Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis

Abstract

Aims To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. Design Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting healthcare utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). Setting and participants People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. Measurements Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).Findings Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.Conclusions People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Use of health care services by people with substance use disorders in Belgium: a register-based cohort study

“…The results of this study con rm the high burden of disease for people with SUD. Our results for ED and hospitalizations episodes are in line with the results of previous studies [27]. At the same time, our study gives a better understanding of the number of contacts with general practitioners by people with SUD.…”

“…Indeed, many studies already pointed out that people with SUD heavily rely on emergency departments and are supposedly less in contact with general health care services [25,26]. As revealed by a recent meta-analysis, people with SUD have on average 4.8 times more episodes in emergency departments than the general population and are 7.1 times more often hospitalized [27]. However, the same review identi ed several gaps in the evidence such as the fact that little is known about the health seeking behavior of people with cannabis use disorders, MDMA or amphetamine use disorders, powder cocaine use disorders, as well as the lack of knowledge about the use of primary health care by people with SUD [27].…”

Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

“…Epidemiological research and health interventions have focused on outcomes perceived to be ‘drug-related’, such as overdoses and HIV or hepatitis infections. Meanwhile, there is limited research into engagement with primary care services, healthcare quality, and treatment options for non-communicable diseases and mental health problems 14 . These are important areas of research because the population of people who use illicit opioids in England (as in many other countries) is ageing 15 and the majority of excess deaths are now caused by non-communicable diseases such as liver disease, chronic obstructive pulmonary disease, and cardiovascular disease 16 .…”

Factors associated with low-acuity hospital admissions in a public safety-net setting: a cross-sectional study

“…Ultimately, the response to reducing unnecessary hospitalizations will likely require interventions that are broader than a healthcare-based response. For example, programs that provide stable housing show promise in this regard [ 52 – 54 ] as do substance use disorder treatment and comprehensive support efforts [ 55 ]. These types of approaches warrant additional consideration.…”