Detecting Substance Abuse in the Emergency Department: A 10-Year Comparative Study

Aims. We have retrospectively analyzed the variations in the clinical profile of patients with a positive consumption of alcohol and/or drugs of abuse that have been confirmed and treated in the Emergency Department of a Virgen de La Arrixaca University Hospital in Murcia (Spain) after a period of 10 years. Secondly, we have assessed if the use of urine toxicology screen tests had any influence on the improvement of the management and/or referral of these patients to specialized services from the Emergency Department or at the time of discharge from hospital, regardless of the specialist or service where they had been treated. Method. 415 patients were selected in the year 2000 and 452 in the year 2010 who had tested positive for alcohol and drugs, assessing the reason for consultation, specific symptoms, drug used, record, diagnosis, and patient management. Results. The most frequent reasons for going to the Emergency Department was common illness, mainly psychiatric disorders, and the type of drug taken, alcohol. There were no significant differences between both groups, but approximately 50% of the patients were not referred for treatment of the abuse or dependency. Conclusions. The clinical profession should consider measures to improve detection and referral of patients with substance abuse disorders. 1. Introduction The consumption of alcohol and drugs of abuse in the Health Services is a frequent problem, but often it is not diagnosed. The abusive consumption of alcohol, anxiolytics and illegal, may lead to demand for direct medical care (intoxication, overdose, or withdrawal), and above all, a high demand for indirect medical care (medical or psychiatric complications). Prevalence of substance abuse disorders is higher in population treated in Healthcare Facilities than in the general population. According to some studies, between patients treated 4 and 40% may show signs of consuming some kind of toxic substance excluding tobacco [1–4]. The abusive consumption of alcohol may reach up to 17% of the adult population seen at the Primary Healthcare Centers [5] and 13.9% of the patients admitted to Hospitals [6]. In the Emergency Department (ED), the problems related with the consumption of alcohol and drugs can be even higher [7, 8]. The variety of doctors taking part in these services to deal with these complications, the reluctance of patients to admit their consumption, could be barriers to diagnosis, referral, and treatment to specialized substance abuse units. Screening tests to determine levels of alcohol or the presence of drugs of abuse in