Longitudinal Substance Use following an Emergency Department Visit for Cocaine-Associated Chest Pain

Thapa, Purushottam B.; Walton, Maureen A.; Cunningham, Rebecca M.; Maio, Ronald F.; Han, Xiaotong; Savary, Patricia E.; Booth, Brenda M.

doi:10.1177/002204260803800401

Cited by 3 publications

(6 citation statements)

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“…Among those participants presenting again to the study ED with chest pain, 66% (n=34/51) had a positive cocaine urine screen at time of presentation to the ED. Five percent of study participants (n=12/219) were hospitalized on repeat chest pain visits from the ED; of these, half had positive cocaine drug screens at time of readmission (Table 4) (see Thapa, et al, In Press27 for detailed longitudinal cocaine/substance use of sample). All patients hospitalized for chest pain were evaluated in the ED initially.…”

Section: Resultsmentioning

confidence: 99%

“…Only 5% were admitted for further cardiac workup on subsequent visit and of these, 64% had recently used cocaine. The majority (79%) of participants completing all follow ups reported recurrent cocaine use at some point over the study year27 and 78% had a positive urine screen at the time of the follow-up interview. Taken together, these findings suggest that self-report of cocaine use appeared to be valid, the cocaine use was often recent, and that that cocaine use is not a rare event following negative CPOU visit for cocaine-related chest pain.…”

Section: Discussionmentioning

confidence: 99%

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One-Year Medical Outcomes and Emergency Department Recidivism After Emergency Department Observation for Cocaine-Associated Chest Pain

Cunningham

Walton

Weber

et al. 2009

Annals of Emergency Medicine

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Chest pain is the most common complaint among cocaine users who present to the ED seeking care and many hospital resources are applied to stratify cocaine users in regard to future cardiac morbidity and mortality. Little is known about the longitudinal cardiac and non cardiac medical outcomes of cocaine users who have been stratified to an ED observation period following their ED visit.Objectives-to examine one-year cardiac outcomes in a low-intermediate risk sample of patients with cocaine-associated chest pain in an urban ED, as well as to examine ED recidivism one year for cardiac and non-cardiac complaints.Methods-Prospective consecutive cohort study of patients (18-60 years) who presented to an urban Level 1 ED with cocaine-associated chest pain and were risk stratified to low-intermediate cardiac risk. Exclusion criteria: EKG suggestive of AMI, elevated serum cardiac markers, history of AMI or CABG, hemodynamic instability, unstable angina. Baseline interviews using validated measures of health functioning, and substance use were conducted during CPOU stay, and 3, 6, and 12 months. ED utilization during the study year was abstracted from medical chart. Zero-Inflated Poisson regression analyses were conducted to predict recurrent ED visits.Results-219 participants (73% participation) were enrolled, 65% returned to the ED post index visit; 23% returned for chest pain, of these 66% had a positive cocaine urine screen. No patient had an AMI within the one year follow up period. Patients with continued cocaine use were more likely to have a recurrent ED visit (p<0.001) but these repeat visits were most often related to musculoskeletal pain (21%), and injury (30%) rather than potential cardiac complaints.Conclusions-Patients with cocaine-associated chest pain who are low to intermediate cardiac risk and complete a CPOU protocol have less then 1% rate of MI in the subsequent 12-months.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One-Year Medical Outcomes and Emergency Department Recidivism After Emergency Department Observation for Cocaine-Associated Chest Pain

Cunningham

Walton

Weber

et al. 2009

Annals of Emergency Medicine

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“…; and, an additional $5 incentive was provided for participants contacting the project (see Cunningham et al, 2008 for detailed methodology). Remuneration for the 12-month interview was $50 with an additional $10 for providing a urine drug screen to increase the accuracy of self-reports (see Thapa et al, In Press). …”

Section: 0 Methodsmentioning

confidence: 99%

Predictors of violence following Emergency Department visit for cocaine-related chest pain

Walton

Cunningham

Chermack

et al. 2009

Drug and Alcohol Dependence

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This study examined one-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age = 38.8, standard deviation 9.06; range = 19 to 60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history).Address for Correspondence and Reprints: Reprints and author correspondence should be directed to: Maureen A. Walton, M.P.H., Ph.D., University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48105. phone: 734-232-2070, fax: 734-998-7992, e-mail: waltonma@umich.edu. Manuscript Authorship: All co-authors contributed in conducting this research, writing the manuscript and approving this final version of the manuscript. Specific contributions include: Maureen Walton, Co-Investigator on the grant that funded this work, was the project director for this research, provided the initiation and development of this manuscript, and wrote the initial draft of the manuscript. Rebecca Cunningham, Co-Investigator on the grant that funded this work, she co-wrote the Introduction section, was a collaborator in the design of data analyses, and reviewed/edited the manuscript multiple times. Steve Chermack, Consultant on the assessment of violence measures, was involved in the conceptualization and data analysis models for the paper and co-wrote the Discussion section, and reviewed/edited the manuscript. James Weber, Co-Principal Investigator on the grant that funded this work, collaborated in the study design and monitored recruitment procedures in the ED, and reviewed/edited the manuscript. Ron Maio, Co-Investigator on the grant that funded this work, collaborated in the study design and development of the recruitment protocol, and reviewed/edited the manuscript. Shanti Tripathi, Data analyst on the grant that funded this work, collaborated in the data analysis plan, conducted the data analyses, wrote the Results section, and edited the manuscript. Brenda Booth, Principal Investigator on the grant that funded this work, provided overall supervision for the research presented in this manuscript, wrote major sections of the manuscript and coordinated the analyses, and reviewed/edited the manuscript.Publisher's Disclaimer: This is a PDF file of an unedited man...

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“…There are several limitations to these data, specifically the very specific nature of our study population (African-American cocaine users in two rural Arkansas Delta counties), but these findings have parallels to other community-based studies (9, 12). Additionally, the results could be attributed to social desirability effects in follow-up interviews, if participants perceived an expectation on the part of interviewers or other study staff to report lowered drug use.…”

Section: Discussionmentioning

confidence: 70%

“…In another study of rural stimulant users, where an inclusion criterion was any stimulant use in the past 30 days, use of cocaine and methamphetamine significantly declined over the three years’ follow-up (11). In a study of emergency room patients with cocaine-associated chest pain, we also found a significant decrease in crack use between baseline and three months, but not between other interviews (12). Other natural history studies (13, 14) have found substantial declines in substance use for sub-groups or on average.…”

Section: Introductionmentioning

confidence: 72%

Trajectory of substance use after an HIV risk reduction intervention

Booth¹,

Wright

Ounpraseuth

et al. 2015

The American Journal of Drug and Alcohol Abuse

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Background Research assessments can confound the results of treatment outcome studies and can be themselves an intervention or form of aftercare. Objective Determine the trajectory of substance use and substance severity in a sample of African-American cocaine users participating in a community-based sexual risk reduction trial. Methods Out-of-treatment participants were recruited using Respondent-Driven Sampling in two African-American majority counties in rural Arkansas. They participated in either the sexual risk reduction condition or an active control focused on access to social services. They were interviewed at baseline, post-intervention, and 6 and 12 months post-intervention. Substance use outcome measures were use of crack cocaine, powder cocaine, marijuana, alcohol, and the Addiction Severity Index Alcohol and Drug Severity composites. A random sample of participants completed qualitative interviews post-12-month interview. Results 251 were enrolled. Substance use outcomes did not differ among the two conditions at any point in the study. Use of measured substances and the ASI composites significantly decreased between baseline and post-intervention (p < 0.01), decreases that persisted at the 12-month assessment period compared to baseline. Qualitative findings suggested that many participants identified increased awareness of their drug use and need to control it through the programs. Participants also noted strong bonding with interviewers. Conclusion Clinical trials may have positive unexpected outcomes in terms of reduced substance use even though the trial is not substance use focused. Behavioral interventions for drug users that are not focused specifically on reducing drug use may nonetheless have unanticipated positive associations with reductions in drug use.

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Longitudinal Substance Use following an Emergency Department Visit for Cocaine-Associated Chest Pain

Cited by 3 publications

References 72 publications

One-Year Medical Outcomes and Emergency Department Recidivism After Emergency Department Observation for Cocaine-Associated Chest Pain

One-Year Medical Outcomes and Emergency Department Recidivism After Emergency Department Observation for Cocaine-Associated Chest Pain

Predictors of violence following Emergency Department visit for cocaine-related chest pain

Trajectory of substance use after an HIV risk reduction intervention

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