Marek C Chawarski1, Kathryn Hawk2, E Jennifer Edelman3, Patrick O'Connor4, Patricia Owens2, Shara Martel2, Edouard Coupet2, Lauren Whiteside5, Judith I Tsui6, Richard Rothman7, Ethan Cowan8, Lynne Richardson8, Michael S Lyons9, David A Fiellin10, Gail D'Onofrio11. 1. Yale School of Medicine, Department of Psychiatry, New Haven, CT; Yale School of Medicine, Department of Emergency Medicine, New Haven, CT. Electronic address: marek.chawarski@yale.edu. 2. Yale School of Medicine, Department of Emergency Medicine, New Haven, CT. 3. Yale School of Medicine, Department of Internal Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT. 4. Yale School of Medicine, Department of Internal Medicine, New Haven, CT. 5. Yale School of Public Health, New Haven, CT. 6. University of Washington, Department of Emergency Medicine, Seattle, WA. 7. Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD. 8. Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY. 9. University of Cincinnati Department of Emergency Medicine, Cincinnati, OH. 10. Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale School of Medicine, Department of Internal Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT. 11. Yale School of Medicine, Department of Emergency Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT.
Abstract
STUDY OBJECTIVE: Concurrent use of amphetamine-type stimulants among individuals with opioid use disorder can exacerbate social and medical harms, including overdose risk. The study evaluated rates of amphetamine-type stimulant use among patients with untreated opioid use disorder presenting at emergency departments in Baltimore, MD; New York, NY; Cincinnati, OH; and Seattle, WA. METHODS: Emergency department (ED) patients with untreated opioid use disorder (N=396) and enrolled between February 2017 and January 2019 in a multisite hybrid type III implementation science study were evaluated for concurrent amphetamine-type stimulant use. Individuals with urine tests positive for methamphetamine, amphetamine, or both were compared with amphetamine-type stimulant-negative patients. RESULTS: Overall, 38% of patients (150/396) were amphetamine-type stimulant positive; none reported receiving prescribed amphetamine or methamphetamine medications. Amphetamine-type stimulant-positive versus -negative patients were younger: mean age was 36 years (SD 10 years) versus 40 years (SD 12 years), 69% (104/150) versus 46% (114/246) were white, 65% (98/150) versus 54% (132/246) were unemployed, 67% (101/150) versus 49 (121/246) had unstable housing, 47% (71/150) versus 25% (61/245) reported an incarceration during 1 year before study admission, 60% (77/128) versus 45% (87/195) were hepatitis C positive, 79% (118/150) versus 47% (115/245) reported drug injection during 1 month before the study admission, and 42% (62/149) versus 29% (70/244) presented to the ED for an injury. Lower proportions of amphetamine-type stimulant-positive patients had cocaine-positive urine test results (33% [50/150] versus 52% [129/246]) and reported seeking treatment for substance use problems as a reason for their ED visit (10% [14/148] versus 19% [46/246]). All comparisons were statistically significant at P<.05 with the false discovery rate correction. CONCLUSION: Amphetamine-type stimulant use among ED patients with untreated opioid use disorder was associated with distinct sociodemographic, social, and health factors. Improved ED-based screening, intervention, and referral protocols for patients with opioid use disorder and amphetamine-type stimulant use are needed.
STUDY OBJECTIVE: Concurrent use of amphetamine-type stimulants among individuals with opioid use disorder can exacerbate social and medical harms, including overdose risk. The study evaluated rates of amphetamine-type stimulant use among patients with untreated opioid use disorder presenting at emergency departments in Baltimore, MD; New York, NY; Cincinnati, OH; and Seattle, WA. METHODS: Emergency department (ED) patients with untreated opioid use disorder (N=396) and enrolled between February 2017 and January 2019 in a multisite hybrid type III implementation science study were evaluated for concurrent amphetamine-type stimulant use. Individuals with urine tests positive for methamphetamine, amphetamine, or both were compared with amphetamine-type stimulant-negative patients. RESULTS: Overall, 38% of patients (150/396) were amphetamine-type stimulant positive; none reported receiving prescribed amphetamine or methamphetamine medications. Amphetamine-type stimulant-positive versus -negative patients were younger: mean age was 36 years (SD 10 years) versus 40 years (SD 12 years), 69% (104/150) versus 46% (114/246) were white, 65% (98/150) versus 54% (132/246) were unemployed, 67% (101/150) versus 49 (121/246) had unstable housing, 47% (71/150) versus 25% (61/245) reported an incarceration during 1 year before study admission, 60% (77/128) versus 45% (87/195) were hepatitis C positive, 79% (118/150) versus 47% (115/245) reported drug injection during 1 month before the study admission, and 42% (62/149) versus 29% (70/244) presented to the ED for an injury. Lower proportions of amphetamine-type stimulant-positive patients had cocaine-positive urine test results (33% [50/150] versus 52% [129/246]) and reported seeking treatment for substance use problems as a reason for their ED visit (10% [14/148] versus 19% [46/246]). All comparisons were statistically significant at P<.05 with the false discovery rate correction. CONCLUSION: Amphetamine-type stimulant use among ED patients with untreated opioid use disorder was associated with distinct sociodemographic, social, and health factors. Improved ED-based screening, intervention, and referral protocols for patients with opioid use disorder and amphetamine-type stimulant use are needed.
Authors: Judith I Tsui; Jim Mayfield; Elizabeth C Speaker; Sawir Yakup; Richard Ries; Harvey Funai; Brian G Leroux; Joseph O Merrill Journal: J Subst Abuse Treat Date: 2019-11-18
Authors: Gail D'Onofrio; E Jennifer Edelman; Kathryn F Hawk; Michael V Pantalon; Marek C Chawarski; Patricia H Owens; Shara H Martel; Paul VanVeldhuisen; Neal Oden; Sean M Murphy; Kristen Huntley; Patrick G O'Connor; David A Fiellin Journal: Implement Sci Date: 2019-05-07 Impact factor: 7.327