Kosteniuk, B.

Patient Perspectives of the Royal Alexandra Hospital Supervised Consumption Service
Kosteniuk, B., Salvalaggio G., Brooks, H.L., & Hyshka, E.

In April 2018, North America's first and only supervised consumption service (SCS) for hospital inpatients was implemented at the Royal Alexandra Hospital (RAH) in Edmonton. SCS are a public health intervention in which illegal drugs can be consumed under medical supervision. SCS also connect clients with external recovery supports, and health and social services. However, no research has examined existing SCS in acute care, nor has this novel service in the RAH been examined. I aimed to understand perspectives of people who use drugs (PWUD) on the RAH SCS to assess whether the service is meeting their needs and to identify opportunities for quality improvement. Specifically, I examined barriers and facilitators to accessing the SCS, and the impact of the SCS on patients.

We adopted a qualitative focused ethnographic design and conducted 21 semi-structured interviews with hospital inpatients who were eligible to access the RAH SCS. Transcripts were coded thematically using latent content analysis.

Nine participants identified as women, 13 as Indigenous, and 13 used the SCS while hospitalized. Harm reduction services provided by the SCS (e.g., overdose prevention; sterile syringes) and several characteristics of the site (e.g., safe environment; approachable staff) facilitated uptake. Participants identified stigma and judgement, surveillance, and site rules as the main barriers to SCS accessibility. Some feared and/or experienced changes in care on the unit following use of the SCS. Participants suggested changes to rules and policies, and clinical practice as potential avenues for quality improvement.

Overall, while not empirically generalizable, these findings will inform improvements to the RAH SCS, and may provide helpful information for other health authorities that intend to open SCS. In turn, this research may lead to improvements in hospital care and outcomes for patients who use drugs.