title: Epidemic increases in cocaine and opiate use by trauma center patients: documentation with a large clinical toxicology database.
abstract: BACKGROUND
  Although reports have documented alcohol and other drug use by trauma patients, no studies of long-term trends have been published. We assessed substance use trends in a large cohort of patients admitted to a regional Level I adult trauma center between July 1984 and June 2000.
  
  
  METHODS
  Positive toxicology results, collected via retrospective database review, were analyzed for patients admitted directly to the center. Data were abstracted from a clinical toxicology database for 53,338 patients. Results were analyzed for alcohol, cocaine, and opiates relative to sex, age (< 40/> or = 40 years), and injury type (nonviolence/violence). Positive toxicology test result trends were assessed for the 3 years at the beginning and end of the period (chi2). Testing biases were assessed for sex, race, and injury type.
  
  
  RESULTS
  The patient profile was as follows: men, 72%; age < 40 years, 69%; nonviolence victims, 77%. Alcohol-positive results decreased 37%, but cocaine-positive and opiate-positive results increased 212% and 543%, respectively (all p < 0.001). Cocaine-positive/opiate-positive results increased 152%/640% for nonviolence and 226%/258% for violence victims, respectively (all p < 0.001). In fiscal year 2000, cocaine-positive and opiate-positive results were highest among violence victims (27.4% for both drugs). Cocaine-positive and opiate-positive results among nonviolence victims were 9.4% and 17.6%, respectively. Patients who were minorities or victims of violence were not tested more frequently than other patients.
  
  
  CONCLUSIONS
  Epidemic increases in cocaine and opiate use were documented in all groups of trauma patients, with the greatest increases being in violence victims. Alcohol use decreased for all groups.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD 21201, USA. csoderstrom@umm.edu
authors.forename: C A
authors.initials: CA
authors.lastname: Soderstrom
authors.forename: P C
authors.initials: PC
authors.lastname: Dischinger
authors.forename: T J
authors.initials: TJ
authors.lastname: Kerns
authors.forename: J A
authors.initials: JA
authors.lastname: Kufera
authors.forename: K A
authors.initials: KA
authors.lastname: Mitchell
authors.forename: T M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000328:Adult; D017677:Age Distribution; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016208:Databases, Factual; D000431:Ethanol / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D017678:Sex Distribution; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014754:Violence
chemical_list: D000431:Ethanol