Burden of Medical Illness in Drug‐ and Alcohol‐dependent Persons Without Primary Care

Abstract

Little is known about the frequency, severity, and risk factors for disease in drug- and alcohol-dependent persons without primary medical care. Our aims are to assess the burden of medical illness, identify patient and substance dependence characteristics associated with worse physical health, and compare measures of illness burden in this population. This was accomplished through a cross-sectional study among alcohol-, heroin- or cocaine-dependent persons without primary medical care who were admitted to an urban inpatient detoxification unit. The mean age of these patients was 35.7 (SD 7.8) years; 76% were male and 46% were Black. Forty-five percent reported being diagnosed with a chronic illness, and 80% had prior medical hospitalizations. The mean age-adjusted SF-36 Physical Component Summary (PCS) score was lower than the general U.S. population norm (44.1 vs 50.1; p<0.001). In multivariable analysis, female gender (adjusted mean change in PCS score: -3.71 points, p=.002), problem use of hallucinogens (-3.51, p=0.013), heroin (-2.94, p=0.008), other opiates (-3.20, p=.045), living alone (-3.15, p=.023), having medical insurance (-2.26, p=0.014) and older age (-.22 points per year, p=0.001) were associated with worse health. From these data, it seems that alcohol- and drug-dependent persons without primary medical care have a substantial burden of medical illness compared to age- and gender-matched U.S. population controls. While the optimal measure of medical illness burden in this population is unclear, a variety of health measures document this medical illness burden in addicted persons.

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

“…30 ], physician diagnosed chronic medical conditions, 31 tobacco use in the past 30 days before study entry, and the following in the past 6 months before study entry: health insurance (receipt of Medicaid, Medicare, health insurance from a job or family member_s job, or any other health benefits plan that paid for medical care expenses), injection drug use, past physical or sexual abuse, 32 buying or selling of sex, any homelessness (one or more nights in a shelter or on the street), and persistent homelessness (921 days in a shelter or on the street). Receipt of primary care (yes/no) since the last research interview was assessed by a series of detailed questions and was entered as a time-varying covariate.…”

Primary Care After Psychiatric Crisis: A Qualitative Analysis

“…[1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders.…”

Co-morbidity is the norm, not the exception: chronic respiratory diseases in chronic drug users

“…The article by Gallagher et al 1 in this issue of the PCRJ is of particular interest, not least because the authors studied 26 adolescents (aged 13 to 19 years) at risk for anaphylaxis and did not find the "rebel without a cause" mentality as the dominant reason why this age group is three to four times more likely to die than children because they take risks and have accidents. 2 The movie, "Rebel Without a Cause", starring James Dean, was released by Warner Bros on 27th October 1955, less than one month after the famous actor's fatal car crash.…”

“…3 Among alcohol or drug dependent patients on the opposite end of the socioeconomic spectrum in the USA -those without primary care who were entering residential detoxification -45% reported having a chronic medical illness. 1 One third of a comparable group reported being in fair or poor health. 4 Thus, it is fair to say that co-morbidity, among the socioeconomic spectrum of chronic drug users in care, is the norm, not the exception.…”

“…1,2 Mertens et al documented the high prevalence of chronic medical conditions and its associated significant morbidity among insured patients in a specialty alcohol and drug treatment clinic. 3 Among alcohol or drug dependent patients on the opposite end of the socioeconomic spectrum in the USA -those without primary care who were entering residential detoxification -45% reported having a chronic medical illness.…”