Emergency department presentations of alcohol and other substance misuse: first cross-sectional national study in Qatar

National study comparing psychiatric presentations among migrants and citizens in Qatar

Arab countries host 10 % of the global migrant population, yet research on the mental health of migrant workers within this region is notably lacking. Addressing this gap, our study marks the inaugural nationwide investigation into psychiatric conditions among migrant workers compared to native Qatari citizens in an inpatient setting. Employing a retrospective cohort methodology, we scrutinized psychiatric presentations among two cohorts: migrant workers (cohort 1) and Qatari nationals (cohort 2) admitted to psychiatric inpatient facilities in Qatar. Our sample comprised 150 migrant workers and 138 Qatari inpatients, with a predominance of males in both cohorts and mean ages around 34-35 years. The median length of hospitalization was 13 days for migrant workers and 14 days for Qatari patients. Qatari inpatients exhibited a higher prevalence of prior psychiatric history and comorbid physical conditions. The primary diagnosis upon discharge for approximately one-third of patients in both groups was schizophrenia spectrum and other psychotic disorders, with bipolar disorder representing roughly one-quarter of cases in each cohort. Notably, migrant workers demonstrated a higher incidence of depressive disorders, trauma, and stress-related conditions, while Qatari patients were more frequently diagnosed with substance use disorder and displayed aggressive behaviors.

Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country

BACKGROUND

Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption.

METHODS

This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as "negative", and BAC >2.2 mmol/L was referred to as "BAC positive". A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied.

RESULTS

A total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%-85.3%), and the test positivity rate was 10% (8.6%-12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS.

CONCLUSION

Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.

False Positive Tramadol Urine Testing in Patients Taking Fexofenadine: A Tale of Two Consecutive Cases

Urine drug screen immunoassays have been widely used as point-of-care testing for detection of various drug classes in substance use disorders. However, these immunoassays frequently result in false positive results. We report two patients that used 180 mg daily dose of fexofenadine hydrochloride for treatment of skin allergy and, falsely, tested positive for use of tramadol during urine drug screening. We recommend caution when interpreting positive tramadol urine screening among patients on fexofenadine treatment.

Policy and legislation for the treatment of mental health and substance use disorders in Qatar

There is a marked paucity of publications on the policy and legislation of mental health, and substance use disorders in the public domain in Qatar. Qatar National Vision provides a framework for national strategies and the State of Qatar has developed policies and legislation dedicated to mental health and substance use. In doing so, Qatar has adopted international guidance to shape its mental health services and relevant policy and legislation. This article is a narrative description of the evolution of the mental health and substance use policy and legislation in Qatar.

Evolution of policy for the treatment of substance use disorders in Qatar

There is a marked paucity of published evidence on the extent and nature of substance use disorders in the State of Qatar. This is mirrored by a dearth of information on the policy for the treatment of substance use disorders in the public domain. Between 2007 and 2017, substance use disorders have risen from the third to leading cause of disability in Qatar. More recently, Qatar has shifted from applying a punitive only paradigm in managing substance use problems to recognizing the role of treatment and care for people with substance use disorders. Recently published official documents in Qatar define addiction as a disease and as a chronic condition where people with substance use disorders should be treated as patients who need care and assistance. This shifts the onus of providing, and developing services, for individuals with substance use disorders with healthcare providers rather than purely with the criminal justice system. Following cabinet approval, the recently established Permanent Committee for Addiction Treatment headed by the Minister of Public Health, signals the need to institutionalize systems and structures to upscale demand reduction programmes in the country. This article is a descriptive examination of the shifts in substance abuse treatment policy in Qatar, the major factors influencing this evolution, and will utilise some of the policy science theories to describe and analyse policy outcomes. The article will also frame the substance use problem in Qatar for the first time, based on documents published by various government organisations.