Prevalence and healthcare burden of illegal drug use among emergency department patients

Abstract

Objectives: Illegal drug use is common in emergency department (ED) patients, but previous prevalence studies have relied upon approaches that may underestimate the true extent of the problem. The aim of this study was to examine illegal drug use in a typical adult ED. Methods: We employed an independent researcher to prospectively and anonymously interview patients attending an inner city adult ED throughout all 168 hours of a typical week. Additional information collected from the treating clinician indicated whether each presentation was directly or indirectly related to illegal drug use. Results: We found that 6.9% of all patient attendances were directly or indirectly related to illegal drug use, and hospital admission was required in nearly half of these. The majority of drug related problems were acute injuries, overdose, and the medical complications of drug use. Conclusions: This suggests that the emergency healthcare burden related to illegal drug use is substantial, and higher than previously reported. I llegal drug use is common. The British Crime Survey 2000, a representative household survey of 13 300 people, found that 34% of people aged 16-59 years had used illegal drugs at some time, and 6% in the previous month. Health problems related to illegal drugs use are well recognised, but are difficult to quantify, as social circumstances make drug users difficult to identify and engage in research. In emergency care, studies of the prevalence of illegal drug use have relied on data collected by treating healthcare professionals, or retrospective review of the clinical notes.2-4 These methods may lead to bias and under-reporting.Our study used an independent researcher to prospectively measure the proportion of illegal drug users among all patients attending an inner city emergency department (ED), and quantified the emergency healthcare burden represented by this patient group. METHODSThe study was approved by Weston local research ethics committee. An independent researcher approached all adult patients attending our inner city ED, and with their consent, completed a confidential semi-structured survey. Patients were excluded if they had a life threatening illness, chronic mental impairment, were unable to understand/give verbal consent, or did not speak English. A technique of representative sampling was used, so that patients were recruited throughout all 168 hours of a typical week. Patients were anonymised, and responses were not shared with clinical staff. The researcher subsequently interviewed the treating doctor regarding the patient's diagnosis, need for admission, and whether they considered the attendance to be directly, indirectly, or not related to illegal drug use. Data were analysed using descriptive statistics and frequencies. RESULTSThe results are summarised in fig 1. The mean age was 40.4 years (range 16-98). Of the patients interviewed, 290 (36.2%) had used illegal drugs in their lifetime (lifetime drug users), 129 (16.1%) in the previous month, and 79 (9.9%) within the previous 2...

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