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Koura S, White A, Masdon J, Brewer KL, Parker‐Cote JL, Meggs WJ. Retrospective chart review of substance abuse in patients with psychiatric emergencies in an emerging urban county. J Am Coll Emerg Physicians Open 2023; 4:e13028. [PMID: 37600902 PMCID: PMC10435894 DOI: 10.1002/emp2.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/07/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives Substance abuse is common in patients with psychiatric emergencies. To further understand the connection between substance abuse and psychiatric disorders, a retrospective chart review was done that included positive drug screens among patients with psychiatric emergencies and to determine whether there was an association between substances used and the psychiatric diagnosis. Methods A retrospective chart review of patients seen in an emergency department with psychiatric emergencies was conducted. The review comprised 1000 charts with diagnoses of anxiety, depression, schizophrenia, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, alcohol abuse, or schizoaffective disorder. Data collected included patient demographics, tobacco abuse, chief complaint, arrival mode, voluntary versus involuntary status, suicide attempt on presentation, psychiatric diagnoses, urine drug screen, and ethanol results. Chi-square statistical analysis was conducted to examine the relationship between substances of abuse and psychiatric diagnoses. Results Approximately 58% of patients with a history of psychiatric illness had a positive urine drug screen. Of 245 patients with schizoaffective disorder, 69 (28%) were positive for tetrahydrocannabinol (THC) and 48 (20%) were positive for cocaine. Of 225 patients with depression, 59 (29%) were positive for THC and 33 (15%) were positive for cocaine. Cannabis was the most commonly reported substance used among patients with depression, schizophrenia, anxiety, schizoaffective disorder, and bipolar disorder, and ethanol was most common in patients with ADHD. No significant correlations were found between psychiatric diagnosis and positive drug screens. A statistically significant secondary end point was found that White people using cannabinoids were more likely to attempt suicide than were African American people (P = 0.02). Conclusions Positive drug screens were common among patients presenting to an ED with psychiatric emergencies. Cannabis was the most commonly reported substance used among patients independent of diagnosis. Ethanol was the most common in patients with ADHD. Urine drug screens are unlikely to provide insights into relationships between specific substance use and psychiatric emergencies.
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Affiliation(s)
- Simran Koura
- Department of Emergency MedicineGreenvilleNorth CarolinaUSA
| | - Avian White
- Department of Public HealthBrody School of medicine at East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Joshua Masdon
- Department of Emergency MedicineGreenvilleNorth CarolinaUSA
| | - Kori L. Brewer
- Department of Emergency MedicineGreenvilleNorth CarolinaUSA
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Ali ZA, Sanders B, El-Mallakh R, Mathews M, Brown S. Treatment of Amphetamine-Induced Truman Show Delusion and Delusional Parasitosis with High-Dose Ziprasidone. Harv Rev Psychiatry 2023; 31:202-207. [PMID: 37437252 DOI: 10.1097/hrp.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Ziad A Ali
- From Department of Psychiatry, University of Kentucky College of Medicine, Lexington, KY (Drs. Ali, Sanders, and Brown); Department of Psychiatry, The Medical Center at Bowling Green, Bowling Green, KY (Drs. Ali, Sanders, and Brown); Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY (Dr. El-Mallakh)
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Clifford E, Kilgore PCSR, Cvek U, Trutschl M, Baker S, Conrad SA, Arnold T, Korneeva N. Trends in drug use among young adult females: a 22-year retrospective analysis. TOXICOLOGY COMMUNICATIONS 2022. [DOI: 10.1080/24734306.2022.2110201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Eric Clifford
- Department of Computer Science, Louisiana State University, Shreveport, LA, USA
| | | | - Urska Cvek
- Department of Computer Science, Louisiana State University, Shreveport, LA, USA
| | - Marjan Trutschl
- Department of Computer Science, Louisiana State University, Shreveport, LA, USA
| | - Stephen Baker
- Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Steven A. Conrad
- Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Thomas Arnold
- Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Nadejda Korneeva
- Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Tolan NV, Terebo T, Chai PR, Erickson TB, Hayes BD, Uljon SN, Petrides AK, Demetriou CA, Melanson SEF. Impact of marijuana legalization on cannabis-related visits to the emergency department. Clin Toxicol (Phila) 2021; 60:585-595. [DOI: 10.1080/15563650.2021.2012576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tolumofe Terebo
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Timothy B. Erickson
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Bryan D. Hayes
- Harvard Medical School, Boston, MA, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sacha N. Uljon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Athena K. Petrides
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Stacy E. F. Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Lockwood TLE, Huynh P, Richard A, Sightes E, Bailey K, Ray B, Lieberman M. Community overdose surveillance: Comparing substances collected from the death scene investigation to toxicology results. Drug Alcohol Depend 2021; 224:108722. [PMID: 33932743 PMCID: PMC8180509 DOI: 10.1016/j.drugalcdep.2021.108722] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent overdose trends are characterized by increased toxicological detection of stimulants with opioids, yet it is unclear whether these substances are mixed prior to consumption or purposefully used simultaneously. METHODS Postmortem toxicology data were collected in Marion County, Indiana, from 45 fatal overdose cases involving heroin, fentanyl, methamphetamine, or cocaine. Substances found by death scene investigators at the scene of the fatal overdose (57 samples) were tested using high-pressure liquid chromatography mass-spectrometry (LC-MS) technology. We compared toxicology and LC-MS results to understand whether substances contributing to overdose were found in combination or separately at the scene of the overdose. RESULTS Comparing toxicology reports with LC-MS results from substances found at the scene of overdose deaths involving opioids and stimulants reveal that deaths are largely the result of the co-use of opioids and stimulants, rather than use of stimulants combined with opioids. CONCLUSIONS Collecting and testing physical samples from fatal overdose scenes and comparing these to post-mortem toxicology results is a new way to examine polydrug use patterns. This community overdose surveillance method can be used to improve overdose prevention and response efforts.
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Affiliation(s)
- Tracy-Lynn E Lockwood
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States
| | - Philip Huynh
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Alex Richard
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Katie Bailey
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Bradley Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, 48202, United States
| | - Marya Lieberman
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, 46556, United States.
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Keller MS, Jusufagic A, Nuckols T, Needleman J, Heilemann M. How Do Clinicians of Different Specialties Perceive and Use Opioid Risk Mitigation Strategies? A Qualitative Study. Subst Use Misuse 2021; 56:1352-1362. [PMID: 34027814 PMCID: PMC8667780 DOI: 10.1080/10826084.2021.1926514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In response to the opioid crisis, states and health systems are encouraging clinicians to use risk mitigation strategies aimed at assessing a patient's risk for opioid misuse or abuse: opioid agreements, prescription drug monitoring programs (PDMPs), and urine drug tests (UDT). Objective: The objective of this qualitative study was to understand how clinicians perceived and used risk mitigation strategies for opioid abuse/misuse and identify barriers to implementation. Methods: We interviewed clinicians who prescribe opioid medications in the outpatient setting from 2016-2018 and analyzed the data using Constructivist Grounded Theory methodology. Results: We interviewed 21 primary care clinicians and 12 specialists. Nearly all clinicians reported using the PDMP. Some clinicians (adopters) found the opioid agreement and UDTs to be valuable, but most (non-adopters) did not. Adopters found the agreements and UDTs helpful in treating patients equitably, setting limits, and having objective evidence of misuse; protocols and workflows facilitated the use of the strategies. Non-adopters perceived the strategies as awkward, disruptive to the clinician-patient relationship, and introducing a power differential; they also cited lack of time and resources as barriers to use. Conclusions: Our study demonstrates that clinicians in certain settings have found effective ways to implement and use the PDMP, opioid agreements, and UDT but that other clinicians are less comfortable with their use. Administrators and policymakers should ensure that the strategies are designed in a way that strengthens the clinician-patient relationship while maximizing safety for patients and that clinicians are adequately trained and supported when introducing the strategies.
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Affiliation(s)
- Michelle S. Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alma Jusufagic
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Teryl Nuckols
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California
| | - MarySue Heilemann
- UCLA School of Nursing, University of California-Los Angeles, Los Angeles, California
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