Use of the urine drug screen in psychiatry emergency service 2

Routine Drug Screening for Patients in the Emergency Department of a State Psychiatric Hospital: A Naturalistic Cohort Study

OBJECTIVE

This study investigates the proportion of drug users among patients with mental disorders who attended the emergency department of one major psychiatric hospital in Northern Israel, the most frequent psychiatric diagnoses associated with drug use, and the impact of confirmed drug use on hospital admission. We hypothesized that the proportion of individuals with positive urine drug test results presenting at the psychiatric emergency department during the study period would be 20% to 30%.

METHODS

An unselected cohort of 2,019 adult patients who visited the emergency department of Sha'ar Menashe Mental Health Center, a university-affiliated government facility, was evaluated and underwent routine urine drug testing between April 2012 and February 2014. Clinical, demographic, and urine drug test data were collected from medical records and statistically analyzed, comparing diagnostic evaluation at admission and after discharge from either the emergency department or the hospital. Univariate and logistic regression analyses were used to identify the possible variables associated with drug use in this sample.

RESULTS

Urine drug test results showed that 194 of the 2,019 subjects (9.6%) had used a psychoactive substance before attending the emergency department. Among patients with positive urine drug test results, the majority (77.8%) used cannabis, 25.8% used opiates, 24.7% used ecstasy, and 5.2% used cocaine. Differences in the prevalence of positive urine drug test results between admitted and nonadmitted patients did not reach a statistically significant level. The frequency of positive urine drug test results across lifetime International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnoses was 27.2% for substance-related disorders, 4.8% for psychotic disorders, 4.2% for mood disorders, 11.0% for personality disorders, and 11.5% for nonpsychotic disorders. Both univariate and logistic regression analyses revealed that younger age (18-40), male sex, fewer years of education, single marital status, and ICD-10 diagnosis of substance-related, personality, and nonpsychotic disorders were indicators of higher likelihood of positive urine drug test findings.

CONCLUSIONS

Results suggest that routine urine toxicology screening is not necessary in the psychiatric emergency department as an adjunct to a thorough psychiatric clinical examination. However, urine drug tests should be performed when the clinical evaluation cannot determine whether the mental disorder is the result of illicit drug use or clearly non-drug-related.