Background Methamphetamine (MAP) users present to the emergency department (ED) for myriad reasons, including trauma, chest pain, and psychosis. The purpose of this study is to determine how their prevalence, demographics, and resource utilization have changed. Methods Retrospective review of MAP patients over 3 months in 2016. Demographics, mode of arrival, presenting complaints, disposition, and concomitant cocaine/ethanol use were compared to a 1996 study at the same ED. Results 638 MAP-positive patients, 3,013 toxicology screens, and 20,203 ED visits represented an increase in prevalence compared to 1996: 461 MAP-positive patients, 3,102 screens, and 32,156 visits. MAP patients were older compared to the past. Mode of arrival was most frequently by ambulance but at a lower proportion than 1996, as was the proportion of MAP patients with positive cocaine toxicology screens and ethanol coingestion. Admission rate was lower compared to the past, as was discharge to jail. The proportion of MAP patients presenting with blunt trauma was lower compared to the past and higher for chest pain. Conclusion A significant increase in the prevalence of MAP-positive patients was found. Differences in presenting complaints and resource utilization may reflect the shifting demographics of MAP users, as highlighted by an older patient population relative to the past.

No abstract

No abstract

Background: Stimulant use disorder is a worldwide problem. Users present to the ED for diverse reasons including trauma, chest and abdominal pain, altered mental status, stroke, suicidality, and skin infection. Objective: To determine what differences exist between stimulant users. Methods: We compared Stimulant users presenting to an urban ED Level I trauma center over a 3-month period with toxicology screens positive for cocaine and/or methamphetamine. Results: Of 718 subjects (465 male, 253 female), 610 (85%) were positive for methamphetamine, 80 (11%) cocaine, and 28 (4%) both. Significant racial differences existed, but not for age, gender, and insurance status. Ethanol co-ingestion was higher for cocaine users, otherwise no significant differences were detected for laboratory values and maximum heart rate, and systolic/diastolic blood pressure. For presenting complaint, the proportion of cocaine users was higher for trauma and lower for altered level of consciousness than other subgroups. There was no significant difference in proportion of subjects admitted to the hospital, but cocaine users had a higher rate of elopement and were placed on 72-h psychiatric holds and/or transferred to inpatient psychiatric facilities at a significantly lower rate than the other subgroups. Conclusion: Cocaine users were more likely to present with trauma, elope from the ED, and have alcohol intoxication. Methamphetamine users were more likely to be Caucasian, have altered level of consciousness, be placed on psychiatric holds, or transferred to inpatient psychiatric facilities. These differences may be explained by regional preferences, socialization, personality types, and the unique neuropsychopharmacological differences between cocaine and methamphetamine.