An Island Health memo last month to acute-care hospital staff instructs nurses not to stop open use of illicit drugs in hospital rooms and to even teach patients how to inject drugs into their IV lines — despite the fact government officials have said drug use is not permitted in hospitals.
The memo dated March 12, raised by the Opposition BC United in question period in the legislature on Tuesday, provides a guide for staff interactions with people who use illicit drugs.
“Instead of requiring patients to stop using substances when they access care or services, a harm reduction approach offers ways for care to be provided,” says the memo.
The memo talks about seeking permission from patients to ask about their substance use, providing drug testing strips, offering supplies and ensuring they are easily accessible, and ensuring patients know where to safely dispose of supplies.
It also says if staff encounter a patient using illicit substances they should assess immediate safety — overdose, flames, behaviour. If it’s deemed safe, they’re advised to let the patient finish their drugs, and if it’s unsafe, they’re told to take steps to address those safety concerns and return “in five minutes” to reassess and speak further with the patient.
BC United health critic Shirley Bond asked the health minister in question period if nurses should be forced to endure daily exposure “to aggressive and volatile behaviour and drug use” that puts them and patients at risk.
“Nurses are told to train patients on how to inject illicit drugs into their veins through IV lines,” said Bond. “They are told to create a plan for substance use during admission. They are told to facilitate patient-identified substance use goals by providing burner kits with crack pipes and matches.”
Bond called it shocking that nurses are being instructed to teach patients how to inject illicit drugs directly into their intravenous lines.
BC Nurses Union president Adriane Gear said while the union supports harm-reduction measures, there are red flags in the memo, which represents a patient-centred approach to harm reduction but doesn’t provide education or resources for nurses not trained in substance use.
“I think it’s concerning for sure,” Gear said in a phone interview Tuesday.
As for the idea that nurses should simply return in five minutes, “well, that area could be actually toxic, there could be dirty needles left, and there’s other hazards.”
With respect to the contradiction between Health Minister Adrian Dix saying illicit drug use is not allowed in hospitals, and health authorities instructing hospital staff to support patients using illicit drugs in hospital, Gear said the problem lies with health-authority inconsistencies.
“Illicit drug use is not allowed in hospitals, however employers are choosing when and when not to enforce policies,” said Gear.
Decriminalization, a three-year pilot by the province to allow people to legally carry personal amounts of drugs, does not allow patients to consume drugs in hospitals, said Gear. She said it’s not the problem and putting people in jail for a health problem is not the answer.
“Decriminalization never meant unfettered, open consumption in hospital settings,” said Gear. “It appears that’s how health employers have interpreted it, and nurses and substance users are kind of caught in the middle of this now.”
Dix recently struck a task force with health authorities to begin to standardize policies across the province with regard to illicit drug use in hospitals.
Gear said this is an opportunity for the health minister to “demonstrate leadership” and ensure there’s one provincial policy, adding it’s the ministry’s responsibility “to ensure that health employers are implementing the policy and adhering to it.”
The Island Health memo also says hospital staff should discuss with patients their potential drug use and a safety plan while on a “day pass.”
It says staff should offer the patient a safe place — such as a safe or locked cabinet — to store their supplies or drugs when they return to the unit from the day pass.
Gear said patients leaving hospital and using drugs or alcohol on or off hospital grounds is not new.
Dix told the Times Colonist in an interview last week that smoking anything is not allowed in hospital, and illicit drug use is not allowed.
But BC United Mental Health and Addictions critic Elenore Sturko said telling nurses to offer drug-use supplies and ensure they are easily accessible is actively promoting drug use in hospitals.
In a statement, Island Health said while drug use is not allowed in hospitals, if a patient is going to break the rules, staff need guidance to manage the situation.
“Not having the conversations outlined in the resource document can create an unsafe situation for everyone involved and often leads to an increase in situations where patients may use substances in a way that violates policies designed to protect everyone’s safety.”
As for providing education on injecting illicit drugs into IV lines, Island Health said staff will not physically administer any medication or substance to a patient that is not prescribed, “and the resource document does not direct them to do so.”
But because patients will sometimes inject unregulated substances into their IVs, and given the significant risks associated with that practice, it’s important to educate patients on safety, Island Health said.
“Providers do not encourage patients to utilize IV lines for this purpose.”
