Patients who leave hospital despite advice more likely to OD: study

A new study has found that patients in British Columbia who are discharged from hospital against their doctor's advice are 60 per cent more likely to suffer an overdose within a month of being discharged, once risk factors are taken into account.

This study Canadian Medical Association Journal The study, conducted Monday, was led by researchers at the University of British Columbia.

The study looked at almost 190,000 people who were hospitalized in the state between 2015 and 2019. Of those, 6,440 (3.4%) were discharged “before medical recommendation” (BMA), meaning they were discharged against a doctor's recommendation.

The study found that within that group, people were 60% more likely to suffer an overdose after accounting for risk factors such as age, sex and being unhoused.

“What concerns me most are patients who decide to begin surgery before their doctor's recommendation for discharge,” said study co-author Dr. John Staples, a physician at Vancouver General Hospital and clinical associate professor at the University of British Columbia (UBC).

“Because I know that once they leave the hospital, their health issues will not be treated.”

Staples said the study shows the health system needs to do more to make people feel safe in hospital and prevent the risk of overdose.

“I think the magnitude of the effect is surprising and impressive,” Staples said. “I think it's a real signal that we as a health care system need to do more to reach out to these vulnerable patients.”

Staples pointed to the following interventions: Safe Places to Take DrugsBetter treatments for pain and substance use disorders are also ways that could help this group of patients who want to leave hospital against medical advice.

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Organizers of retreats for families who have experienced tragic losses in British Columbia say demand is growing, in part because of the province's worsening drug crisis: More than 1,150 British Columbians died from drugs in the first half of 2024 alone.

Nurses Demand Humility and Respect

Nikola Grgic, a psychiatrist at Sunnybrook Health Sciences Centre in Toronto, said the study reaffirms what many health professionals already knew, and it's good to see hard data on the issue.

Grujic said opioid addiction, in particular, can be a very strong motivator to stop taking drugs because patients may experience withdrawal symptoms.

he, Opioid agonist therapy This is to prevent patients from experiencing those symptoms, and is recommended in studies.

The psychiatrist added that doctors cannot hospitalize patients against their will.

He added that information-sharing arrangements between safe injection sites and hospitals needed to be strengthened because patients often wanted medicines immediately after being discharged from BMAs.

“In theory, if someone who's been recently hospitalized shows up at an injection site, there's always an opportunity to communicate with the hospital,” he said, “but there's really no clear mechanism to facilitate that collaboration.”

Keren Elmir, a nurse at Moss Park Consumption and Treatment Services in Toronto, said the drug users she works with often feel neglected and discriminated against when they have to go to hospital, which sometimes leads to early discharge.

She recommends hospitals hire Indigenous liaison officers and culturally sensitive staff to help people feel comfortable when receiving medical care.

“I think our health care system also needs to have a real learning curve and a little bit of humility that people have a right to autonomy,” she said.

“Every human being deserves respect. It doesn't matter how old you are. It doesn't matter how much money you make or how little you earn. It doesn't matter what you look like or smell like. Everybody deserves respect, right?”

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