Taylor Baisey

Objectives: To understand patient and staff experiences with in-hospital substance use (IHSU) and develop recommendations to better support patients and staff navigating IHSU. Methods: Semi-structured qualitative interviews with patients engaging in and hospital staff responding to IHSU in the past year at a safety-net hospital in San Francisco, California, from July 2024 to August 2025. We used iterative thematic analysis to identify major themes. Results: Patients (n=19) were recruited from the community (84.2%) and hospital (15.8%). Most identified as men (73.7%), White (63.2%), and unhoused (57.9%); most used fentanyl during hospitalization (57.9%). Staff (n=21) included clinicians (28.6%), nurses (28.6%), nurse leaders (19.0%), administrators (14.3%), and other staff members (9.5%); primary work areas were administration (23.8%), the addiction consult team (19.0%), and medical-surgical departments (19.0%). We identified seven themes regarding patient and staff experiences: (1) IHSU helped patients endure hospitalization; (2) punitive responses exacerbated patient experiences of mistrust, stigma, and distress; (3) patient-centered responses improved patient and staff experiences; (4) staff were concerned for patient and staff safety; (5) nurses were concerned about personal liability; (6) nurses felt unheard in concerns; and (7) staff felt underprepared to respond to IHSU. Conclusions: IHSU helped patients avoid patient-directed discharge but distressed staff—especially nurses—due to a lack of training and support. To improve patient and staff experiences, hospitals can implement standardized addiction medicine training, proactive evidence-based inpatient addiction treatment, trauma-informed IHSU responses, and evidence-based patient-centered policies for responding to IHSU that support patients and staff.

Nearly one-third of the entire U.S. food supply is sent to landfills. As food decomposes, it emits methane, a potent greenhouse gas that fuels global warming. To reduce greenhouse gas emissions and create a more circular food system, states across the country are mandating food waste diversion from landfills through several mechanisms, includ­ing composting. In 2016, California passed Senate Bill 1383 (SB-1383), which requires organic (including food) waste diversion from landfills in part by mandating municipal procurement of recy­cled organic waste products. To comply with SB-1383, the city of Albany, California, established a Compost Distribution Hub in April 2023 in part­nership with an urban community farm to distrib­ute free compost to the farm and the community. This paper investigates the successes, challenges, and initial impacts of the Compost Distribution Hub in meeting SB-1383 requirements and contributing to a circular food system, as well as a circular economy more broadly. Through 26 semi-struc­tured interviews with implementing partners and community patrons and an analysis of the compost quality, we found the Compost Distribution Hub contributed to organic waste diversion require­ments, provided additional social co-benefits, and contributed to the broader circular economy by recycling non-food organic waste. However, it did not contribute to a circular food system, as it sourced compost made from green waste rather than food waste. It also was unable to provide community education due to insufficient funds. To maximize community and circularity benefits, com­post distribution programs must ensure that com­post is sourced from food waste, incorporate community education, and dedicate funding for the educational efforts.