{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:52:10Z","timestamp":1785772330449,"version":"3.56.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Hospital clinicians may request that security personnel search patients\u2019 rooms and belongings in response to suspected possession or use of illicit substances. Although searches are intended to protect patient and employee safety, little is known about search outcomes or consequences for clinical care.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the clinical context and outcomes of room searches among patients with substance-related hospital encounters.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Retrospective cohort study of security incident reports and electronic health record data for patients with substance-related hospital encounters between July 2021 and July 2023 at an urban, academic hospital with approximately 1000 beds in Philadelphia, Pennsylvania. Participants were adults with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic> codes consistent with substance use disorders, chief concerns of drug overdose or withdrawal, and\/or positive verbal screenings for opioid use who had emergency department visits or inpatient hospitalizations.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Primary outcomes were search requests, items confiscated, and patient-directed discharges (PDDs). Secondary measures centered on the clinical context of searches, including location and receipt of medications for opioid use disorder.<\/jats:p><\/jats:sec>Results<\/jats:title>There were 13\u202f827 total substance-related hospital encounters over the study period involving 6985 unique patients (median [IQR] age, 47 [34-58] years; 3863 [55.3%] male; 3688 [52.7%] Black; 302 [4.3%] Hispanic; 2597 [37.2%] White). Over this time, security reported 576 room search requests, among which 457 (79.3%) were requests for searches among patients with substance-related hospital encounters. Nurses requested most searches (376 searches [82.3%]), and 195 searches (43.6%) resulted in no items confiscated. Confiscated items included syringes and unspecified paraphernalia (129 searches [28.9%]), confirmed or suspected drugs and alcohol (102 searches [22.8%]), tobacco products (54 searches [12.1%]), and pipes and smoking materials (53 searches [11.9%]). Patients who had 1 or more search requests during a substance-related hospital encounter had a statistically significant odds ratio (OR) of having a PDD compared with patients who did not undergo searches (OR, 2.99; 95% CI, 2.32-3.86).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of patients with substance-related hospital encounters, most searches did not result in the confiscation of illicit substances, and searches were associated with PDDs. There is an overall need for clear, patient-centered hospital search protocols that support both staff and patient well-being.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.1068","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T15:00:36Z","timestamp":1742310036000},"page":"e251068","source":"Crossref","is-referenced-by-count":3,"title":["Hospital Security Searches Among Patients With Substance-Related Encounters"],"prefix":"10.1001","volume":"8","author":[{"given":"Sarah J.","family":"Nessen","sequence":"first","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Penn Center for Emergency Care and Policy Research, Penn Center for Addiction Medicine and Policy, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Thakrar","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanmarie","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Penn Center for Addiction Medicine and Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"McFadden","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Penn Center for Addiction Medicine and Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Lowenstein","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Penn Center for Addiction Medicine and Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"zoi250078r3","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.drugalcdep.2017.12.043","article-title":"Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service.","volume":"186","author":"Nordeck","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"zoi250078r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2022.100114","article-title":"Initiation of medication for opioid use disorder across a health system: a retrospective analysis of patient characteristics and inpatient outcomes.","volume":"5","author":"O\u2019Rourke","year":"2022","journal-title":"Drug Alcohol Depend Rep"},{"issue":"1-2","key":"zoi250078r6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.drugalcdep.2013.02.018","article-title":"Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review.","volume":"131","author":"van Boekel","year":"2013","journal-title":"Drug Alcohol Depend"},{"key":"zoi250078r7","doi-asserted-by":"publisher","DOI":"10.1177\/11782218221103859","article-title":"\u201cYou\u2019re not supposed to be on it forever\u201d: medications to treat opioid use disorder (MOUD) related stigma among drug treatment providers and people who use opioids.","author":"Dickson-Gomez","year":"2022","journal-title":"Subst Abuse"},{"key":"zoi250078r8","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1184951","article-title":"A conceptual framework for how structural changes in emerging acute substance use service models can reduce stigma of medications for opioid use disorder.","volume":"14","author":"Becker","year":"2023","journal-title":"Front Psychiatry"},{"issue":"11","key":"zoi250078r10","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1007\/s10995-020-03006-1","article-title":"Secrecy versus disclosure: women with substance use disorders share experiences in help seeking during pregnancy.","volume":"24","author":"Paris","year":"2020","journal-title":"Matern Child Health J"},{"issue":"6","key":"zoi250078r11","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1007\/s11469-018-9930-8","article-title":"Disclosure, stigma, and social support among young people receiving treatment for substance use disorders and their caregivers: a qualitative analysis.","volume":"17","author":"Earnshaw","year":"2019","journal-title":"Int J Ment Health Addict"},{"key":"zoi250078r12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.socscimed.2014.01.010","article-title":"Hospitals as a \u2018risk environment\u2019: an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs.","volume":"105","author":"McNeil","year":"2014","journal-title":"Soc Sci Med"},{"issue":"2","key":"zoi250078r13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1155\/2015\/868746","article-title":"Denial of pain medication by health care providers predicts in-hospital illicit drug use among individuals who use illicit drugs.","volume":"20","author":"Ti","year":"2015","journal-title":"Pain Res Manag"},{"issue":"3","key":"zoi250078r14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229713","article-title":"Illicit drug use while admitted to hospital: patient and health care provider perspectives.","volume":"15","author":"Strike","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"zoi250078r15","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1111\/dar.13246","article-title":"Non-medical prescription opioid use and in-hospital illicit drug use among people who use drugs.","volume":"40","author":"Parmar","year":"2021","journal-title":"Drug Alcohol Rev"},{"issue":"1","key":"zoi250078r16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/ADM.0000000000001046","article-title":"In-hospital substance use policies: an opportunity to advance equity, reduce stigma, and offer evidence-based addiction care.","volume":"17","author":"Martin","year":"2023","journal-title":"J Addict Med"},{"key":"zoi250078r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103324","article-title":"Hospital policy as a harm reduction intervention for people who use drugs.","volume":"97","author":"Lennox","year":"2021","journal-title":"Int J Drug Policy"},{"issue":"9","key":"zoi250078r19","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1002\/jhm.13162","article-title":"Response to substance use during hospitalization: a survey study of current and ideal policies and practices.","volume":"18","author":"Huxley-Reicher","journal-title":"J Hosp Med"},{"issue":"10","key":"zoi250078r20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224335","article-title":"\u201cYou\u2019re kind of at war with yourself as a nurse\u201d: perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder.","volume":"14","author":"Horner","year":"2019","journal-title":"PLoS One"},{"key":"zoi250078r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103206","article-title":"A qualitative assessment of discharge against medical advice among patients hospitalized for injection-related bacterial infections in West Virginia.","volume":"94","author":"Pollini","year":"2021","journal-title":"Int J Drug Policy"},{"issue":"4","key":"zoi250078r22","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1080\/08897077.2019.1671942","article-title":"Understanding why patients with substance use disorders leave the hospital against medical advice: a qualitative study.","volume":"41","author":"Simon","year":"2020","journal-title":"Subst Abus"},{"issue":"23","key":"zoi250078r23","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1001\/jama.2023.21288","article-title":"Trends in before medically advised discharges for patients with opioid use disorder, 2016-2020.","volume":"330","author":"Thakrar","year":"2023","journal-title":"JAMA"},{"issue":"1","key":"zoi250078r24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.amjmed.2021.08.007","article-title":"Patient-directed discharges among persons who use drugs hospitalized with invasive staphylococcus aureus infections: opportunities for improvement.","volume":"135","author":"Appa","year":"2022","journal-title":"Am J Med"},{"issue":"9","key":"zoi250078r25","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1007\/s11606-010-1371-4","article-title":"Leaving against medical advice (AMA): risk of 30-day mortality and hospital readmission.","volume":"25","author":"Glasgow","year":"2010","journal-title":"J Gen Intern Med"},{"issue":"6","key":"zoi250078r26","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.amjmed.2011.12.017","article-title":"Increased risk of mortality and readmission among patients discharged against medical advice.","volume":"125","author":"Southern","year":"2012","journal-title":"Am J Med"},{"issue":"9596","key":"zoi250078r27","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"zoi250078r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108537","article-title":"Using ICD-10-CM codes to detect illicit substance use: a comparison with retrospective self-report.","volume":"221","author":"Rowe","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"zoi250078r29","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.21.0297","article-title":"Redesign of opioid use disorder screening and treatment in the ED.","volume":"3","author":"Lowenstein","year":"2022","journal-title":"NEJM Catal Innov Care Deliv"},{"issue":"2","key":"zoi250078r31","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.annemergmed.2023.03.033","article-title":"Impact of universal screening and automated clinical decision support for the treatment of opioid use disorder in emergency departments: a difference-in-differences analysis.","volume":"82","author":"Lowenstein","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"1","key":"zoi250078r32","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jnma.2017.10.009","article-title":"Visiting Black patients: racial disparities in security standby requests.","volume":"110","author":"Green","year":"2018","journal-title":"J Natl Med Assoc"},{"issue":"1","key":"zoi250078r33","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s11606-022-07525-1","article-title":"Race and ethnicity and the utilization of security responses in a hospital setting.","volume":"38","author":"Valtis","year":"2023","journal-title":"J Gen Intern Med"},{"key":"zoi250078r34","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.drugalcdep.2019.01.037","article-title":"Strategies used by people who inject drugs to avoid stigma in healthcare settings.","volume":"198","author":"Biancarelli","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"zoi250078r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.07.027","article-title":"\u201cA spray bottle and a lollipop stick\u201d: an examination of policy prohibiting sterile injecting equipment in prison and effects on young men with injecting drug use histories.","volume":"80","author":"Walker","year":"2020","journal-title":"Int J Drug Policy"},{"issue":"4","key":"zoi250078r36","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.drugpo.2007.08.004","article-title":"Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver.","volume":"19","author":"Werb","year":"2008","journal-title":"Int J Drug Policy"},{"issue":"1","key":"zoi250078r37","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/ADM.0000000000000688","article-title":"Discharges \u201cagainst medical advice\u201d in patients with opioid-related hospitalizations.","volume":"15","author":"Santos","year":"2021","journal-title":"J Addict Med"},{"issue":"5","key":"zoi250078r38","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1097\/HRP.0000000000000259","article-title":"The opioid crisis and the inpatient floor: considering injection drug use in the management of infective endocarditis and acute pain.","volume":"28","author":"Mitchell","year":"2020","journal-title":"Harv Rev Psychiatry"},{"issue":"1","key":"zoi250078r39","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/S2155-8256(23)00047-9","article-title":"The 2022 national nursing workforce survey.","volume":"14","author":"Smiley","year":"2023","journal-title":"J Nurs Regul"},{"issue":"2","key":"zoi250078r40","doi-asserted-by":"publisher","first-page":"241","DOI":"10.5172\/conu.2011.37.2.241","article-title":"Interpersonal challenges as a constraint on care: the experience of nurses\u2019 care of patients who use illicit drugs.","volume":"37","author":"Ford","year":"2011","journal-title":"Contemp Nurse"},{"issue":"1","key":"zoi250078r41","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1080\/08897077.2020.1732512","article-title":"Improving medical students\u2019 attitude toward patients with substance use problems through addiction medicine education.","volume":"43","author":"Ayu","year":"2022","journal-title":"Subst Abus"},{"issue":"4","key":"zoi250078r42","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/ADM.0000000000000314","article-title":"Institutional substance use disorder intervention improves general internist preparedness, attitudes, and clinical practice.","volume":"11","author":"Wakeman","year":"2017","journal-title":"J Addict Med"},{"issue":"1","key":"zoi250078r43","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/08897077231169566","article-title":"The creation of an addiction nursing fellowship program for registered nurses: a unique approach to enhancing the addiction-treatment workforce.","volume":"44","author":"Fox","year":"2023","journal-title":"Subst Abus"},{"issue":"1","key":"zoi250078r44","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1177\/107845352202900102","article-title":"\u201cLooks can be deceiving\u201d: an innovative way to teach nursing students about substance use disorder.","volume":"29","author":"DeBrew","year":"2023","journal-title":"Creat Nurs"},{"issue":"1","key":"zoi250078r45","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.51734","article-title":"Prevalence of behavioral flags in the electronic health record among Black and White patients visiting the emergency department.","volume":"6","author":"Agarwal","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi250078r46","doi-asserted-by":"publisher","first-page":"62","DOI":"10.12788\/jhm.2861","article-title":"Expanding treatment opportunities for hospitalized patients with opioid use disorders.","volume":"13","author":"Winetsky","year":"2018","journal-title":"J Hosp Med"},{"issue":"1","key":"zoi250078r47","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jnma.2017.10.009","article-title":"Visiting Black patients: racial disparities in security standby requests.","volume":"110","author":"Green","year":"2018","journal-title":"J Natl Med Assoc"},{"issue":"1","key":"zoi250078r48","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s11606-022-07525-1","article-title":"Race and ethnicity and the utilization of security responses in a hospital setting.","volume":"38","author":"Valtis","year":"2023","journal-title":"J Gen Intern Med"},{"key":"zoi250078r49","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2024.111419","article-title":"Decrease in injection and rise in smoking and snorting of heroin and synthetic opioids, 2000-2021.","volume":"263","author":"Karandinos","year":"2024","journal-title":"Drug Alcohol Depend"},{"key":"zoi250078r50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108589","article-title":"The intersection of race and opioid use disorder treatment: a quantitative analysis.","volume":"131","author":"Entress","year":"2021","journal-title":"J Subst Abuse Treat"},{"key":"zoi250078r51","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2023.100298","article-title":"\u201cA lack of empathy:\u201d a qualitative study of Black people seeking treatment for opioid use disorder.","volume":"4","author":"Khatri","year":"2023","journal-title":"SSM Qual Res Health"},{"issue":"2","key":"zoi250078r52","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/MLR.0000000000000638","article-title":"Perceived discrimination in health care and mental health\/substance abuse treatment among Blacks, Latinos, and Whites.","volume":"55","author":"Mays","year":"2017","journal-title":"Med Care"},{"issue":"5","key":"zoi250078r53","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1080\/10826084.2019.1703750","article-title":"Opioid Addiction Stigma: The Intersection of Race, Social Class, and Gender.","volume":"55","author":"Wood","year":"2020","journal-title":"Subst Use Misuse"},{"issue":"6","key":"zoi250078r55","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.19651","article-title":"Comparison of substance use disorder diagnosis rates from electronic health record data with substance use disorder prevalence rates reported in surveys across sociodemographic groups in the Veterans Health Administration.","volume":"5","author":"Williams","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi250078r2","volume-title":"Treating Opioid Use Disorder in General Medical Settings","author":"Weinstein","year":"2021"},{"key":"zoi250078r4","volume-title":"Medications for Opioid Use Disorder Save Lives","author":"Mancher","year":"2019"},{"key":"zoi250078r9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/978-3-319-27580-2_7","volume-title":"Stigma and Prejudice: Touchstones in Understanding Diversity in Healthcare","author":"Brezing","year":"2016"},{"key":"zoi250078r1","unstructured":"U.S. Centers for Disease Control and Prevention, National Center for Health Statistics. Hospital encounters involving drug use by month from selected hospitals. September 3, 2024. Accessed September 10, 2024. https:\/\/www.cdc.gov\/nchs\/dhcs\/drug-use\/drug-use.htm"},{"key":"zoi250078r17","unstructured":"Burnette? AT. Searches of hospital patients, their rooms and belongings. Health Care Law Monthly. October 2012. Accessed August 16, 2023. https:\/\/www.alston.com\/-\/media\/files\/insights\/publications\/2012\/10\/searches-of-hospital-patients-their-rooms-and--bel\/files\/hcmonthlyoct2012burnette\/fileattachment\/hcmonthlyoct2012burnette.pdf"},{"key":"zoi250078r30","unstructured":"Owens? PL, Weiss? AJ, Barrett? ML. Table 2, ICD-10-CM diagnosis codes defining opioid-related inpatient stays. May 26, 2020. Accessed June 17, 2024. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK559382\/table\/sb258.tab4\/"},{"key":"zoi250078r54","unstructured":"Philadelphia Department of Public Health. Division of Substance Use Prevention and Harm Reduction 2021 annual report. 2021. Accessed February 5, 2025. https:\/\/www.phila.gov\/documents\/2020-annual-report-of-the-division-of-suphr\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2831665\/nessen_2025_oi_250078_1741708847.88984.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T15:00:42Z","timestamp":1742310042000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2831665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":55,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.1068","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,18]]}}}