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4. “Who Else has that Opportunity but us?”: Acute Hospitalization as an Opportunity to Engage Young People who Inject Drugs into Treatment

      Purpose

      Hospitalized young people who inject drugs (YPWID) suffer from high hospital readmission rates, recurrent infections, and repeat surgical interventions, all of which contribute to high mortality and long-term disability. As hospitalization presents an opportunity to engage YPWID into treatment, there is an urgent need to identify strategies to engage and retain this vulnerable population into treatment. Our study examines barriers and facilitators to OUD treatment engagement among hospitalized YPWID.

      Methods

      We recruited 26 participants representing key stakeholder groups (hospitalized YPWID ages 18-30 years [n=6], hospital social workers [n=7], and nurses and other clinicians [n=13]). Participants were identified using purposive sampling. They completed 20-75 minute semi-structured interviews asking about barriers and facilitators for engaging YPWID into treatment. The interview guide was informed by the Capacity-Opportunity-Motivation and Behavior (COM-B) framework. Interviews were audio-recorded and transcribed verbatim. Interviews were analyzed iteratively using rapid analytic methods. Transcribed interviews were placed in a summary matrix based on interview guides used to identify broad domains at the patient, provider and health system level informed by our theoretical framework. We then identified themes, sub-themes and concepts related to each domain, including exemplar quotes.

      Results

      Emergent themes define hospitalization as a critical window to engage YPWID into treatment. Hospitalization influences treatment-seeking behaviors across the COM-B domains of capability, motivation, and opportunity. Hospitalization was viewed as potentially positive as YPWID had greater intrinsic motivation because of their acute illness and providers were able to leverage family and community supports to engage YPWID into treatment. Hospitalization was also viewed as a potentially retraumatizing experience as YPWID experienced significant health anxiety, chafed at restrictive hospital policies, and were vulnerable to provider stigma. Preliminary analyses show possible intervention points at the patient, provider, health system, and community level. While current practice focuses on medications to treat opioid use, a recurrent theme suggests YPWID would benefit from more holistic approaches to treatment engagement: more intensive behavioral health engagement, improved identification and interventions for trauma, and improved linkage to social and community supports that promote recovery and abstinence. Multiple themes highlighted the importance of using patient-centered and trauma-informed communication to build on trust, respect patient autonomy, to let patients feel cared for, and to build on the assets and skills YPWID possess to support their own motivation and treatment-seeking desires. Because social-connectedness remains highly valued at this developmental stage, stakeholders found value in linking YPWID to those with lived experience and pro-recovery community supports spanning hospital to discharge home. For the many YPWID experiencing violent or coercive relationships, hospitalization was viewed as an opportunity to link to community resources and hospital-based interventions interrupting trauma.

      Conclusions

      Hospitalization represents both a window to engage YPWID into treatment, and also a source of stress and possible retraumatization. Our findings suggest key intervention points at the patient, provider, and health system level focused on strengthening interpersonal relationships, linking to community supports, and offering behavioral health treatment in addition to medication are necessary to reduce morbidity and mortality among this vulnerable population.

      Sources of Support

      NIDA: K23DA04898.