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Makutonin M, Ramdin C, Meltzer A, Mazer-Amirshahi M, Nelson L. Concurrent Alcohol and Opioid Intoxication in Emergency Department Patients Leads to Greater Resource Utilization. Subst Use Misuse 2024; 59:616-621. [PMID: 38192231 DOI: 10.1080/10826084.2023.2294963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: Concurrent alcohol intoxication can complicate emergency department (ED) presentations for opioid-related adverse events. We sought to determine if there was a difference in resource utilization among patients who presented to the ED with concurrent opioid and alcohol intoxication compared to opioid intoxication alone. Methods: Using linked state-wide databases from the Maryland Healthcare Cost and Utilization Project (HCUP), we identified patients with a diagnosis of opioid intoxication treated in the ED from 2016 to 2018. We measured healthcare utilization for each patient in the ED settings for one year after the initial ED visit and estimated direct costs. We performed logistic regression comparing patients presented with co-intoxication to those without. Results: Of 12,295 patients who presented to the ED for opioid intoxication during the study period, 703 (5.7%) had concurrent alcohol intoxication. Patients with co-intoxication had more recurrent ED visits (340 vs 247.4 per 1000 patients, p < 0.05), higher index ED visit admission rates (26.9% vs 19.4%, p < 0.001), but similar overall costs ($3736 vs $2861, p < 0.05) at one year. Co-intoxication was associated with suicidal ideation (OR = 1.58, 95% CI 1.51-1.65), high zip code income (OR = 1.16, 95% CI 1.12-1.21), and higher rates of intoxication with all classes of drugs analyzed (p < 0.001). Conclusion: Our study demonstrated that mental health disorders, socioeconomic status, and increased ED utilization are associated with co-intoxication of opioids and alcohol presenting to the ED. Further research is needed to elucidate factors responsible for the increased resource use in this population.
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Affiliation(s)
- Michael Makutonin
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Christine Ramdin
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Andrew Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Romero-Rodríguez E, Amezcua-Prieto C, Morales Suárez-Varela M, Ayán-Pérez C, Mateos-Campos R, Martín-Sánchez V, Ortíz-Moncada R, Redondo-Martín S, Alguacil Ojeda J, Delgado-Rodríguez M, Blázquez Abellán G, Alonso-Molero J, Cancela-Carral JM, Valero Juan LF, Fernández-Villa T. Patterns of Alcohol Consumption and Use of Health Services in Spanish University Students: UniHcos Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6158. [PMID: 35627695 PMCID: PMC9141368 DOI: 10.3390/ijerph19106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
The aim of the study was to examine the association of alcohol consumption patterns (hazardous alcohol use and binge drinking) and the use of emergency services and primary care consultations in university students. An observational, descriptive, cross-sectional study was conducted at eleven Spanish universities collaborating within the uniHcos Project. University students completed an online questionnaire that assessed hazardous alcohol use and binge drinking using the AUDIT questionnaire and evaluated the use of emergency services and primary care. A descriptive analysis of the data was performed, as well as the chi-squared test and Student’s t-test and nonconditional logistic regression models to examine this association. Results: There were 10,167 participants who completed the questionnaire. The prevalence of hazardous alcohol use was 16.9% (95% CI: 16.2−17.6), while the prevalence of binge drinking was 48.8% (95% CI: 47.9−49.8). There were significant differences in the use of emergency services in those surveyed with hazardous alcohol use (p < 0.001) or binge drinking pattern (p < 0.001). However, no significant differences were observed in terms of attendance during primary care visits in individuals with hazardous alcohol use (p = 0.367) or binge drinking pattern (p = 0.755). The current study shows the association between university students with a pattern of hazardous alcohol use or binge drinking and greater use of emergency services. However, no significant association was observed between the said consumption patterns and the use of primary care services.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, 14001 Cordoba, Spain;
| | - Carmen Amezcua-Prieto
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
| | - María Morales Suárez-Varela
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain
| | - Carlos Ayán-Pérez
- Well-Move Research Group, Department of Special Didactics, University of Vigo, 36310 Vigo, Spain;
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - Vicente Martín-Sánchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Biomedical Sciences, University of León, 24071 León, Spain
- The Research Group in Gene-Environment and Health Interactions, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Rocío Ortíz-Moncada
- Public Health Research Group, Food and Nutrition Research Group, University of Alicante, 03550 Alicante, Spain;
| | - Susana Redondo-Martín
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain;
| | - Juan Alguacil Ojeda
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain;
| | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Gemma Blázquez Abellán
- Department of Medical Sciences, School of Pharmacy, University of Castilla-La Mancha, 02008 Albacete, Spain;
| | - Jéssica Alonso-Molero
- Department of Preventive Medicine and Public, University of Cantabria-IDIVAL, 39008 Santander, Spain;
| | - José María Cancela-Carral
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain;
- Department of Specials Didactics, University of Vigo, 36310 Vigo, Spain
| | - Luis Félix Valero Juan
- Area of Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - Tania Fernández-Villa
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Biomedical Sciences, University of León, 24071 León, Spain
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Marshall B, McGlynn E, King A. Sobering centers, emergency medical services, and emergency departments: A review of the literature. Am J Emerg Med 2020; 40:37-40. [PMID: 33340876 DOI: 10.1016/j.ajem.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute alcohol intoxication accounts for a large proportion of potentially unnecessary emergency department visits and expenditure. Sobering centers are a cheaper alternative treatment option for alcohol intoxication and can provide an opportunity to treat the psychosocial aspects of alcohol use disorder. OBJECTIVE OF THE REVIEW The objective of this review is to analyze the existing literature regarding the use of sobering centers, EMS and their role in transporting to sobering centers, and the appropriate triage of the intoxicated patient. DISCUSSION Excessive alcohol consumption accounts for an estimated $24.6 billion in healthcare costs and patients are often referred to the emergency department for expensive care. Current literature suggests sobering centers are an alternative to acute hospitalization and are safe, relatively inexpensive, and may facilitate more aggressive connection to resources such as longitudinal rehabilitation programs for the acutely intoxicated patient. EMS plays a pivotal role in triage and transportation of intoxicated individuals, but demonstration of outcomes in lacking. CONCLUSIONS Sobering centers are a cost effective alternative to emergency department visits for acute alcohol intoxication and further research is required to identify safe, effective protocols for EMS to triage patients to appropriate treatment destinations.
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Affiliation(s)
- Brandon Marshall
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
| | - Erin McGlynn
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
| | - Andrew King
- Department of Emergency Medicine, Detroit Receiving Hospital, 4201 St. Antoine Street, UHC Suite 6F, Detroit, MI 48201, USA.
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