ER Visits Offer Opportunities to Treat Substance Use, SPH Study Says.
Women of reproductive age who had substance use disorders were twice as likely to show up with injuries at Massachusetts emergency rooms, suggesting the need for screening and referrals for substance use as part of emergency department treatment protocols, according to a new study led by BU School of Public Health researchers.
Those findings, published in the journal Academic Emergency Medicine, were an offshoot of a primary study examining outcomes for Massachusetts women, ages 15 to 49, who were identified in hospital and other databases as having a substance use disorder (SUD), the diagnostic category that covers both significant substance abuse and dependence on alcohol and other drugs.
The primary study, published in the journal Drug and Alcohol Dependence, found that rates of relapse and subsequent hospital and emergency department (ED) admissions were higher for women who had received “acute only” treatment than for those who received “ongoing” services.
The study – in collaboration with the Adolescent Health Research and Policy Center for Children, MassGeneral Hospital, and the Massachusetts Department of Public Health – found that of 1.7 million Massachusetts women who sought hospital and related medical care from 2002 to 2008, 8.5 percent were identified as SUD-positive. In nearly half of those cases – 48.3 percent – the women received hospital or facility-based substance use treatment. The treatment was either short term or ongoing.
“’Ongoing’ services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care,” the researchers said.
The study found that women who reported cannabis, hallucinogen and/or stimulant use were most likely to receive ongoing treatment services, while those who reported opiate use were most likely to receive “acute only” care.
“However, a substantial number of women remained in the ‘acute only’ category, indicating that there is still work to do to increase utilization of ongoing services.”
The researchers said SUD identification within the medical system is critical, so that patients can be properly assessed and referred to treatment.
The study findings “support the state’s central strategy to invest in screening and brief intervention (SBIRT) programming to enhance screening rates in emergency departments and in primary care settings, and provide training for intervention and referral for assessment and specialty treatment, if appropriate.”
The research team used three large data sets that included ED and inpatient discharge records, maternal delivery hospitalization records, birth certificates, and substance abuse treatment system admissions.
In the second study, the researchers sought to compare patterns of injury requiring ED visits among women with and without substance use disorders. They found that almost two-thirds of SUD-positive women had some type of injury, compared to 44.8 percent of SUD-negative women.
The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women, with the greatest differences in rates of self-inflicted injuries.
Injury rates were lowest for alcohol disorders only, and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 6.3 percent presented to the ED with overdoses. Multiple overdose visits were common.
“Substance use disorder is a very important contributor to injury among women of childbearing age,” the researchers said. The strength of that association “suggests the importance of targeted screening for drug and alcohol use disorders when injured women present to the ED.”
Injuries to a woman in her middle years can have “many concentric circles of impact beyond her immediate diagnostic condition, since this is typically the time of life that society relies on women to manage household and job and care for both children and elders,” the researchers said.
They noted that injuries to this population carry a significant price tag: Falls, for example, involve 1.4 million ED visits and carry a mean cost of $771 for the visit, at a total annual cost of $1.1 billion. Work loss expenses account for an additional $4.2 billion, and the extra expense of paying substitutes for caregiving responsibilities after falls means the cost is even greater.
“Efforts to identify and address the drug and alcohol use that increases the risk of falls among adult women could make a significant contribution to reducing health care costs,” the study says.
The studies were led by Judith Bernstein, professor of community health sciences at BUSPH. Co-authors from BU include: Candice Belanoff, clinical assistant professor of community health sciences; Howard J. Cabral, professor of biostatistics; Stephen R. Evans, senior program analyst for the data coordinating center; and Dr. Carole Douriez of Boston Medical Center.
Submitted by: Lisa Chedekel