Hospitals face urgent need for drug treatment in emergency departments

UCSF study shows emergency visits and hospitalizations for drug addicted patients increased by 30% compared to 2014-2018

By Élisabeth Fernandez

A growing percentage of emergency visits and hospitalizations in the United States before the pandemic involved patients with alcohol and other substance disorders, according to a study by researchers at UC San Francisco . The authors say hospitals need to develop better ways to identify and treat these patients.

The study, led by Leslie Suen, MD, MAS, of the UCSF Department of Medicine, found that between 2014 and 2018, emergency room visits by adults with alcohol use disorders and of substances increased by 30%. Hospitalizations among patients with these disorders increased by 57 percent.

The authors found that over the study period, one in 11 emergency room visits and one in nine hospitalizations each year involved someone with an alcohol or other substance disorder.

“These statistics are comparable to common ailments such as heart failure, but hospitals and emergency departments are rarely as equipped to treat drug addiction as they are to treat cardiovascular disease,” said Suen, member of the National Clinician Scholars. UCSF Philip R. Lee Program. Institute for Health Policy Studies.

“These data suggest that there is an urgent need for hospitals to develop inpatient intervention systems to provide drug addiction treatment to those accessing emergency care and inpatients. Models of inpatient drug addiction services already exist, including the UCSF addiction care team at San Francisco General Hospital.

The study was published on September 13, 2021 in the Journal of General Internal Medicine.

Researchers found that patients with alcoholism and other substance use disorders who came to the emergency room were more likely to have Medicaid health insurance, experience depression, be homeless, ” have received mental health treatment and present injuries and trauma.

“Illnesses and deaths from complications of alcohol and other substance use are on the rise nationwide,” Suen noted. “Hospitals are a place where we can start to reverse this trend, but we have to be prepared to identify and treat these patients while they are in hospital and continue to monitor and treat them after discharge as well.”

For the study, researchers analyzed data from the National Hospital Ambulatory Medical Care Survey, an annual survey administered by the National Center for Health Statistics. Alcohol use disorders and other substance use disorders were identified on the basis of patient medical records.

“Our estimate of alcohol and substance use disorders during emergency room visits is higher than in some other recent studies,” Suen said. “This may be because our study is the first to use comprehensive medical chart reviews, which are more likely to reflect the true prevalence of these disorders, rather than relying solely on billing diagnostic codes.”

UCSF co-authors are Leslie Suen, MD, MAS; Anil N. Makam, MD, MAS; Hannah R. Snyder, MD; Daniel Repplinger, MD; Margot B. Kushel, MD; Marlene Martin, MD; and Oanh Kieu Nguyen, MD, MAS. The study was supported by the National Heart, Lung and Blood Institute. The authors declare no conflict of interest.

The University of California at San Francisco (UCSF) focuses exclusively on the health sciences and is dedicated to promoting health around the world through advanced biomedical research, higher education in the sciences of life and health professions and excellence in patient care. UCSF Health, which serves as the primary academic medical center for UCSF, includes leading specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.

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