Wendy L Macias Konstantopoulos1, Jessica A Dreifuss2, Katherine A McDermott3, Blair Alden Parry4, Melissa L Howell4, Raul N Mandler5, Garrett M Fitzmaurice6, Michael P Bogenschutz7, Roger D Weiss8. 1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: wmacias@mgh.harvard.edu. 2. Department of Psychiatrys, Boston, MA; Harvard Medical School, Boston, MA; Behavioral Health Partial Program, McLean Hospital, Belmont, MA. 3. Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA. 4. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. 5. Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD. 6. Department of Biostatistics, Harvard School of Public Health, Boston, MA. 7. Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM. 8. Department of Psychiatrys, Boston, MA; Harvard Medical School, Boston, MA; Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA.
Abstract
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.
RCT Entities:
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.
Authors: T Kerr; E Wood; E Grafstein; T Ishida; K Shannon; C Lai; J Montaner; M W Tyndall Journal: J Public Health (Oxf) Date: 2004-11-25 Impact factor: 2.341
Authors: Michael J Mello; Ted D Nirenberg; Richard Longabaugh; Robert Woolard; Alison Minugh; Bruce Becker; Janette Baird; Lynda Stein Journal: Ann Emerg Med Date: 2005-06 Impact factor: 5.721
Authors: R Longabaugh; R E Woolard; T D Nirenberg; A P Minugh; B Becker; P R Clifford; K Carty; F Sparadeo; A Gogineni Journal: J Stud Alcohol Date: 2001-11
Authors: Herbert C Duber; Isabel A Barata; Eric Cioè-Peña; Stephen Y Liang; Eric Ketcham; Wendy Macias-Konstantopoulos; Shawn A Ryan; Mark Stavros; Lauren K Whiteside Journal: Ann Emerg Med Date: 2018-06-05 Impact factor: 5.721