Patients leaving hospital against advice likelier to OD: study

A new study has found that patients in B.C. who left hospitals against medical advice were 60 per cent more likely to suffer an overdose within a month of leaving when risk factors were considered.

The study, published in the Canadian Medical Association Journal on Monday, was led by researchers at the University of B.C.

It examined nearly 190,000 hospital stays in the province between 2015 and 2019. Of those, 6,440 (3.4 per cent) resulted in a "before medically advised" (BMA) discharge. In other words, they left against their doctor's advice.

Among that cohort, the study found that when risk factors — like age, sex and being unhoused — were considered, they were 60 per cent likelier to suffer an overdose.

"It's often the patients who decide to initiate before medically advised discharge that I'm most worried about," said Dr. John Staples, a clinical associate professor at UBC and a physician at Vancouver General Hospital, who co-wrote the study.

"Because I know that their medical problem isn't going to be treated once they leave."

Staples said that the study shows the need for the health-care system to perform more interventions to make people feel safe in hospitals and prevent the risk of overdose.

"I think that the size of the effect is surprising and impressive," Staples said. "I think it's a real signal that, as a health-care system, we need to be doing a better job of reaching out to these vulnerable patients."

Staples pointed to interventions like safe drug consumption sites, as well as better treatment of pain and substance use disorder, as ways that could be helpful for the group of patients who want to leave against their doctor's advice.

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Nurse asks for humility, respect

Nikola Grujich, a staff psychiatrist at Sunnybrook Health Sciences Centre in Toronto, says the study reaffirms what a lot of health-care providers already knew, and it was good to see hard data on the subject.

Grujich says that opiate addiction, in particular, can be a very strong incentive for patients to leave, as they may be feeling withdrawals.

He suggests using opioid agonist therapy to stop patients from feeling those symptoms — something the study also recommends.

The psychiatrist added that doctors can't keep people in hospitals against their will.

He added that there needs to be more information-sharing arrangements between safe injection sites and hospitals, as BMA-discharged patients can often seek drugs very quickly.

"Theoretically, if someone had recently been in hospital and they show up at an injection site, I guess there's always the opportunity to connect with the hospital," he said. "But there isn't really a clear highway to facilitate that collaboration."

Keren Elumir, a nurse at Toronto's Moss Park Consumption and Treatment Service, says that the drug users she's worked with have often felt disrespected and discriminated against when they have to go to hospital — which could lead to them leaving early.

She recommends that hospitals hire Indigenous liaisons and culturally aware workers to make people feel safe when they access health care.

"I think that there's also some real learning that our health-care system needs to have, and maybe a bit of humility, that people have the right to autonomy," she said.

"Every human being deserves respect. It doesn't matter their age. It doesn't matter how much money they make or don't make. It doesn't matter what they look like, smell like. They each deserve respect, right?"