Annals of Emergency Medicine 2014;64(5)516–525. [doi: 10.1016/j.annemergmed.2014.05.012]
Wendy L. Macias Konstantopoulos, MD, MPH (Massachusetts General Hospital, NEC Node), Jessica A. Dreifuss, PhD (McLean Hospital, NEC Node), Katherine A. McDermott (McLean Hospital, NEC Node), Blair Alden Parry (Massachusetts General Hospital, NEC Node), Melissa L. Howell (Massachusetts General Hospital, NEC Node), Raul N. Mandler, MD (National Institute on Drug Abuse (NIDA)), Garrett M. Fitzmaurice, ScD (Harvard School of Public Health, NEC Node), Michael P. Bogenschutz, MD (University of New Mexico, SW Node), Roger D. Weiss, MD (McLean Hospital, NEC Node).
Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. This secondary analysis of data from the National Drug Abuse Treatment Clinical Trials Network protocol CTN-0047 (Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED)) aimed to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment.
Using previously validated tests, 15,224 adult ED patients across 6 academic institutions were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included. Self-reported variables related to demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use. Of the 3,240 patients, 2,084 (64.3%) met criteria for problematic drug use (Drug Abuse Screening Test score >= 3). Age greater than or equal to 30 years, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary noncannabis drug use, resource-intense ED triage level, and perceived drug-relatedness of ED visit were highly correlated with problematic drug use. Among primary cannabis users, correlates of problematic drug use were age younger than 30 years, tobacco smoking, binge drinking, daily drug use, and perceived relatedness of the ED visit to drug use. A brief clinical decision tool, developed as part of this study, demonstrated an 88% positive predictive value and would allow clinicians to more rapidly determine whether detailed assessment for a drug problem is indicated in a patient who has used any drug in the past 30 days.
Conclusions: The higher emergency department utilization and hospital admission rates among ED patients with unmet substance abuse treatment needs argue for greater attention to the development of multidisciplinary, cost-effective ways to support ED-based substance use screening, intervention, and referral to treatment. The correlation between problematic drug use and resource-intense ED triage levels in this analysis offers further evidence that ED patients with unmet substance abuse treatment needs incur higher health care costs than their counterparts, and highlights the potential opportunity for decreasing overall health care cost by identifying those patients who are at highest risk of problematic drug use and referring them to treatment. The screening and clinical decision rule proposed here provides a rapid and simple method of identifying patients on whom more comprehensive ED-based SBIRT should be focused as part of emergency care practice. This research and future cost-effectiveness research could inform policy and resource allocation for the advancement of ED-based drug abuse mitigating-activities. (Article (Peer-Reviewed), PDF, English, 2014)
Keywords: Alcohol | Brief intervention | CTN platform/ancillary study | Emergency departments | Marijuana | Screening, Brief Intervention, Referral to Treatment (SBIRT) | Smoking | Annals of Emergency Medicine (journal)
Document No: 1067, PMID: 24999283, PMCID: PMC4252835.
Submitted by Jack Blaine, MD (NIDA), 7/8/2014.