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Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs

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  • McNeil, Ryan
  • Small, Will
  • Wood, Evan
  • Kerr, Thomas

Abstract

People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social–structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social–structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the ‘risk environment’ framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social–structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm reduction supports, including supervised drug consumption services.

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  • McNeil, Ryan & Small, Will & Wood, Evan & Kerr, Thomas, 2014. "Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs," Social Science & Medicine, Elsevier, vol. 105(C), pages 59-66.
    • Handle: RePEc:eee:socmed:v:105:y:2014:i:c:p:59-66
    DOI: 10.1016/j.socscimed.2014.01.010
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    References listed on IDEAS

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    1. Rhodes, Tim & Watts, Louise & Davies, Sarah & Martin, Anthea & Smith, Josie & Clark, David & Craine, Noel & Lyons, Marion, 2007. "Risk, shame and the public injector: A qualitative study of drug injecting in South Wales," Social Science & Medicine, Elsevier, vol. 65(3), pages 572-585, August.
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    Cited by:

    1. Collins, Alexandra B. & Boyd, Jade & Cooper, Hannah L.F. & McNeil, Ryan, 2019. "The intersectional risk environment of people who use drugs," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    2. Lianping Ti & M-J Milloy & Jane Buxton & Ryan McNeil & Sabina Dobrer & Kanna Hayashi & Evan Wood & Thomas Kerr, 2015. "Factors Associated with Leaving Hospital against Medical Advice among People Who Use Illicit Drugs in Vancouver, Canada," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-10, October.
    3. Kanna Hayashi & Lianping Ti & Huiru Dong & Brittany Bingham & Andrew Day & Ronald Joe & Rolando Barrios & Kora DeBeck & M-J Milloy & Thomas Kerr, 2019. "Moving into an urban drug scene among people who use drugs in Vancouver, Canada: Latent class growth analysis," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-15, November.
    4. Caroline A King & Honora Englander & P Todd Korthuis & Joshua A Barocas & K John McConnell & Cynthia D Morris & Ryan Cook, 2021. "Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-14, September.
    5. Kiepek, Niki & Jones-Bonofiglio, Kristen & Freemantle, Stacey & Byerley-Vita, Mandy & Quaid, Kristine, 2021. "Exploring care of hospital inpatients with substance involvement," Social Science & Medicine, Elsevier, vol. 281(C).

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