Identifying Patients With Problematic Drug Use in the Emergency Department: Results of a Multisite Study - 21/10/14
, Jessica A. Dreifuss, PhD b, c, d, Katherine A. McDermott, BA e, Blair Alden Parry, BA, CCRC a, Melissa L. Howell, BA, BS a, Raul N. Mandler, MD f, Garrett M. Fitzmaurice, ScD g, Michael P. Bogenschutz, MD h, Roger D. Weiss, MD b, c, eAbstract |
Study objective |
Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. The present study aims to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment.
Methods |
Using previously validated tests, 15,224 adult ED patients across 6 academic institutions were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included. Self-reported variables related to demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use.
Results |
Of the 3,240 patients, 2,084 (64.3%) met criteria for problematic drug use (Drug Abuse Screening Test score ≥3). Age greater than or equal to 30 years, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary noncannabis drug use, resource-intense ED triage level, and perceived drug-relatedness of ED visit were highly correlated with problematic drug use. Among primary cannabis users, correlates of problematic drug use were age younger than 30 years, tobacco smoking, binge drinking, daily drug use, and perceived relatedness of the ED visit to drug use.
Conclusion |
Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from comprehensive screening, intervention, and referral to treatment. A clinical decision rule is proposed. The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs.
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| Please see page 517 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Debra E. Houry, MD, MPH |
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| Author contributions: WLMK, MPB, and RDW developed this secondary analysis. RDW obtained the funding. JAD, KAM, and GMF performed the statistical analyses. WLMK and RDW interpreted the results. WLMK wrote the article, and all authors contributed substantially to its revision. WLMK takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Macias Konstantopoulos reports receiving grants from the National Institute on Drug Abuse through McLean Hospital during the conduct of the study. Ms. Parry reports receiving salary support from grants from the National Institute on Drug Abuse (grant #5U10DA015) through McLean Hospital during the conduct of the study. Dr. Mandler, an employee of the National Institute on Drug Abuse, reviewed and approved the article as a part of his authorship role. His role in the project is through the National Institute on Drug Abuse Clinical Trials Network (U10-DA13720). The National Institute on Drug Abuse appointed members and coordinated meetings of the data and safety monitoring board. Dr. Bogenschutz reports receiving grants from the National Institute on Drug Abuse during the conduct of the study. Dr. Weiss reports receiving grants from the National Institute on Drug Abuse during the conduct of the study. This secondary analysis was completed with financial support from the National Institute on Drug Abuse, grants U10 DA01583, K24 DA022288, U10 DA020036, U10 DA13720, U10 DA13035, U10 DA15831, U10 DA13732, and U10 DA15833. |
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| The authors are solely responsible for the content of this article, which does not necessarily represent the official views of the National Institute on Drug Abuse and the National Institutes of Health. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 64 - N° 5
P. 516-525 - novembre 2014 Retour au numéro
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