Addressing in-hospital substance use: A bioethical evaluation of two possible approaches

Up to 40% of patients with substance use disorder report using non-prescribed drugs when hospitalized. In-hospital substance (IHSU) use is associated with poor outcomes and raises safety concerns for healthcare providers. Despite its prevalence, little guidance exists regarding best practices in responding to IHSU. Here, we present a case-based, bioethical evaluation comparing two possible approaches to address IHSU: (1) a "containment-focused" approach that relies on involvement of security and uses restrictive interventions to prevent further drug use, and (2) a "patient-first" approach, which seeks to understand and address underlying reasons for IHSU and makes calling security a last resort.