Substance-Related Encounters and Hospital Security Searches i

Hospital security searches have become a standard practice for addressing substance-related encounters in healthcare. These encounters are a growing concern, with almost 1 in 4 hospitalisations in the US linked to substance use. While the goal of searches is to enhance safety, both for patients and medical staff, they also raise important questions about patient care and outcomes. Are these searches effective? Or do they pose unintended consequences, such as stigma and increased patient distrust?

This blog explores the role and impact of security searches on patients with substance-related issues, examining clinical contexts, outcomes, and the implications for hospital protocols. We’ll unpack how these searches affect patients, explore the relevance of patient-directed discharges (PDDs), and offer insights on creating patient-centred policies.

Substance-related encounters occur when patients seek treatment for issues related to substance use, including overdoses, withdrawal symptoms, or related complications, such as infections. These situations present opportunities for hospitals to provide medications for opioid use disorder (MOUD), offer harm reduction advice, and guide patients into long-term substance use treatment.

However, hospitals often face challenges with these cases. Patients may conceal substance use due to stigma, fear of judgment, or the concern that it may lead to punitive measures such as room searches. This concealment can result in risky behaviours, including using substances discreetly in hospital spaces, which could increase the risk of overdose or medical complications.

Security Searches as a Response to Substance Use

One common response from hospital staff, particularly nurses, is to request security to search patient rooms. These searches aim to recover illicit substances or paraphernalia that could harm patients or staff. Yet, there is limited data on the effectiveness of these searches.

A recent study conducted at an academic hospital provides helpful insights into security search outcomes. Among the 13,827 substance-related hospital visits analysed, 457 search requests were made. Nurses initiated 82.3% of these search requests. Despite the frequency of searches, 43.6% resulted in no items being recovered. When items were confiscated, they included syringes, drugs, alcohol, and tobacco products.

The Link Between Security Searches and Patient Outcomes

Interestingly, the study found that security searches correlated with higher rates of patient-directed discharges (PDDs). Patients subjected to searches were roughly three times more likely to leave the hospital before completing their medical treatment compared to patients who were not searched. These premature discharges can have severe consequences, including higher risks of readmission, untreated conditions, and even death.

Why are these outcomes so prevalent? Searches can amplify feelings of shame, mistrust, and stigma among patients struggling with substance use. This hostile environment diminishes the likelihood of patients returning for future treatment or engaging in critical addiction services.

Beyond Searches—A Closer Look at Contributing Factors

Pain and Withdrawal Management

One striking finding was that more than a quarter of patients flagged for searches had received insufficient or no medications for opioid use disorder (MOUD) before being searched. Poor pain and withdrawal management may drive some patients to continue using substances in hospital settings, increasing the chances of being subjected to a search.

Disparities and Stigma

While prior research suggested that Black patients were more likely to face security interventions, this study revealed that White patients were more likely to undergo security searches. These disparities may reflect differences in how substance use disorders are recognised or documented between racial groups. Additionally, behavioural “flags” that were added to patient records after searches could perpetuate stereotypes and unequal care.

Staff Perception and Training

Another challenge is the role of healthcare staff in initiating searches. Without adequate training in addiction care, nurses and other staff may rely on searches as a default response to perceived risks. However, this approach can exacerbate harm rather than mitigate it. Evidence-based training for hospital staff can help ensure that responses to in-hospital substance use are both effective and compassionate.

Balancing Safety and Patient-Centred Care

Security searches undeniably aim to protect patient and staff safety. However, this study reveals that most searches fail to recover illicit substances and may have negative consequences for patient outcomes. To strike the right balance, hospitals must reconsider how they handle substance-related encounters.

Alternative Approaches

Develop Clear Policies: Hospitals should establish transparent, evidence-based guidelines for conducting searches. This could include requiring authorisation from senior medical staff and offering patients clear explanations about policies.
Provide Adequate Pain Relief and MOUD: Addressing pain and withdrawal early can help discourage in-hospital substance use, reducing the need for searches.
Offer Safe Storage Solutions: Some hospitals allow patients to safely store substances or paraphernalia, minimising the risk of harm while encouraging trust.
Engage Patients as Partners: Treating patients with dignity and respect can reduce stigma and improve engagement with treatment plans.

Staff Training

Providing staff with addiction training can help them respond to substance use with empathy and evidence-based care. Nurses, in particular, should have access to education that equips them to manage these complex situations without defaulting to punitive measures.

Substance-related encounters are challenging yet crucial opportunities for meaningful medical intervention. While security searches can be a short-term safety measure, they often exacerbate negative outcomes for patients. Hospitals need to invest in better strategies that focus on patient-centred care, equitable treatment, and comprehensive staff training.

Substance use disorders require nuanced approaches that address both the health needs and dignity of patients. Creating supportive hospital environments can reduce risky behaviours, improve trust, and ultimately lead to better outcomes for all.

Source: Jama Network