdrawal, but do not produce a high or feeling of euphoria.

If patients are admitted to the hospital with injuries following a motor-vehicle accident, or they have been diagnosed with hepatitis and are addicted to drugs, physicians do have the ability to legally provide this type of therapy to prevent withdrawal, Savage said.

"I think that we have evidence-based treatment and pilots that are already working, and we should use those before moving to something that has not yet been studied and is probably more perpetuating of the addiction," she added.

Still, Savage acknowledged that this is not yet the standard of care in New Hampshire, and that opioid-agonist therapy treatment should be embraced by the health care community.

"It takes a little change in perspective. There is still a misunderstanding and general discomfort about it," she said.

Aside from exploring in-hospital safe drug-use rooms, Lahey said outpatient rooms that could be accessed by nearby hospitals and clinics should also be considered as an option.

He stressed that there is clear data that most hospitals throughout the nation are not good at implementing the standard of care, and fail to offer methadone and other treatments.

If someone is unable to stop injecting, it would be nice to promote the use of clean needles in a clean environment without the fear of complications, maintained Lahey. There are clearly some cons, he admits, explaining there are legal liability concerns and the possibility of overdoses and unknown behaviors.

Still, he said it is important to begin the conversation here in the Granite State once the standard of care is implemented.

khoughton@newstote.com

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