Intravenous drug abuse and one academic health center.

Increasing reports of management problems involving intravenous drug abuse patients prompted our study. From 1983 to 1988, the recorded inpatient prevalence of diagnoses consistent with drug abuse/dependence, other than alcohol or nicotine, rose hospitalwide from 0.6% to 3.5%. Disruptive behavior was documented in the records of 38 of 71 active cocaine or heroin users admitted during 1988 vs 12 of 64 matched control subjects. Care and teaching focused principally on secondary complications of intravenous drug use. Study recommendations included (1) establishment of a comprehensive substance abuse treatment education, and research program with a dedicated inpatient unit; (2) use of an explicit social contract between patients and care givers; and (3) staff education about legal limits in managing disruptive patients and searching for illegal substances. Primary and secondary prevention, including combating societal enabling of substance abuse, should be the institution's long-term goals.