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Choi NG, Moore J, Choi BY. Cannabis use disorder and substance use treatment among U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209486. [PMID: 39151799 DOI: 10.1016/j.josat.2024.209486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Recent expansion of cannabis legalization in multiple states calls for reexamination of the prevalence of cannabis use, cannabis use disorder (CUD), and the associations between CUD severity and substance use treatment. We used Andersen's behavioral model of healthcare use as the conceptual/analytic framework for examining treatment use. METHODS We used data from the 2022 National Survey on Drug Use and Health (NSDUH; N = 47,100, age 18+) to describe the prevalence of past-year cannabis use, CUD and CUD severity, other substance use disorders, and substance use treatment. We compared sociodemographic, mental health, healthcare use, and cannabis and other substance use characteristics by CUD severity. Finally, we used logistic regression models to examine the associations between CUD severity and substance use treatment. RESULTS Of the U.S. adult population, 23.0 % used cannabis in the past year; 7.0 % had a CUD (3.9 % mild, 1.9 % moderate, and 1.2 % severe CUD); and 4.7 % received substance use treatment. Of past-year cannabis users, 30.3 % had CUD (16.9 % mild, 8.4 % moderate, and 5.0 % severe CUD), and 9.6 % received substance use treatment. Cannabis users had 3-4 times higher rates of other substance use disorders than nonusers. Of those with CUD, 38.4 % had moderate/severe mental illness, 52.4 % had other substance use disorders, and 16.5 % received substance use treatment. Among all cannabis users, moderate (aOR [adjusted odds ratios] = 1.48, 95 % CI = 1.03-2.13) and severe (aOR = 2.57, 95 % CI = 1.60-4.11) CUDs were associated with greater odds of substance use treatment. Among cannabis users without nicotine dependence and alcohol, opioid, tranquilizer/sedative, and stimulant use disorders, only severe CUD (aOR = 6.03, 95 % CI = 3.37-10.78) was associated with greater odds of substance use treatment. CONCLUSIONS This study shows increased prevalence of cannabis use and CUD among U.S. adults, and with or without other substance use disorders, CUD was associated with greater odds of substance use treatment. However, the overall low rate of treatment use among those with CUD is concerning. Healthcare providers need to provide education for both medical and recreational users on the development of tolerance and dependence. Harm reduction strategies to minimize the negative consequences of CUD are also needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.
| | - John Moore
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Rosic T, Cloutier P, Myran D, Imsirovic H, Kurdyak P, Gardner W. Physician Follow-Up of Pediatric and Young Adult Emergency Department Visits for Substance Use in Ontario, Canada. J Adolesc Health 2024:S1054-139X(24)00303-3. [PMID: 39140931 DOI: 10.1016/j.jadohealth.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/08/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth. METHODS We examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10-24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit. RESULTS Between April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17). DISCUSSION Youth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care.
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Affiliation(s)
- Tea Rosic
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Daniel Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Paul Kurdyak
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Simon EL, Abbomerato M, Patel M, Kaylor T, Sanchez J, Krizo J. Virtual access to recovery services for substance use disorder in the emergency department. Am J Emerg Med 2024; 79:225-227. [PMID: 38072731 DOI: 10.1016/j.ajem.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave. Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA.
| | - Micaela Abbomerato
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave. Akron, OH 44307, USA
| | - Mili Patel
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave. Akron, OH 44307, USA
| | - Tammy Kaylor
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave. Akron, OH 44307, USA
| | - Jonathan Sanchez
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave. Akron, OH 44307, USA
| | - Jessica Krizo
- Cleveland Clinic Akron General, Department of Health Sciences, Akron, OH 44307, USA
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Watson DP, Swartz JA, Magee LA, Bray BC, Phalen P, Medcalf S, McGuire AB. Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209282. [PMID: 38135121 PMCID: PMC11060927 DOI: 10.1016/j.josat.2023.209282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/23/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND People with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns. METHOD A retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes. RESULTS The study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED. CONCLUSION Results highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients.
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Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, 221 W. Walton Street, Chicago, IL 60610, USA.
| | - James A Swartz
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison Street, Chicago, IL 60607, USA
| | - Lauren A Magee
- Paul H. O'Neill School of Environmental and Public Affairs, Indiana University - Purdue University Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46202, USA
| | - Bethany C Bray
- Institute for Health Research and Policy, The University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Spencer Medcalf
- Indiana University Health, 950 N Meridian Street, Suite 900, Indianapolis, IN 46204, USA
| | - Alan B McGuire
- Indiana University Richard M. Fairbanks School of Public Health, Department of Social and Behavioral Sciences, 1050 Wishard Boulevard, Indianapolis, IN 46202, USA; Richard L. Roudebush VAMC, Health Services Research and Development, 1481 W. 10(th) Street (11H) Room C8108, Indianapolis, IN 46202, USA
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Schuler MS, Seney V. "It's My Secret": Shame as a Barrier to Care in Individuals With Opioid Use Disorder. J Am Psychiatr Nurses Assoc 2024; 30:456-464. [PMID: 38581184 DOI: 10.1177/10783903241242748] [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: 04/08/2024]
Abstract
BACKGROUND Substance use disorder (SUD) is a chronic illness impacting more than 59 million Americans last year. Opioid use disorder (OUD) is a subset of SUD. The literature supports that healthcare providers frequently stigmatize patients with OUD. Individuals with OUD often feel shame associated with their disorder. Shame has been associated with maladaptive and avoidant behaviors. AIM The aim of this qualitative descriptive study was to examine and describe the experiences of shame and health-seeking behaviors in individuals with OUD. METHODS A qualitative exploratory design using focus groups with individuals in treatment for OUD was used to identify the issue of shame and its relationship to health-seeking behaviors. RESULTS A systematic content analysis of discussions with 11 participants in four focus groups revealed four major themes and associated subthemes: Avoidance of Preventive Care (belief providers are judgmental); the Hidden Disorder (keeping secrets); Constraints of Shame (justification for the continuation of drug usage); and Trust in MOUD (Medication for Opioid Use Disorder) Providers. The feeling of shame leads to a reluctance to engage in health-promoting actions, such as scheduling appointments with primary care providers and dentists. CONCLUSION Healthcare practitioners must prioritize providing a safe, nonstigmatizing environment for patients with SUD/OUD. This includes establishing trust and rapport, providing education, collaboration with psychiatric mental health specialists and other healthcare providers, and the offering support and resources to help patients manage their condition to achieve optimal health outcomes.
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Affiliation(s)
- Monika S Schuler
- Monika S. Schuler, PhD, FNP-BC, CNE, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Valerie Seney
- Valerie Seney, PhD, MA, LMHC, PMHNP-BC, University of Massachusetts, North Dartmouth, MA, USA
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Touali R, Chappuy M, Berger-Vergiat A, Deletoille M, Ragonnet D, Rochet T, Poulet E, Tazarourte K, Haesebaert J, Michel P, Rolland B. Screening problematic use of substances among young subjects attending an emergency department, and subsequent treatment seeking. L'ENCEPHALE 2024; 50:170-177. [PMID: 37331923 DOI: 10.1016/j.encep.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Young individuals constitute a key population for the screening of problematic use of substances (PUS), but they are not likely to seek support and are hard to reach. Targeted screening programs should thus be developed in the places of care they may attend for other reasons, including emergency departments (EDs). We aimed to explore the factors associated with PUS in young people attending an ED; we measured the subsequent access to addiction care after ED screening. METHODS This was a prospective interventional single-arm study which included any individual aged between 16 and 25 years who attended the main ED of Lyon, France. Baseline data were sociodemographic characteristics, PUS status using self-report questionnaires and biological measures, level of psychological health, and history of physical/sexual abuse. Quick medical feedback was provided to the individuals presenting a PUS; they were advised to consult an addiction unit, and contacted by phone at three months to ask whether they had sought treatment. Baseline data were used to compare PUS and non-PUS groups using multivariable logistic regressions, to provide adjusted odds ratios (aORs) and 95% confidence intervals (95% CI), with age, sex, employment status, and family environment as the adjustment variables. The characteristics of PUS subjects who subsequently sought treatment were also assessed using bivariable analyses. RESULTS In total, 460 participants were included; 320 of whom (69.6%) were presenting current substance use, and 221 (48.0%) with PUS. Compared to non-PUS individuals, PUS ones were more likely to be males (aOR=2.06; 95% CI [1.39-3.07], P<0.001), to be older (per one-year increase: aOR=1.09; 95% CI [1.01-1.17], P<0.05), to have an impaired mental health status (aOR=0.87; 95% CI [0.81-0.94], P<0.001), and to have a history of sexual abuse (aOR=3.33; 95% CI [2.03-5.47], P<0.0001). Only 132 (59.7%) subjects with PUS could be reached by phone at 3 months, among whom only 15 (11.4%) reported having sought treatment. Factors associated with treatment seeking were social isolation (46.7% vs. 19.7%; P=0.019), previous consultation for psychological disorders (93.3% vs. 68.4%; P=0.044), lower mental health score (2.8±1.6 vs. 5.1±2.6; P<0.001), and post-ED hospitalization in a psychiatric unit (73.3% vs. 19.7%; P<0.0001). DISCUSSION/CONCLUSION EDs are relevant places to screen PUS in youth, but the level of seeking further treatment needs to be substantially improved. Offering systematic screening during an emergency room visit could allow for more appropriate identification and management of youth with PUS.
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Affiliation(s)
- Rdah Touali
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France.
| | - Mathieu Chappuy
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France; CSAPA, groupement hospitalier Nord, hospices civils de Lyon, Lyon, France; Service pharmaceutique, hospices civils de Lyon, Lyon, France
| | - Aurélie Berger-Vergiat
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Marion Deletoille
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Delphine Ragonnet
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Thierry Rochet
- Service de Pédopsychiatrie, CH Le Vinatier, Bron, France
| | - Emmanuel Poulet
- Service de psychiatrie d'urgences, groupement hospitalier centre, hospices civils de Lyon, Lyon, France; Inserm U1028, CNRS UMR 5292, CRNL, université de Lyon, UCBL1, Bron, France
| | - Karim Tazarourte
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service d'accueil des urgences, groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service recherche et épidémiologie cliniques, hospices civils de Lyon, pôle santé publique, 69003 Lyon, France
| | - Philippe Michel
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service recherche et épidémiologie cliniques, hospices civils de Lyon, pôle santé publique, 69003 Lyon, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Inserm U1028, CNRS UMR 5292, CRNL, université de Lyon, UCBL1, Bron, France
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Harrison LD, Dumicho AY, Eddeen AB, Tanuseputro P, Kendall CE, Fiedorowicz JG, Rosic T, Fernando SM, McNaughton CD, Corace K, Kurdyak P, Beckerleg W, Webber C, Gardner W, Sood M, Myran DT. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. Acad Emerg Med 2024; 31:220-229. [PMID: 38097531 DOI: 10.1111/acem.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND METHODS We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models. RESULTS A total of 71,776 AYA had a first-time ED visit due to alcohol (56.1% male, mean age 20.7 years) between 2009 and 2015, representing 3.3% of the 2,166,838 AYA with an ED visit in this time period. At 1 year, there were 2396 deaths, 248 (10.3%) following an ED visit related to alcohol. First-time alcohol ED visits were associated with a threefold higher risk in mortality at 1 year (0.35% vs. 0.10%, adjusted hazard ratio [aHR] 3.07, 95% confidence interval [CI] 2.69-3.51). Mortality was associated with age 25-29 years (aHR 3.88, 95% CI 2.56-5.86), being male (aHR 1.98, 95% CI 1.49-2.62), having a history of mental health or substance use (aHR 3.22, 95% CI 1.64-6.32), cause of visit being withdrawal/dependence (aHR 2.81, 95% CI 1.96-4.02), and having recurrent ED visits (aHR 1.97, 95% CI 1.27-3.05). Trauma (42.7%), followed by poisonings from drugs other than opioids (38.3%), and alcohol (28.6%) were the most common contributing causes of death. CONCLUSION Incident ED visits due to alcohol in AYA are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation. These findings may help inform the need and urgency for follow-up care in this population.
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Affiliation(s)
- Lyndsay D Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Asnake Y Dumicho
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Primary Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Lamont Primary Health Care Research Centre, Riverside Campus Family Health Team, Ottawa, Ontario, Canada
| | - Jess G Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Candace D McNaughton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Kim Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kurdyak
- ICES Central, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Weiwei Beckerleg
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - William Gardner
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
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Avalone L, Lalane M, King C, Pfeiffer K, Linn-Walton R, Barron C. Integrating substance use peer support and screening brief intervention and referral to treatment services in the emergency department: a descriptive study of the ED leads program. Addict Sci Clin Pract 2024; 19:15. [PMID: 38419101 PMCID: PMC10902983 DOI: 10.1186/s13722-024-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The ED Leads program was introduced to 11 emergency departments (EDs) within New York City public hospitals from 2018 to 2019 to address a need for addiction support services in the ED. The purpose of this study is to (i) describe the ED Leads blended licensed-clinician and peer counselor team model in the ED at three hospitals, (ii) provide a descriptive analysis of patient engagement and referrals to substance use disorder (SUD) care post-intervention, and (iii) highlight potential barriers and facilitators to implementing the model. METHODS The program intended to combine Screening Brief Intervention and Referral to Treatment and peer support services. The authors analyzed electronic medical records data for patients encountered by ED Leads in the first 120 days of program launch. Data included the outcome of an encounter when a patient was engaged with one or both staff types, and 7-day attendance at an SUD treatment appointment when a patient accepted a referral within the 11-hospital system. RESULTS There were 1785 patients approached by ED Leads staff during the study period. Engagement differed by staff type and patient demographics, and encounter outcomes varied significantly by hospital. Eighty-four percent (N = 1503) of patients who were approached engaged with at least one staff type, and 6% (N = 86) engaged with both. Patients were predominantly male (N = 1438, 81%) with an average age of 45 (SD = 13), and enrolled in Medicaid (N = 1062, 59%). A majority (N = 801, 45%) had alcohol use disorder. Of the patients who accepted a referral within the system (N = 433), 63% received treatment services within 7 days of the ED Leads encounter, a majority at detoxification treatment (N = 252, 58%). CONCLUSIONS This study describes the potential value and challenges of implementing a blended peer counselor and licensed clinician model in the ED to provide SUD services. While teams provided a high volume of referrals and the analysis of post-intervention treatment follow up is promising, the blended team model was not fully realized, making it difficult to assess the benefits of this combined service. Further research might examine patient outcomes among ED patients who are offered services by both a peer counselor and licensed clinician.
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Affiliation(s)
- Lynsey Avalone
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA.
| | - Monique Lalane
- NYC Health + Hospitals/Bellevue, 462 1st Avenue, New York City, NY, 10016, USA
| | - Carla King
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Kayna Pfeiffer
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Rebecca Linn-Walton
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Charles Barron
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
- Mt. Sinai Ichan School of Medicine, 1 Gustave L. Levy Pl, New York City, NY, 10029, USA
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Swimmer KR, Sandelich S. Substance Use Disorder. Emerg Med Clin North Am 2024; 42:53-67. [PMID: 37977753 DOI: 10.1016/j.emc.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Substance use disorders (SUDs) present a challenge in the emergency department (ED) setting. This article provides an overview of SUDs, their clinical assessment, legal considerations in drug testing, diagnosis, and treatment approaches. SUDs are prevalent and coexist with mental health disorders, necessitating comprehensive evaluation and management. Clinical assessment involves screening tools, substance use history, and identification of comorbidities. Diagnosis relies on a thorough evaluation of substance abuse patterns and associated medical conditions. Treatment approaches encompass a multidisciplinary approach, incorporating counseling, medications, and social support. Effective management of SUDs in the ED requires a comprehensive understanding of these complex disorders.
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Affiliation(s)
- Kaitlyn R Swimmer
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Stephen Sandelich
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA; Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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Kiyokawa M, Kanja K. Database Versus Patient - Things to Consider when Utilizing the Hawai'i Prescription Drug Monitoring Program. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:29-31. [PMID: 38223465 PMCID: PMC10782391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Miki Kiyokawa
- Department of Psychiatry John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MK, KK)
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MK)
| | - Kassidy Kanja
- Department of Psychiatry John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (MK, KK)
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E, Fleury MJ. Acute care utilization and its associated determinants among patients with substance-related disorders: A worldwide systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2023; 30:1096-1113. [PMID: 37211655 DOI: 10.1111/jpm.12936] [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] [Received: 12/23/2022] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Identifying determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRDs) can improve health services to address unmet health needs. AIM The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients with SRDs. METHODS Studies in English published from January 1, 1995, to December 1, 2022, were searched on PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies. RESULTS The pooled prevalence rates of ED use and hospitalization among patients with SRDs were 36% and 41%, respectively. Patients with SRDs who were the most at risk of being both ED users and hospitalized were those (i) having medical insurance, (ii) having other drug and alcohol use disorders, (iii) having mental health disorders, and (iv) having chronic physical illnesses. A lower level of education increased the risk of ED use only. DISCUSSION To decrease ED use and hospitalization, more comprehensive services may be offered to these vulnerable patients with diversified needs. IMPLICATIONS FOR PRACTICE Chronic care integrating outreach interventions could be more provided for patients with SRDs after discharge from acute care units or hospitals.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Parks RM, Rowland ST, Do V, Boehme AK, Dominici F, Hart CL, Kioumourtzoglou MA. The association between temperature and alcohol- and substance-related disorder hospital visits in New York State. COMMUNICATIONS MEDICINE 2023; 3:118. [PMID: 37752306 PMCID: PMC10522658 DOI: 10.1038/s43856-023-00346-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Limited evidence exists on how temperature increases are associated with hospital visits from alcohol- and substance-related disorders, despite plausible behavioral and physiological pathways. METHODS In the present study, we implemented a case-crossover design, which controls for seasonal patterns, long-term trends, and non- or slowly-varying confounders, with distributed lag non-linear temperature terms (0-6 days) to estimate associations between daily ZIP Code-level temperature and alcohol- and substance-related disorder hospital visit rates in New York State during 1995-2014. We also examined four substance-related disorder sub-causes (cannabis, cocaine, opioid, sedatives). RESULTS Here we show that, for alcohol-related disorders, a daily increase in temperature from the daily minimum (-30.1 °C (-22.2 °F)) to the 75th percentile (18.8 °C (65.8 °F)) across 0-6 lag days is associated with a cumulative 24.6% (95%CI,14.6%-34.6%) increase in hospital visit rates, largely driven by increases on the day of and day before hospital visit, with an association larger outside New York City. For substance-related disorders, we find evidence of a positive association at temperatures from the daily minimum (-30.1 °C (-22.2 °F)) to the 50th percentile (10.4 °C (50.7 °F)) (37.7% (95%CI,27.2%-48.2%), but not at higher temperatures. Findings are consistent across age group, sex, and social vulnerability. CONCLUSIONS Our work highlights how hospital visits from alcohol- and substance-related disorders are currently impacted by elevated temperatures and could be further affected by rising temperatures resulting from climate change. Enhanced social infrastructure and health system interventions could mitigate these impacts.
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Affiliation(s)
- Robbie M Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- The Earth Institute, Columbia University, New York, NY, USA.
| | - Sebastian T Rowland
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Vivian Do
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Columbia University Medical School, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Francesca Dominici
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Carl L Hart
- Department of Psychology, Columbia University, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Carruthers S, Sutton-Inocencio E. The Impact of Universal Screening for Substance Use Disorders During Emergency Services Within an Integrated Health Care System. Crit Care Nurs Q 2023; 46:282-298. [PMID: 37226920 DOI: 10.1097/cnq.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Each day, across America, people come to emergency service providers in need of care and support. Although not ideal, emergency departments have become the de facto outpatient treatment center in many communities. This positions emergency department providers to be ideal partners in the treatment of substance use disorders. Substance use and deaths by overdose have been of great concern for many years, and since the start of the pandemic, the trends have caused further concern. Drug overdoses have claimed the lives of more than 932 000 Americans over the past 21 years. Excessive alcohol use is a leading cause of premature death in the United States. In 2020, of people identified as needing substance use treatment in the past year, only 1.4% received any treatment. As we watch the death tolls and cost of care continue to trend upward, emergency service providers have the unique opportunity to quickly screen, intervene, and refer to help get these complex and sometimes challenging patients better care, while also avoiding the worsening of the crisis in which we find ourselves.
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Kratovil A, Schuler MS, Vottero BA, Aryal G. Original Research: Nurses' Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder. Am J Nurs 2023; 123:26-33. [PMID: 36951342 DOI: 10.1097/01.naj.0000925496.18847.c6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Substance use disorder (SUD) is a chronic illness, but it's often seen as an intentional choice rather than as a disease. People with SUD are frequently stigmatized, leading to disparate care. Findings from previous studies have indicated that nurses feel inadequately prepared to care for, and tend to have negative attitudes toward, patients with SUD. But it's unknown what kind of education would better prepare nurses caring for this patient population, or whether these negative attitudes vary across practice settings. PURPOSE AND DESIGN This observational, cross-sectional, mixed-methods study sought to explore nurses' self-assessed knowledge of and attitudes toward caring for patients with SUD (whether formally diagnosed or not) in hospital settings across the United States. A secondary aim was to determine nurses' educational preferences and needs in this area. METHODS Data were collected over a three-month period in early 2020, using the online social networking platform Facebook. All participants were nurses working in hospital settings throughout the United States. Participants were surveyed using two tools: the Drug and Drug Problems Perceptions Questionnaire, and another questionnaire that included open-ended questions regarding nurses' SUD-related education and their experiences and perceived needs in caring for patients with SUD. Quantitative data were analyzed using analysis of variance and post hoc Tukey tests. Qualitative data were analyzed using thematic analysis. RESULTS A total of 691 nurses participated. Nurses reported having been educated in SUD but wanted additional face-to-face education from mental health specialists. The nurses working on mental health units had significantly more positive attitudes toward caring for patients with SUD than nurses on other units. Older nurses had significantly more positive attitudes toward patients with SUD than younger nurses. Qualitative analysis uncovered four themes: unmet needs, personal experiences inform care, personal beliefs inform perceptions, and judgmental attitudes. CONCLUSIONS Study findings indicate that, in general, hospital nurses have negative attitudes toward patients with SUD. The results further reaffirm the need for empathy-based nursing education for nurses who care for these patients. Participants expressed a preference for face-to-face training by mental health specialists experienced in SUD. Given the increasing prevalence of SUD and the expected retirement of older nurses, it is urgent that we prioritize empathy-based nursing education, particularly for newer-to-practice nurses, in order to improve nurses' attitudes and ensure best care for patients with SUD.
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Affiliation(s)
- Amanda Kratovil
- Amanda Kratovil is an assistant professor of nursing and Beth A. Vottero is an associate professor of nursing at the College of Nursing, Purdue University Northwest, Hammond, IN. Monika S. Schuler is an associate professor at the College of Nursing and Health Sciences, University of Massachusetts (UMass) Dartmouth. Gokarna Aryal is a professor of statistics at the College of Engineering and Sciences, Purdue University Northwest. Funding for this study was provided through UMass Dartmouth's University-Industry Collaborative Seed Funding Program. Contact author: Amanda Kratovil, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Bressan J, Kenig KC. Helping patients with substance use disorder: The nurse practitioner role in access to treatment. J Am Assoc Nurse Pract 2023; 35:254-257. [PMID: 36745033 DOI: 10.1097/jxx.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/22/2022] [Indexed: 02/07/2023]
Abstract
ABSTRACT Over 21 million people in the United States require substance use disorder (SUD) treatment. However, less than 4 million people receive treatment. The surge of deaths due to opioid overdose requires aggressive public health interventions. This article will describe the role of the hospital emergency department (ED), not simply in emergency treatment of overdose but as a provider of care for underlying addiction and as a catalyst for change in our approach to drug use as a society. It has been found that EDs and hospitals serve as an important point for initiating treatment for SUDs. It is important to provide equitable access to care because the ED serves as an important access point for those with socioeconomic disadvantages. This article presents case studies and the nurse practitioner role in providing medication for addiction and treatment in the ED while also addressing misconceptions about treatment.
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Affiliation(s)
- John Bressan
- CA Bridge Program/Public Health Institute, Oakland, California
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Armoon B, Fleury MJ, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Emergency Department Use, Hospitalization, and Their Sociodemographic Determinants among Patients with Substance-Related Disorders: A Worldwide Systematic Review and Meta-Analysis. Subst Use Misuse 2023; 58:331-345. [PMID: 36592043 DOI: 10.1080/10826084.2022.2161313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32-2.83; hospitalization: OR = 1.53, 95%CI = 1.36-1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13-1.59; hospitalization: OR = 1.42, 95%CI = 1.20-1.69). Being female (OR = 1.24, 95%CI = 1.14-1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24-3.21) and tobacco (OR = 1.25, 95%CI = 1.11-1.42), having HIV (OR = 1.70, 95%CI = 1.47-1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27-2.85) and injury (OR = 2.62, 95%CI = 1.08-6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08-1.81) and using cocaine (OR = 1.60, 95%CI = 1.32-1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Moe J, Wang YE, Schull MJ, Dong K, McGregor MJ, Hohl CM, Holroyd BR, McGrail KM. Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada. BMC Emerg Med 2022; 22:127. [PMID: 35836121 PMCID: PMC9281237 DOI: 10.1186/s12873-022-00673-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00673-x.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Yueqiao Elle Wang
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Michael J Schull
- Institute for Clinical Evaluative Sciences, G1 06, 075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health and Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
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Identifying barriers to emergency department-initiated buprenorphine: A spatial analysis of treatment facility access in Michigan. Am J Emerg Med 2021; 51:393-396. [PMID: 34826787 DOI: 10.1016/j.ajem.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVES Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. METHODS Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers. RESULTS Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p < 0.0001) and annual patient volumes (58,616 vs. 17,484; p < 0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p = 0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress. CONCLUSION Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.
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