Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008–2018

BMC Emergency Medicine

Kathy T. LeSaint¹  Elise D. Riley²  Phillip O. Coffin³  Thibaut Davy-Mendez⁴  Leslie W. Suen⁵ 

[1] Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA;Department of Public Health, San Francisco, CA, USA;Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA;National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, Box 0936, 290 Illinois Street, Suite 7227, 94158, San Francisco, CA, USA;San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;

关键词: Amphetamines;    Cocaine;    Stimulants;    Emergency department;    Opioids;    Overdose;   

DOI  :  10.1186/s12873-022-00573-0

来源: Springer

【 摘 要 】

BackgroundDrug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US).MethodsWe used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness.ResultsCocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits.ConclusionPresentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

【 授权许可】

CC BY