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    Harm Reduction in the ED

    Special Populations, Substance Use, Toxicology

    Last Updated Jun 22, 2021
    Read Disclaimer
    By Rukaiyah Lakkadghatwala, Asha Olmstead, Jane Buxton, Glyn Townson, Reija Roberts, Andrew Kestler


    • Opioid-related overdoses and deaths continue to rise in British Columbia and across North America.
    • Injection drug use increases the risk of blood-borne infections — such as HIV and hepatitis C — and bacterial infections.
    • Safer injection and inhalation supplies decrease the risk of transmission of blood-borne and bacterial infections.
    • Patients who use substances and patients with substance use disorders often visit emergency departments (ED), making this a critical setting for harm reduction. Harm reduction aims to reduce the risks associated with substance use.
    • Patients who are in withdrawal when discharged from the ED are at increased risk of non-sterile supply use.
    • ED-based harm reduction is a key component of the ED approach to opioid use disorder and substance use in general. See how harm reduction can be incorporated into an ED care pathway here.



    Expert Tip

    • People who use drugs are at higher risk of leaving before their visit is complete. Address harm reduction and provide resources and supplies early in the visit.

    Foster a Non-Judgemental ED Environment and Screen for Substance Use

    • Let patients know it is an ED best practice to ask all patients about any potential substance use in order to improve their care. Ask permission to have a conversation about their substance use.
    • Use person-first language. For example, “person who uses drugs” instead of “drug user” or “addict.”
    • Screening identifies patients who may benefit from harm reduction education and safer injection and inhalation supplies. Screen all patients for current substance use, even those without the more easily recognized risk factors (prior substance use or injection drug use history, positive drug screen results, or complications associated with substance use).
    • “How many times in the past year have you used a street drug or a prescription medication for non-medical reasons?” is an effective single-question screening tool.

    Provide Take Home Naloxone Kits

    Provide Safer Injection and Inhalation Supplies

    Review Safer Drug Use Tips

    Recommend using supervised consumption sites and the Lifeguard App or BeSafe App.

    • Ask what strategies patients are currently using to keep themselves safe when they are using substances.
    • Encourage using small drug amounts as “test doses,” going slowly, and using one drug at a time.
    • Recommend using with a friend, rather than alone.
    • Supervised consumption sites and overdose prevention services decrease the risk of overdoses, over-dose related deaths, and blood-borne infections. Help connect your patient to local supervised consumption sites and community partners that can provide safer injection and inhalation supplies, drug testing, and other supports. Use the site finder to find local supervised consumption sites and sites where patients can access replacement naloxone kits and more safe injection and inhalation supplies.
    • Recommend using the Lifeguard App or BeSafe App if using alone. The Lifeguard App contacts emergency services when patients are unable to turn off a 1-minute timer. The BeSafe App allows patients to create an individualized Rescue Plan outlining when the supporter should call for help and who should be called for help—a friend or emergency services.

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