Prevalence of illicit substance use among patients presenting to the emergency department with acute behavioural disturbance: Rapid point‐of‐care saliva screening

Abstract

Objective: To determine the prevalence of illicit substance use among patients presenting to one ED with acute behavioural disturbance using point-of-care saliva testing. Methods: A prospective observational study was conducted. Acute behavioural disturbance was defined as any episode requiring a security response for unarmed threat (Code Grey). The setting was a single ED and tertiary referral centre located in metropolitan Australia. Participants were adults presenting to the ED requiring a Code Grey. Saliva was analysed for meth/amphetamine, cannabis, cocaine and opiates using a rapid point-of-care test. Self-reported drug use was recorded at the time of saliva testing. Data collection occurred between August 2016 and March 2017. Results: There were 229 valid saliva samples. Participants were, on average, 35 years (range 18-72) and male (168/229; 73%). Forty percent (95% confidence interval 34-47) of samples tested positive, with 20% positive for two or more substances. Meth/ amphetamines was detected in 92% of positive samples, 17% of samples tested positive for opiates, 8% for cannabis and 7% for cocaine. Among participants, 19% selfreported current substance use and 20% reported using illicit substances within the past 24 h. Conclusions: The prevalence of illicit substance use among this cohort was 40%. Self-reporting was unreliable. Pointof-care saliva testing is feasible. Early identification of harmful drug use may assist clinical decision making in selected or undifferentiated cases and provide an opportunity to implement harm minimisation strategies and make referrals.

Amphetamine‐type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes

“…This was a prospective observational study of prevalence and referral patterns undertaken in a behavioural assessment unit (BAU). Two previous studies informed the research design: An evaluation of the BAU model of care (Braitberg et al, 2018) and A prospective study of prevalence of illicit substance use among individuals presenting to the ED with acute behavioural disturbance using POC saliva testing (Gerdtz et al, 2019). …”

“…Point‐of‐care saliva testing and self‐report were selected outcome measures for this research on the basis of an earlier study of prevalence of illicit substance use among patients presenting to the ED requiring a security response within four hours of arrival (Gerdtz et al, 2019). In this earlier study, individuals who presented to the ED and required a security response for unarmed treat (code grey) were tested for cannabis, amphetamine‐type stimulants (including MDMA, ecstasy), cocaine, and opiates using the Securetec DrugWipe ® 5S POC saliva test.…”

“…Lower prevalence rates have been observed in studies using self‐report methods (5.7%) when compared to those studies that used toxicological analysis of urine (22.8%) (Sibanda et al, 2019). This finding suggests that self‐reported drug use may be a less reliable method of detection than biological measures (urinalysis or saliva testing) (Gerdtz et al, 2019).…”

“…Urinalysis provides a window of detection between 24 and 72 hours for amphetamine‐type stimulants (Rouen et al, 2001). In practice, this approach to screening can be difficult to implement when individuals are uncooperative or unable to produce a urine sample (Gerdtz et al, 2019).…”

“…Point‐of‐care (POC) saliva testing offers a more immediate window of detection between 1 and 24 hours for amphetamine‐type stimulants (Wille et al, 2010). The feasibility of this approach has been demonstrated in roadside drug testing (Blencowe et al, 2011; Musshoff et al, 2014; Wille et al, 2010), nightlife settings (Gripenberg‐Abdon et al, 2012), and most recently in the ED (Gerdtz et al, 2019).…”