Tool Identifies ER Patients With Substance Abuse Issues

Wendy Macias Konstantopoulos, MD, MPH Department of Emergency Medicine Division of Global Health & Human Rights Massachusetts General Hospital Harvard Medical SchoolMedicalResearch.com Interview with:
Wendy Macias Konstantopoulos, MD, MPH
Department of Emergency Medicine
Division of Global Health & Human Rights
Massachusetts General Hospital
Harvard Medical School

Medical Research: What are the main findings of the study?

Dr. Macias-Konstantopoulos: Nearly two-thirds (64%) of 3240 emergency department (ED) patients who endorsed using drugs in the last 30 days, met criteria for problematic drug use (DAST-10 score ≥3). Of patients who identified their primary drug of use as being a substance other than cannabis, approximately 91% met criteria for problematic drug use, including nearly 94% of those using illicit drugs and 76% of those using pharmaceuticals. Compared to those who used cannabis primarily, primary non-cannabis users had an almost 15 times higher odds of meeting criteria for problematic drug use. Finally, we know from previous studies that drug-using individuals are more likely to access medical care through the ED and more likely to require hospitalization than their non-drug using counterparts. Our study found that drug-using ED patients who met criteria for problematic drug use tended to have ED triage levels associated with higher levels of severity or resource utilization when compared to drug-using ED patients who did not meet criteria for a drug problem.


Medical Research: Were any of the findings unexpected?

Dr. Macias-Konstantopoulos: Although cannabis is traditionally thought of as a more benign substance in our society, almost half (46.6%) of those who identified cannabis as their primary drug of use met criteria for problematic drug use. Among primary cannabis users, tobacco smoking, daily drug use, binge drinking, and perceived relatedness of the ED visit to drug use were associated with higher odds of meeting criteria for problematic drug use.

Medical Research: What should clinicians and patients take away from your report?

Dr. Macias-Konstantopoulos: Exclusive of substance use treatment, medical care costs alone accounted for over $5 billion of the total annual cost of illicit drug use in 2008. The Drug Abuse Warning Network (DAWN), a public health surveillance system that monitors drug-related morbidity and mortality, estimated that of the 5.1 million drug-related ED visits across the US in 2011, 2.5 million were directly related to the use of illicit drugs and/or the nonmedical use of pharmaceuticals. Our study proposes a very simple decision rule that can help busy emergency clinicians identify patients who may benefit from further screening and referral to treatment. Incorporated into standard practice, the use of this rule may increase the number of ED patients offered the opportunity to enter into substance use treatment at a moment when they are more likely to seriously consider the ill effects of their drug use (the “teachable moment”). By identifying and referring those patients who would most benefit from substance use treatment, emergency medicine can play a more proactive role not only in improving health outcomes for these patients, but also in reducing medical care cost related to substance use, misuse, or abuse.

Citation:

Identifying Patients With Problematic Drug Use in the Emergency Department: Results of a Multisite Study
Macias Konstantopoulos WL1, Dreifuss JA2, McDermott KA3, Parry BA4, Howell ML4, Mandler RN5, Fitzmaurice GM6, Bogenschutz MP7, Weiss RD8.
Ann Emerg Med. 2014 Jul 3. pii: S0196-0644(14)00417-X. doi: 10.1016/j.annemergmed.2014.05.012. [Epub ahead of print]