ArticleSocial science & medicine (1982)2014
Hospitals as a 'risk environment': an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs.
Article in Social science & medicine (1982), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 173 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
173 citing papers in PubMed, 3 syntheses or guidelines pooled it, 313 citations in OpenAlex.
- Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2023Pooled it
- Pooled it
- Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review.American journal of public health · 2015Pooled it
- Addiction Consult Services, Mortality, and Acute Care Utilization in Inpatients With Opioid Use Disorder: A Secondary Analysis of a Cluster Randomized Clinical Trial.JAMA network open · 2025Trial
- Experiences of patients at high risk of opioid overdose accessing emergency department and behavioral health interventions: a qualitative analysis in an urban emergency department.BMC health services research · 2023Trial
- Characteristics associated with motivation to stop substance use and improve skin and needle hygiene among hospitalized patients who inject drugs.Substance abuse · 2022Trial
- Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs.Drug and alcohol dependence · 2020Trial
- Improving hospital substance use care from the ground up and from the outside in.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- Meeting people where they are, whenever they are here: the implementation of harm reduction programs in two U.S. emergency departments.International journal of emergency medicine · 2026Article
- An application of hospital at home for precariously housed people who use drugs in a community-based harm reduction setting in Vancouver, Canada.Addiction science & clinical practice · 2026Article
- Implementation and sustainability of hospital-based harm reduction delivery: a qualitative analysis.Harm reduction journal · 2026Article
- Short-Acting Opioid Dose and Patient-Directed Discharge in Hospitalized Patients With Opioid Use Disorder.JAMA network open · 2026Article
- Examining nurses' attitudes toward patients who use substances in the hospital setting: A scoping review.International journal of nursing studies advances · 2026Review
- Patient-Directed Discharge Among Hospitalized Persons With Opioid Use Disorder in the Fentanyl Era: A Scoping Review.American journal of medicine open · 2026Review
- "They Never, Never, Never Give Up on Me": Perspectives on an Addiction Consult Service From Hospitalized People Who Use Opioids at 6 New York City Public Hospitals.Substance use & addiction journal · 2026Article
- "He said he could take his own advice": Stigmatizing language in notes documenting discharges against medical advice.Journal of hospital medicine · 2026Article
- Integrated infectious disease and substance use disorder treatment for severe injection-related infections: protocol for the randomized controlled HI-SIRI trial.Addiction science & clinical practice · 2026Article
- Long-acting glycopeptides: what are the barriers to access in patients who need them most, and how can they be overcome?The Journal of antimicrobial chemotherapy · 2026Article
- The Role of Psychosocial Stressors in Shaping the Attitudes of Nurses in a Canadian Acute Care Hospital Toward Patients Who Use Substances: A Cross-Sectional Study.Journal of nursing management · 2026Article
- Leaving against medical assumptions: reframing "AMA" discharges in the care of people who use drugs.CJEM · 2026Article
113 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the 'risk environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm reduction supports, including supervised drug consumption services.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.