Screening for Substance Abuse in Emergency Departments
Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. This is a very expensive practice and a drain on medical resources.
In a recently completed study, researchers gathered data from 15,224 adult ED patients across six academic institutions who were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included and showed that 2,084 (64.3%) met criteria for problematic drug use.
Wendy Macias Konstantopoulos, MD, MPH Department of Emergency Medicine, Massachusetts General Hospital, and Harvard Medical School claims,
“Exclusive of substance use treatment, medical care costs alone accounted for over $5 billion of the total annual cost of illicit drug use in 2008. The Drug Abuse Warning Network (DAWN), a public health surveillance system that monitors drug-related morbidity and mortality, estimated that of the 5.1 million drug-related ED visits across the US in 2011, 2.5 million were directly related to the use of illicit drugs and/or the nonmedical use of pharmaceuticals.”
A very simple clinical practice could help busy emergency clinicians identify patients who may benefit from further screening and referral to treatment. Dr. Konstanopoulos suggests incorporating drug screening into standard practice. The use of this rule has the potential to increase the number of ED patients offered the opportunity to enter into substance use treatment at a moment when they are more likely to consider the ill effects of their drug use in a the “teachable moment.”
By identifying and referring those patients who would most benefit from substance use treatment, emergency medicine can play a more proactive role not only in improving health outcomes for these patients, but also in reducing medical care cost related to substance use, misuse, or abuse. The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs. Addiction is problem that needs better solutions.