Grant: Catalyst Grant: Ethics

People who inject drugs are at increased risk of HIV and Hepatitis C, overdose, and many other negative health outcomes. Syringe exchange programs (SEPs) are a key strategy for reducing this harm, and have been widely implemented in Canada. Scientific evidence supports SEP effectiveness, however, these programs have limited reach in hospitals. This is problematic because people who inject drugs experience high rates of hospitalization, and almost half report using drugs while hospitalized. Not being able to access sterile syringes while in hospital leads to syringe reuse and sharing, premature discharge, and negative health outcomes. Bans on injection supplies also reinforce a moral and not medical perspective on addiction, and fuel distrust between patients and their healthcare teams. This distrust can undermine patient-healthcare provider relationships, and introduce barriers to healthcare access. To prevent these serious consequences, Edmonton's Royal Alexandra Hospital implemented Canada's first formal SEP for acute care inpatients in 2014. This innovative program was developed ad hoc because internationally, no research documents the practice of providing sterile syringes to hospital inpatients. Therefore, we plan to study the inpatient SEP to develop ethical practice guidelines for hospital staff. We will conduct interviews with patients and staff to hear about their experiences. We are particularly interested in learning how the inpatient SEP impacts patient-healthcare provider relationships, and what norms, rules, and policies help or hinder ethical healthcare practice. The findings from this research will be used to develop and refine practice guidelines to enhance the inpatient SEP and advance knowledge in this area. Overall this project will support the development of additional strategies for improving hospital care for people who inject drugs.