Ethical Management of Challenging Behaviors in Hospitalized People Who Use Drugs

From drug use in the hospital to patient-directed discharges and threatening behavior, challenging behaviors arise frequently in inpatients with infectious complications of substance use disorders (SUDs). The management of such challenging behaviors can bring key ethical values into tension and be susceptible to clinician bias. Here, we characterize the ethical tensions that emerge in the management of challenging behaviors in inpatients with infectious complications of SUD, identify preventive approaches, and delineate how clinicians can respond when preventive measures fail. Such preventive and post hoc responses incorporate the principles of harm reduction as well as of patient-centered care and trauma-informed care.