The substance abuser and home intravenous therapy: above all else, do no harm

Home care therapy is being challenged by changes in patient populations and technologic advances. The selection of appropriate candidates for home intravenous therapy is a critical issue faced by health care professionals. This process is more complex when the patient has a history of intravenous drug abuse. The issues concern patient compliance, safety, ethics, and legal responsibilities. Safe care depends on the ability of the patient to demonstrate a predetermined level of competence with catheter use. The potential use of illicit drugs may influence the ability of the patient to be compliant. Ethical principles of the patient's autonomy and free choice are weighed against the health professional's sense of beneficence. Legal guidelines stress informed consent, standards of care, and adequate documentation. An exploration of each of these factors outlines the potential risks and benefits and provides a basis for making clinical judgments.