{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:22:09Z","timestamp":1788175329003,"version":"build-2803163510"},"reference-count":77,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Social Sciences and Humanities Research Council of Canada (SSHRC) Doctoral Fellowships"},{"name":"University of British Columbia (UBC) Helen Shore Nursing Endowment Fund"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Harm Reduct J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200999) and one-on-one semi-structured interviews (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Study findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12954-024-01088-6","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T14:05:36Z","timestamp":1726754736000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Opioid-specific harm reduction in the emergency department: how staff provide harm reduction and contextual factors that impact their capacity to engage in harm reduction practice"],"prefix":"10.1186","volume":"21","author":[{"given":"Sunny","family":"Jiao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Bungay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilou","family":"Gagnon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"1088_CR1","unstructured":"CATIE, Unit. 2: Harm reduction principles and practices. What is harm reduction? [Internet]. Toronto (CA): CATIE; 2022 [cited 2024 Feb 12]. https:\/\/elearning.catie.ca\/HRTOOLKIT\/unit2\/content\/#\/lessons\/sGlrFs517B6OlQ2pnE4gl0NgZHHOewvC"},{"key":"1088_CR2","unstructured":"Harm Reduction International. What is harm reduction? [Internet]. London (UK): Harm Reduction International; 2022 [cited 2024 Feb 12]. https:\/\/hri.global\/what-is-harm-reduction\/"},{"key":"1088_CR3","doi-asserted-by":"publisher","unstructured":"Amato L, Davoli M, Minozzi S, Ferroni E, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database of Systematic Reviews [Internet]. 2013 [cited 2024 Feb 12]; Issue 2. Art. No.: CD003409. Available from: https:\/\/doi.org\/10.1002\/14651858.CD003409.pub4","DOI":"10.1002\/14651858.CD003409.pub4"},{"issue":"4","key":"1088_CR4","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1111\/1742-6723.13925","volume":"34","author":"E Black","year":"2022","unstructured":"Black E, Monds LA, Chan B, Brett J, Hutton JE, Acheson L, et al. Overdose and take-home naloxone in emergency settings: a pilot study examining feasibility of delivering brief interventions addressing overdose prevention with \u2018take-home naloxone\u2019 in emergency departments. Emerg Med Australas. 2022;34(4):509\u201318. https:\/\/doi.org\/10.1111\/1742-6723.13925.","journal-title":"Emerg Med Australas"},{"key":"1088_CR5","doi-asserted-by":"publisher","unstructured":"Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database of Systematic Reviews [Internet]. 2011 [cited 2024 Feb 12]; Issue 8. Art. No.: CD003410. Available from: https:\/\/doi.org\/10.1002\/14651858.CD003410.pub3","DOI":"10.1002\/14651858.CD003410.pub3"},{"key":"1088_CR6","doi-asserted-by":"publisher","unstructured":"Ferri M, Minozzi S, Bo A, Amato L. Slow-release oral morphine as maintenance therapy for opioid dependence. Cochrane Database of Systematic Reviews [Internet]. 2013 [cited 2024 Feb 12]; Issue 6. Art. No.: CD009879. Available from: https:\/\/doi.org\/10.1002\/14651858.CD009879.pub2","DOI":"10.1002\/14651858.CD009879.pub2"},{"key":"1088_CR7","doi-asserted-by":"publisher","first-page":"108202","DOI":"10.1016\/j.drugalcdep.2020.108202","volume":"216","author":"A Ivsins","year":"2020","unstructured":"Ivsins A, Boyd J, Mayer S, Collins A, Sutherland C, Kerr T, et al. Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study. Drug Alcohol Depend. 2020;216:108202. https:\/\/doi.org\/10.1016\/j.drugalcdep.2020.108202.","journal-title":"Drug Alcohol Depend"},{"key":"1088_CR8","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12954-018-0252-8","volume":"15","author":"M Karamouzian","year":"2018","unstructured":"Karamouzian M, Dohoo C, Forsting S, McNeil R, Kerr T, Lysyshyn M. Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada. Harm Reduct J. 2018;15:46. https:\/\/doi.org\/10.1186\/s12954-018-0252-8.","journal-title":"Harm Reduct J"},{"key":"1088_CR9","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12954-017-0154-1","volume":"14","author":"T Kerr","year":"2017","unstructured":"Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm Reduct J. 2017;14:28. https:\/\/doi.org\/10.1186\/s12954-017-0154-1.","journal-title":"Harm Reduct J"},{"key":"1088_CR10","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12954-018-0212-3","volume":"15","author":"C Strike","year":"2018","unstructured":"Strike C, Miskovic M. Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm Reduct J. 2018;15:6. https:\/\/doi.org\/10.1186\/s12954-018-0212-3.","journal-title":"Harm Reduct J"},{"key":"1088_CR11","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1186\/s12889-017-4210-2","volume":"17","author":"RM Fernandes","year":"2017","unstructured":"Fernandes RM, Cary M, Duarte G, Jesus G, Alarc\u00e3o J, Torre C, et al. Effectiveness of needle and syringe programmes in people who inject drugs \u2013 an overview of systematic reviews. BMC Public Health. 2017;17:309. https:\/\/doi.org\/10.1186\/s12889-017-4210-2.","journal-title":"BMC Public Health"},{"key":"1088_CR12","unstructured":"Lightfoot B, Panessa C, Hayden S, Thumath M, Goldstone I, Pauly B. (2009). Gaining Insite: harm reduction in nursing practice. Can Nurse. 2009:105(4):19\u201322."},{"issue":"9775","key":"1088_CR13","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/S0140-6736(10)62353-7","volume":"377","author":"BD Marshall","year":"2011","unstructured":"Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America\u2019s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429\u201337. https:\/\/doi.org\/10.1016\/S0140-6736(10)62353-7.","journal-title":"Lancet"},{"issue":"7","key":"1088_CR14","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1111\/add.13326","volume":"111","author":"R McDonald","year":"2016","unstructured":"McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177\u201387. https:\/\/doi.org\/10.1111\/add.13326.","journal-title":"Addiction"},{"issue":"1","key":"1088_CR15","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1017\/S0950268814000284","volume":"143","author":"VD Hope","year":"2015","unstructured":"Hope VD, Ncube F, Parry JV, Hickman M. Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England. Epidemiol Infect. 2015;143(1):120\u201331. https:\/\/doi.org\/10.1017\/S0950268814000284.","journal-title":"Epidemiol Infect"},{"issue":"1","key":"1088_CR16","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1093\/pubmed\/fdh189","volume":"27","author":"T Kerr","year":"2005","unstructured":"Kerr T, Wood E, Grafstein E, Ishida T, Shannon K, Lai C, et al. High rates of primary care and emergency department use among injection drug users in Vancouver. J Public Health. 2005;27(1):62\u20136. https:\/\/doi.org\/10.1093\/pubmed\/fdh189.","journal-title":"J Public Health"},{"issue":"6","key":"1088_CR17","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/add.14892","volume":"115","author":"D Lewer","year":"2020","unstructured":"Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, et al. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction. 2020;115(6):1011\u201323. https:\/\/doi.org\/10.1111\/add.14892.","journal-title":"Addiction"},{"key":"1088_CR18","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1747-597X-2-31","volume":"2","author":"J Neale","year":"2007","unstructured":"Neale J, Sheard L, Tompkins CN. Factors that help injecting drug users to access and benefit from services: a qualitative study. Subst Abuse Treat Prev Policy. 2007;2:31. https:\/\/doi.org\/10.1186\/1747-597X-2-31.","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"1088_CR19","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.drugalcdep.2018.06.010","volume":"190","author":"PJ Summers","year":"2018","unstructured":"Summers PJ, Hellman JL, MacLean MR, Rees VW, Wilkes MS. Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis. Drug Alcohol Depend. 2018;190:200\u20138. https:\/\/doi.org\/10.1016\/j.drugalcdep.2018.06.010.","journal-title":"Drug Alcohol Depend"},{"key":"1088_CR20","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12954-017-0143-4","volume":"14","author":"CE Kendall","year":"2017","unstructured":"Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J. 2017;14:16. https:\/\/doi.org\/10.1186\/s12954-017-0143-4.","journal-title":"Harm Reduct J"},{"issue":"1","key":"1088_CR21","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.annemergmed.2019.04.020","volume":"75","author":"SG Weiner","year":"2020","unstructured":"Weiner SG, Baker O, Bernson D, Schuur JD. One-year mortality of patients after emergency department treatment for nonfatal opioid overdose. Ann Emerg Med. 2020;75(1):13\u20137. https:\/\/doi.org\/10.1016\/j.annemergmed.2019.04.020.","journal-title":"Ann Emerg Med"},{"issue":"5","key":"1088_CR22","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1111\/acem.14197","volume":"28","author":"K Hawk","year":"2021","unstructured":"Hawk K, Grau LE, Fiellin DA, Chawarski M, O\u2019Connor PG, Cirillo N, et al. A qualitative study of emergency department patients who survived an opioid overdose: perspectives on treatment and unmet needs. Acad Emerg Med. 2021;28(5):542\u201352. https:\/\/doi.org\/10.1111\/acem.14197.","journal-title":"Acad Emerg Med"},{"issue":"1","key":"1088_CR23","doi-asserted-by":"publisher","first-page":"E242","DOI":"10.9778\/cmajo.20200169","volume":"9","author":"J Moe","year":"2021","unstructured":"Moe J, Chong M, Zhao B, Scheuermeyer FX, Purssell R, Slaunwhite A. Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis. CMAJ Open. 2021;9(1):E242\u201351. https:\/\/doi.org\/10.9778\/cmajo.20200169.","journal-title":"CMAJ Open"},{"key":"1088_CR24","doi-asserted-by":"publisher","first-page":"261","DOI":"10.2147\/OAEM.S267416","volume":"12","author":"SS Cao","year":"2020","unstructured":"Cao SS, Dunham SI, Simpson SA. Prescribing buprenorphine for opioid use disorders in the ED: a review of best practices, barriers, and future directions. Open Access Emerg Med. 2020;12:261\u201374. https:\/\/doi.org\/10.2147\/OAEM.S267416.","journal-title":"Open Access Emerg Med"},{"issue":"3","key":"1088_CR25","doi-asserted-by":"publisher","first-page":"381","DOI":"10.5811\/westjem.2015.2.24909","volume":"16","author":"K Dwyer","year":"2015","unstructured":"Dwyer K, Walley AY, Langlois BK, Mitchell PM, Nelson KP, Cromwell J, et al. Opioid education and nasal naloxone rescue kits in the emergency department. West J Emerg Med. 2015;16(3):381\u20134. https:\/\/doi.org\/10.5811\/westjem.2015.2.24909.","journal-title":"West J Emerg Med"},{"issue":"6","key":"1088_CR26","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.5811\/westjem.2018.8.38829","volume":"19","author":"AH Gunn","year":"2018","unstructured":"Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ. The emergency department as an opportunity for naloxone distribution. West J Emerg Med. 2018;19(6):1036\u201342. https:\/\/doi.org\/10.5811\/westjem.2018.8.38829.","journal-title":"West J Emerg Med"},{"issue":"2","key":"1088_CR27","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/dar.12894","volume":"38","author":"TJ Holland","year":"2019","unstructured":"Holland TJ, Penm J, Dinh M, Aran S, Chaar B. Emergency department physicians\u2019 and pharmacists\u2019 perspectives on take-home naloxone. Drug Alcohol Rev. 2019;38(2):169\u201376. https:\/\/doi.org\/10.1111\/dar.12894.","journal-title":"Drug Alcohol Rev"},{"issue":"2","key":"1088_CR28","doi-asserted-by":"publisher","first-page":"261","DOI":"10.5811\/westjem.2019.11.44382","volume":"21","author":"DD Im","year":"2020","unstructured":"Im DD, Chary A, Condella AL, Vongsachang H, Carlson LC, Vogel L, et al. Emergency department clinicians\u2019 attitudes toward opioid use disorder and emergency department-initiated buprenorphine treatment: a mixed-methods study. West J Emerg Med. 2020;21(2):261\u201371. https:\/\/doi.org\/10.5811\/westjem.2019.11.44382.","journal-title":"West J Emerg Med"},{"issue":"2","key":"1088_CR29","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1017\/cem.2018.368","volume":"21","author":"A Kestler","year":"2019","unstructured":"Kestler A, Giesler A, Buxton J, Meckling G, Lee M, Hunte G, et al. Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone. CJEM. 2019;21(2):226\u201334. https:\/\/doi.org\/10.1017\/cem.2018.368.","journal-title":"CJEM"},{"issue":"4","key":"1088_CR30","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1017\/cem.2019.368","volume":"21","author":"A Kestler","year":"2019","unstructured":"Kestler A, Wale J, Allan M. The time for emergency department opioid agonist therapy is now: a BC perspective. CJEM. 2019;21(4):443\u20135. https:\/\/doi.org\/10.1017\/cem.2019.368.","journal-title":"CJEM"},{"issue":"1","key":"1088_CR31","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1017\/cem.2017.390","volume":"20","author":"L Lacroix","year":"2018","unstructured":"Lacroix L, Thurgur L, Orkin AM, Perry JJ, Stiell IG. Emergency physicians\u2019 attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments. CJEM. 2018;20(1):46\u201352. https:\/\/doi.org\/10.1017\/cem.2017.390.","journal-title":"CJEM"},{"key":"1088_CR32","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12873-021-00443-1","volume":"21","author":"D Wiercigroch","year":"2021","unstructured":"Wiercigroch D, Hoyeck P, Sheikh H, Hulme J. A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department. BMC Emerg Med. 2021;21:48. https:\/\/doi.org\/10.1186\/s12873-021-00443-1.","journal-title":"BMC Emerg Med"},{"issue":"4","key":"1088_CR33","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/s1553-7250(10)36024-7","volume":"36","author":"SW Dekker","year":"2010","unstructured":"Dekker SW. We have Newton on a retainer: reductionism when we need systems thinking. Jt Comm J Qual Patient Saf. 2010;36(4):147\u20139. https:\/\/doi.org\/10.1016\/s1553-7250(10)36024-7.","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"3","key":"1088_CR34","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1111\/jep.12862","volume":"24","author":"MA Widmer","year":"2018","unstructured":"Widmer MA, Swanson RC, Zink BJ, Pines JM. Complex systems thinking in emergency medicine: a novel paradigm for a rapidly changing and interconnected health care landscape. J Eval Clin Pract. 2018;24(3):629\u201334. https:\/\/doi.org\/10.1111\/jep.12862.","journal-title":"J Eval Clin Pract"},{"key":"1088_CR35","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12954-023-00871-1","volume":"20","author":"S Jiao","year":"2023","unstructured":"Jiao S, Bungay V, Jenkins E, Gagnon M. How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective. Harm Reduct J. 2023;20:139. https:\/\/doi.org\/10.1186\/s12954-023-00871-1.","journal-title":"Harm Reduct J"},{"key":"1088_CR36","unstructured":"Canadian Nurses Association, Canadian Association of Nurses in HIV\/AIDS Care, Harm Reduction Nurses Association. Joint position statement: harm reduction and substance use [Internet]. Ottawa: Canadian Nurses Association; 2018 [cited 2024 Feb 12]. https:\/\/hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com\/CNA\/2f975e7e-4a40-45ca-863c-5ebf0a138d5e\/UploadedImages\/documents\/Joint_Position_Statement_Harm_Reduction_and_Substance_Use.pdf"},{"key":"1088_CR37","unstructured":"British Columbia Nurses\u2019 Union. Position statement: harm reduction [Internet]. Burnaby: British Columbia Nurses\u2019 Union; 2011 [cited 2024 Feb 12]. https:\/\/www.bcnu.org\/AboutBcnu\/Documents\/position-statement-harm-reduction.pdf"},{"key":"1088_CR38","unstructured":"Doctors of British Columbia. Illicit drugs toxicity \/ overdose crisis [Internet]. Vancouver: Doctors of British Columbia; 2021 [cited 2024 Feb 12]. https:\/\/www.doctorsofbc.ca\/file\/30207\/download?token=H94KWgaS"},{"issue":"1","key":"1088_CR39","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.ajem.2018.10.013","volume":"37","author":"DH Cisewski","year":"2019","unstructured":"Cisewski DH, Santos C, Koyfman A, Long B. Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting. Am J Emerg Med. 2019;37(1):143\u201350. https:\/\/doi.org\/10.1016\/j.ajem.2018.10.013.","journal-title":"Am J Emerg Med"},{"key":"1088_CR40","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1186\/s13104-016-2268-z","volume":"9","author":"ML Drainoni","year":"2016","unstructured":"Drainoni ML, Koppelman EA, Feldman JA, Walley AY, Mitchell PM, Ellison J, et al. Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment. BMC Res Notes. 2016;9:465. https:\/\/doi.org\/10.1186\/s13104-016-2268-z.","journal-title":"BMC Res Notes"},{"issue":"3","key":"1088_CR41","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s10488-004-0841-6","volume":"32","author":"CA Allred","year":"2005","unstructured":"Allred CA, Burns BJ, Phillips SD. The assertive community treatment team as a complex dynamic system of care. Adm Policy Ment Health. 2005;32(3):211\u201320. https:\/\/doi.org\/10.1007\/s10488-004-0841-6.","journal-title":"Adm Policy Ment Health"},{"issue":"1","key":"1088_CR42","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1111\/jep.12794","volume":"24","author":"BA de Bock","year":"2018","unstructured":"de Bock BA, Willems DL, Weinstein HC. Complexity perspectives on clinical decision making in an intensive care unit. J Eval Clin Pract. 2018;24(1):308\u201313. https:\/\/doi.org\/10.1111\/jep.12794.","journal-title":"J Eval Clin Pract"},{"issue":"1","key":"1088_CR43","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1177\/0840470415614842","volume":"29","author":"C Kuziemsky","year":"2016","unstructured":"Kuziemsky C. Decision-making in healthcare as a complex adaptive system. Healthc Manage Forum. 2016;29(1):4\u20137. doi: s10.1177\/0840470415614842.","journal-title":"Healthc Manage Forum"},{"issue":"11","key":"1088_CR44","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1016\/j.socscimed.2010.08.013","volume":"71","author":"P Nugus","year":"2010","unstructured":"Nugus P, Carroll K, Hewett DG, Short A, Forero R, Braithwaite J. Integrated care in the emergency department: a complex adaptive systems perspective. Soc Sci Med. 2010;71(11):1997\u20132004. https:\/\/doi.org\/10.1016\/j.socscimed.2010.08.013.","journal-title":"Soc Sci Med"},{"key":"1088_CR45","doi-asserted-by":"publisher","unstructured":"McDaniel RR, Driebe DJ. Complexity science and health care management. Advances in health care management. Emerald Group Publishing Limited; 2001. pp. 11\u201336. https:\/\/doi.org\/10.1016\/S1474-8231(01)02021-3.","DOI":"10.1016\/S1474-8231(01)02021-3"},{"issue":"Suppl 4","key":"1088_CR46","doi-asserted-by":"publisher","first-page":"iv54","DOI":"10.1093\/heapol\/czs090","volume":"27","author":"RC Swanson","year":"2012","unstructured":"Swanson RC, Cattaneo A, Bradley E, Chunharas S, Atun R, Abbas KM, et al. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan. 2012;27(Suppl 4):iv54\u201361. https:\/\/doi.org\/10.1093\/heapol\/czs090.","journal-title":"Health Policy Plan"},{"key":"1088_CR47","unstructured":"Providence Health Care. Our populations of emphasis [Internet]. Vancouver: Providence Health Care; 2019 [cited 2024 Feb 12]. https:\/\/www.providencehealthcare.org\/about-providence\/who-we-serve\/our-populations-emphasis"},{"key":"1088_CR48","unstructured":"Providence Health Care. About St. Paul\u2019s Hospital [Internet]. Vancouver: Providence Health Care; 2016 [cited 2024 Feb 12]. https:\/\/thenewstpauls.ca\/app\/uploads\/2016\/06\/FS-About-St.-Pauls-21-June-2016.pdf"},{"key":"1088_CR49","unstructured":"Watson H, Maclaren W, Shaw F, Nolan A. Measuring staff attitudes to people with drug problems: The development of a tool [Internet]. Glasgow (SCT): Scottish Executive Drug Misuse Research Programme; 2003 [cited 2024 Feb 12]. https:\/\/www.gov.scot\/Publications\/2003\/08\/17735\/23454."},{"issue":"6","key":"1088_CR50","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/NNE.0000000000000793","volume":"45","author":"KT Williams","year":"2020","unstructured":"Williams KT, Baron KA, Gee JP, Chan J. Educating students about opioid use disorder and treatments in the community using an educational video. Nurse Educ. 2020;45(6):326\u201330. https:\/\/doi.org\/10.1097\/NNE.0000000000000793.","journal-title":"Nurse Educ"},{"issue":"4","key":"1088_CR51","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/JAN.0000000000000247","volume":"29","author":"P Kelly","year":"2018","unstructured":"Kelly P, Gotham HJ, Knopf-Amelung S, Kohnle K, Kuofie A. Distance versus on-site educational strategies for competency-based screening, brief intervention, and referral to treatment education. J Addict Nurs. 2018;29(4):E1\u20138. https:\/\/doi.org\/10.1097\/JAN.0000000000000247.","journal-title":"J Addict Nurs"},{"issue":"3","key":"1088_CR52","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/NNE.0000000000000439s","volume":"43","author":"S Knopf-Amelung","year":"2018","unstructured":"Knopf-Amelung S, Gotham H, Kuofie A, Young P, Manney Stinson R, Lynn J, et al. Comparison of instructional methods for screening, brief intervention, and referral to treatment for substance use in nursing education. Nurse Educ. 2018;43(3):123\u20137. https:\/\/doi.org\/10.1097\/NNE.0000000000000439s.","journal-title":"Nurse Educ"},{"issue":"2","key":"1088_CR53","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa.","journal-title":"Qual Res Psychol"},{"issue":"4","key":"1088_CR54","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","volume":"11","author":"V Braun","year":"2019","unstructured":"Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589\u201397. https:\/\/doi.org\/10.1080\/2159676X.2019.1628806.","journal-title":"Qual Res Sport Exerc Health"},{"issue":"2","key":"1088_CR55","doi-asserted-by":"publisher","first-page":"e12286","DOI":"10.1111\/nin.12286","volume":"26","author":"S Jiao","year":"2019","unstructured":"Jiao S. Harm reduction: philosophical drivers of conceptual tensions and ways forward. Nurs Inq. 2019;26(2):e12286. https:\/\/doi.org\/10.1111\/nin.12286.","journal-title":"Nurs Inq"},{"key":"1088_CR56","first-page":"1","volume-title":"SAGE handbook of mixed methods in social and behavioural research","author":"AJ Onwuegbuzie","year":"2015","unstructured":"Onwuegbuzie AJ, Combs JP. Emergent data analysis techniques in mixed methods research: a synthesis. In: Tashakkori A, Teddlie C, editors. SAGE handbook of mixed methods in social and behavioural research. 2nd ed. Thousand Oaks: SAGE Publications, Inc; 2015. pp. 1\u201351.","edition":"2"},{"issue":"1","key":"1088_CR57","first-page":"67","volume":"4","author":"KMT Collins","year":"2006","unstructured":"Collins KMT, Onwuegbuzie AJ, Sutton IL. A model incorporating the rationale and purpose for conducting mixed-methods research in special education and beyond. Learn Disabil Contemp J. 2006;4(1):67\u2013100.","journal-title":"Learn Disabil Contemp J"},{"key":"1088_CR58","unstructured":"Providence Health Care. Harm reduction and managing substance use \u2013 Acute care [Internet]. Vancouver: Providence Health Care. 2021 [cited 2024 Feb 12]. http:\/\/shop.healthcarebc.ca\/phc\/PHCDSTs\/B-00-07-10096.pdf"},{"issue":"5","key":"1088_CR59","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1097\/ADM.0000000000000507","volume":"13","author":"P Hemmons","year":"2019","unstructured":"Hemmons P, Bach P, Colizza K, Nolan S. Initiation and rapid titration of methadone in an acute care setting for the treatment of opioid use disorder: a case report. J Addict Med. 2019;13(5):408\u201311. https:\/\/doi.org\/10.1097\/ADM.0000000000000507.","journal-title":"J Addict Med"},{"key":"1088_CR60","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12954-022-00622-8","volume":"19","author":"GK Khan","year":"2022","unstructured":"Khan GK, Harvey L, Johnson S, Long P, Kimmel S, Pierre C, et al. Integration of a community-based harm reduction program into a safety net hospital: a qualitative study. Harm Reduct J. 2022;19:35. https:\/\/doi.org\/10.1186\/s12954-022-00622-8.","journal-title":"Harm Reduct J"},{"issue":"11","key":"1088_CR61","doi-asserted-by":"publisher","first-page":"2786","DOI":"10.1007\/s11606-021-07305-3","volume":"37","author":"SL Calcaterra","year":"2022","unstructured":"Calcaterra SL, Lockhart S, Callister C, Hoover K, Binswanger IA. Opioid use disorder treatment initiation and continuation: a qualitative study of patients who received addiction consultation and hospital-based providers. J Gen Intern Med. 2022;37(11):2786\u201394. https:\/\/doi.org\/10.1007\/s11606-021-07305-3.","journal-title":"J Gen Intern Med"},{"key":"1088_CR62","doi-asserted-by":"publisher","first-page":"108411","DOI":"10.1016\/j.jsat.2021.108411","volume":"130","author":"AB Collins","year":"2021","unstructured":"Collins AB, Beaudoin FL, Samuels EA, Wightman R, Baird J. Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: a qualitative evaluation. J Subst Abuse Treat. 2021;130:108411. https:\/\/doi.org\/10.1016\/j.jsat.2021.108411.","journal-title":"J Subst Abuse Treat"},{"key":"1088_CR63","unstructured":"The Health Foundation. Evidence scan: complex adaptive systems [Internet]. London: The Health Foundation. 2010 [cited 2024 Feb 12]. https:\/\/www.health.org.uk\/sites\/default\/files\/ComplexAdaptiveSystems.pdf"},{"issue":"9","key":"1088_CR64","doi-asserted-by":"publisher","first-page":"510","DOI":"10.3928\/01484834-20200817-06","volume":"59","author":"M Gagnon","year":"2020","unstructured":"Gagnon M, Payne A, Denis-Lalonde D, Wilbur K, Pauly B. Substance use education in Canadian nursing programs: a student survey. J Nurs Educ. 2020;59(9):510\u20133. https:\/\/doi.org\/10.3928\/01484834-20200817-06.","journal-title":"J Nurs Educ"},{"issue":"5","key":"1088_CR65","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1097\/00001888-200105000-00007","volume":"76","author":"NS Miller","year":"2001","unstructured":"Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Acad Med. 2001;76(5):410\u20138. https:\/\/doi.org\/10.1097\/00001888-200105000-00007.","journal-title":"Acad Med"},{"issue":"1","key":"1088_CR66","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/ACM.0b013e3181ff92cf","volume":"86","author":"D Kothari","year":"2011","unstructured":"Kothari D, Gourevitch MN, Lee JD, Grossman E, Truncali A, Ark TK, et al. Undergraduate medical education in substance abuse: a review of the quality of the literature. Acad Med. 2011;86(1):98\u2013112. https:\/\/doi.org\/10.1097\/ACM.0b013e3181ff92cf.","journal-title":"Acad Med"},{"issue":"2","key":"1088_CR67","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.psc.2012.04.001","volume":"35","author":"E Rasyidi","year":"2012","unstructured":"Rasyidi E, Wilkins JN, Danovitch I. Training the next generation of providers in addiction medicine. Psychiatr Clin North Am. 2012;35(2):461\u201380. https:\/\/doi.org\/10.1016\/j.psc.2012.04.001.","journal-title":"Psychiatr Clin North Am"},{"key":"1088_CR68","doi-asserted-by":"publisher","first-page":"1466574","DOI":"10.1080\/10872981.2018.1466574","volume":"23s","author":"MC Ratycz","year":"2018","unstructured":"Ratycz MC, Papadimos TJ, Vanderbilt AA. Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. Med Educ Online. 2018;23s:1466574. https:\/\/doi.org\/10.1080\/10872981.2018.1466574.","journal-title":"Med Educ Online"},{"issue":"8","key":"1088_CR69","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1007\/s11606-017-4077-z","volume":"32","author":"SE Wakeman","year":"2017","unstructured":"Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. J Gen Intern Med. 2017;32(8):909\u201316. https:\/\/doi.org\/10.1007\/s11606-017-4077-z.","journal-title":"J Gen Intern Med"},{"issue":"3","key":"1088_CR70","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1007\/s40596-015-0314-0","volume":"40","author":"A Ram","year":"2016","unstructured":"Ram A, Chisolm MS. The time is now: improving substance abuse training in medical schools. Acad Psychiatry. 2016;40(3):454\u201360. https:\/\/doi.org\/10.1007\/s40596-015-0314-0.","journal-title":"Acad Psychiatry"},{"issue":"3","key":"1088_CR71","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/NNE.0000000000000438","volume":"43","author":"DS Finnell","year":"2018","unstructured":"Finnell DS, Savage CL, Hansen BR, Sanchez M, White KM, Johnson JA, et al. Integrating substance use content in an overcrowded nursing curriculum. Nurse Educ. 2018;43(3):128\u201331. https:\/\/doi.org\/10.1097\/NNE.0000000000000438.","journal-title":"Nurse Educ"},{"issue":"3","key":"1088_CR72","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/JAN.0000000000000293","volume":"30","author":"C Clancy","year":"2019","unstructured":"Clancy C, Kelly P, Loth C. State of the art in European addictions nursing: perspectives from the United Kingdom, Ireland, and the Netherlands. J Addict Nurs. 2019;30(3):139\u201348. https:\/\/doi.org\/10.1097\/JAN.0000000000000293.","journal-title":"J Addict Nurs"},{"issue":"6","key":"1088_CR73","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.jcjq.2021.03.002","volume":"47","author":"M Funke","year":"2021","unstructured":"Funke M, Kaplan MC, Glover H, Schramm-Sapyta N, Muzyk A, Mando-Vandrick J, et al. Increasing naloxone prescribing in the emergency department through education and electronic medical record work-aids. Jt Comm J Qual Patient Saf. 2021;47(6):364\u201375. https:\/\/doi.org\/10.1016\/j.jcjq.2021.03.002.","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"1","key":"1088_CR74","doi-asserted-by":"publisher","first-page":"62","DOI":"10.12788\/jhm.2861","volume":"13","author":"D Winetsky","year":"2018","unstructured":"Winetsky D, Weinrieb RM, Perrone J. Expanding treatment opportunities for hospitalized patients with opioid use disorders. J Hosp Med. 2018;13(1):62\u20134. https:\/\/doi.org\/10.12788\/jhm.2861.","journal-title":"J Hosp Med"},{"issue":"9","key":"1088_CR75","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1016\/j.ajem.2019.02.025","volume":"37","author":"M Lowenstein","year":"2019","unstructured":"Lowenstein M, Kilaru A, Perrone J, Hemmons J, Abdel-Rahman D, Meisel ZF, et al. Barriers and facilitators for emergency department initiation of buprenorphine: a physician survey. Am J Emerg Med. 2019;37(9):1787\u201390. https:\/\/doi.org\/10.1016\/j.ajem.2019.02.025.","journal-title":"Am J Emerg Med"},{"issue":"4","key":"1088_CR76","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/j.annemergmed.2018.04.007","volume":"72","author":"HC Duber","year":"2018","unstructured":"Duber HC, Barata IA, Cio\u00e8-Pe\u00f1a E, Liang SY, Ketcham E, Macias-Konstantopoulos W, et al. Identification, management, and transition of care for patients with opioid use disorder in the emergency department. Ann Emerg Med. 2018;72(4):420\u201331. https:\/\/doi.org\/10.1016\/j.annemergmed.2018.04.007.","journal-title":"Ann Emerg Med"},{"issue":"9","key":"1088_CR77","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1056\/NEJMp1606157","volume":"375","author":"L Fanucchi","year":"2016","unstructured":"Fanucchi L, Lofwall MR. Putting parity into practice \u2013 integrating opioid-use disorder treatment into the hospital setting. N Engl J Med. 2016;375(9):811\u20133. https:\/\/doi.org\/10.1056\/NEJMp1606157.","journal-title":"N Engl J Med"}],"container-title":["Harm Reduction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01088-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12954-024-01088-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01088-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T14:07:37Z","timestamp":1726754857000},"score":1,"resource":{"primary":{"URL":"https:\/\/harmreductionjournal.biomedcentral.com\/articles\/10.1186\/s12954-024-01088-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":77,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1088"],"URL":"https:\/\/doi.org\/10.1186\/s12954-024-01088-6","relation":{},"ISSN":["1477-7517"],"issn-type":[{"value":"1477-7517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]},"assertion":[{"value":"29 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval for this research was obtained from the University of British Columbia (UBC) Behavioural Research Ethics Board (BREB), reference no. H19-02470. Informed consent was obtained from all study participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"171"}}