Abstract:Background
Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorders in an integrated health system.
Methods
In a retrospective design, electronic health record (EHR) data identified patients with ≥1 of 3 common S… Show more
“…Previous studies in Australia and the United States found similar high levels of emergency department and hospital use among drug users. [7][8][9][10] Although other studies have suggested that people who use drugs visit primary care and preventive health services at lower rates, 8 we found the proportion accessing community physicians to be about the same as matched controls. An important caveat is that about onequarter of community physician visits coincided with periods of opioid agonist therapy (e.g.…”
Section: Discussioncontrasting
confidence: 74%
“…14 Substance use and mental health-related concerns were found to be the most common diagnoses during health care visits by people who later overdose, which is consistent with previous studies. 7,15 Of particular note is that diagnoses related to alcohol, stimulant and polysubstance use were frequent in this population, highlighting (as others have found 16,17 ) the role of polysubstance use in predisposing to overdose.…”
People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
“…Previous studies in Australia and the United States found similar high levels of emergency department and hospital use among drug users. [7][8][9][10] Although other studies have suggested that people who use drugs visit primary care and preventive health services at lower rates, 8 we found the proportion accessing community physicians to be about the same as matched controls. An important caveat is that about onequarter of community physician visits coincided with periods of opioid agonist therapy (e.g.…”
Section: Discussioncontrasting
confidence: 74%
“…14 Substance use and mental health-related concerns were found to be the most common diagnoses during health care visits by people who later overdose, which is consistent with previous studies. 7,15 Of particular note is that diagnoses related to alcohol, stimulant and polysubstance use were frequent in this population, highlighting (as others have found 16,17 ) the role of polysubstance use in predisposing to overdose.…”
People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
“…The proportion of participants visiting ED in the past 12 months ranged from 10% to 72% . Studies including relative measures showed frequency of ED utilization of three to 10 times that of comparison groups not using illicit drugs . Exceptions were a study in rural Taiwan, showing that people who inject heroin had a similar rate of ED presentation as the general population , and a study of older people who use cannabis in the United States showing similar odds of ED presentation as those who do not use cannabis .…”
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.
“…Les personnes ayant fait une surdose de drogues illicites ont fréquemment utilisé le système de soins de santé au cours de l'année précédant cet événement, comme en témoignent les visites aux services d'urgence, les admissions à l'hôpital et les rendez-vous chez des médecins en milieu communautaire. Des études antérieures menées en Australie et aux États-Unis ont révélé des taux élevés similaires de fréquentation des services d'urgence et des hôpitaux parmi les utilisateurs de drogues [7][8][9][10] . Bien que d'autres études aient laissé entendre que les personnes qui consomment des drogues fréquentent moins les services de soins primaires et de santé préventive 8 , nous avons constaté que la proportion de personnes ayant consulté des médecins en milieu communautaire est à peu près la même que pour les témoins appariés.…”
Section: Analyseunclassified
“…Des problèmes de dépendance et de santé mentale étaient les diagnostics les plus fréquents lors des visites en lien avec des soins de santé effectuées par des personnes qui ont fait une surdose par la suite, ce qui concorde avec certaines études antérieures 7,15 . Il convient de souligner, en particulier, que les diagnostics liés à la consommation d'alcool, de stimulants et de combinaison de plusieurs substances étaient fréquents au sein de cette population, ce qui met en lumière (comme d'autres l'ont constaté 16,17 ) le rôle de la consommation de plusieurs substances combinées dans la prédisposition à une surdose.…”
Introduction
La Colombie-Britannique (C.-B.) a déclaré un état d'urgence en santé publique
en avril 2016 en réaction à une augmentation rapide du nombre de décès par surdose. Une
meilleure compréhension de l'utilisation des soins de santé est nécessaire pour guider les
stratégies de prévention pour les personnes qui font une surdose de drogues illicites.
Méthodologie
La cohorte provinciale des victimes de surdoses comprend des données
administratives couplées sur l'utilisation des soins de santé par les personnes qui ont été
victimes d'une surdose de drogues illicites en Colombie-Britannique entre le 1er janvier
2015 et le 30 novembre 2016. Les cas de surdose ont été relevés à l'aide de données
provenant des services ambulanciers, des enquêtes des coroners, des appels aux centres
antipoison et des dossiers administratifs des hôpitaux, des services d'urgence et des
médecins. Au total, 10 455 cas de surdose ont été recensés et comparés à 52 275 témoins
appariés selon l'âge, le sexe et la zone de résidence en vue d'une analyse descriptive de
l'utilisation des soins de santé.
Résultats
Les deux tiers (66 %) des cas de surdose concernaient des hommes, et environ
la moitié (49 %) les 20 à 39 ans. Plus de la moitié des cas (54 %) se sont rendus au service
d'urgence, et environ le quart (26 %) ont été admis à l'hôpital au cours de l'année
précédant la surdose, comparativement à respectivement 17 % et 9 % des témoins.
Cependant, près d'un cinquième (19 %) des cas ont été enregistrés comme ayant quitté le
service d'urgence sans avoir été vus par le médecin ou contre son avis. Des proportions
élevées de cas (75 %) et de témoins (72 %) ont consulté un médecin en milieu communautaire.
La consommation de substances et des problèmes en santé mentale ont été les
diagnostics les plus courants chez les personnes qui ont fait une surdose.
Conclusion
Les personnes qui ont fait une surdose ont souvent eu accès au système de
soins de santé au cours de l'année précédant la surdose. Compte tenu de ces taux élevés
d'utilisation des soins de santé, on pourrait peut-être repérer les personnes à risque avant
qu'elles ne fassent de surdose et les aiguiller vers des programmes ciblés et des interventions
fondées sur des données probantes. Il est prévu d'utiliser la cohorte provinciale des
victimes de surdoses de la Colombie-Britannique pour déterminer les facteurs de risque
relatifs aux surdoses et aux décès par surdose.
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