Evaluating the impact of an emergency department protocol that guides management of methamphetamine-induced agitation and psychosis

Abstract

Background Methamphetamine is an addictive stimulant that may induce symptoms of agitation and psychosis. The estimated rate of methamphetamine use is 6.6 per 1000 people. Currently, no treatment guidelines exist to support the optimal management of patients presenting with methamphetamine-induced agitation. Emergency department (ED) providers may prescribe various benzodiazepines (BZDs) and antipsychotics (APs) as first-line agents to stabilize these agitated patients. This study aims to determine the effectiveness of a protocol to guide management of this condition. Methods This was a retrospective, pre- and poststudy conducted from July 2020 to March 2021 at a large academic medical center. A multidisciplinary protocol was designed to help manage methamphetamine-induced agitation in the ED. The primary outcome of the study was a reduction in the number of BZDs and APs used for the treatment of methamphetamine-induced agitation. This was measured by the incidence of overprescribing, defined as 3 or more APs or BZDs administered within 30 minutes. Secondary outcomes included the use of physical restraints, ED length of stay, and adverse events. Results We did not observe a significantly lower incidence of overprescribing, adverse events, or ED length of stay when comparing pre- and postprotocol groups. A subgroup analysis demonstrated that when protocol was followed, there was a statistically significant reduction in overprescribing (P = .001). Discussion We did not find any differences among our primary and secondary outcomes, which may be attributed to protocol nonadherence. Full compliance to the protocol may reduce the rate of overprescribing APs or BZDs in patients with methamphetamine-induced agitation.

Evaluation of the BEAT Meth Intervention for Emergency Department Patients with Methamphetamine Psychosis

“…A recent evaluation of a medication algorithm for treating methamphetamine-induced agitation in the ED did not show a reduction in overall medication burden, and the investigators did not study outcomes related to subsequent treatment engagement or addiction recovery. 6 We describe and evaluate a pilot intervention to treat patients with MIP called Beginning Early and Assertive Treatment for Methamphetamine Psychosis (BEAT Meth). This evaluation describes the implementation of BEAT Meth and initial patient outcomes in a safety net hospital and health system.…”

“…Patients present to EDs for medical illness; psychiatric symptoms, including paranoia and hallucinations; and violence and agitation. Patients often require intensive management and experience coercive interventions such as physical and chemical restraint 5,6 . Methamphetamine use disorder is correlated with high rates of psychosis, mood symptoms, suicidality, and ongoing ED utilization 7–9 .…”

“…Patients often require intensive management and experience coercive interventions such as physical and chemical restraint. 5,6 Methamphetamine use disorder is correlated with high rates of psychosis, mood symptoms, suicidality, and ongoing ED utilization. [7][8][9] A methamphetamine use diagnosis is also associated with higher mortality after ED discharge.…”

“…These interventions generally combine active psychological and pharmacotherapeutic management during the ED visit and enhanced care coordination to connect patients to postdischarge care. A recent evaluation of a medication algorithm for treating methamphetamine-induced agitation in the ED did not show a reduction in overall medication burden, and the investigators did not study outcomes related to subsequent treatment engagement or addiction recovery 6 …”