title: [Drug users attending at hospital emergency rooms. Changes in sociodemographic features, health care, referral attitudes and impact of substitution therapy, between 1993 and 1998].
abstract: The purpose of this work was to assess changes observed between 1993 and 1998 relative to drug users seen at hospital emergency rooms. We retrospectively reviewed our medical files for two periods, 1993-1995 and 1996-1998, i.e. before and after routine institution of substitution therapy with buprenorphine and methadone. A predefined grid was used to select files. All patients whose file indicated drug use, irrespective of the reason for consultation, were eligible for inclusion. Overall demographic features were: mean age 29 years, men 74%, known address 60%, indication of medical coverage 29%, institutional transportation 70%, heroine abusers 53%, injecting drug users 65%, associated acute alcohol intoxication 27%. There was a significant decline in the incidence of drug abusers during the second period (2.42% versus 3.44%) with no difference for age, sex, or area of residence. Documentation of medical coverage improved. There was no change in the hour of arrival, more than 50% arrived outside regular hospital hours but a higher proportion arrived during the weekend, indicating some access difficulty. Our results are in agreement with the OFDT data on product use: reduction in the use of heroine and significant increase in the use of cocaine, alcohol consumption remaining unchanged. Among the 63 patients seen during the second period, 31.7% stated they were taking substitution therapy, indicating this population has access to treatment. There was no statistical difference for diagnosis, but certain trends were observed: acute intoxication with loss of consciousness leading to emergency squad transfer to the emergency room remained the most common situation, rate of trauma was unchanged at approximately 10%, as was the rate of post-IV abscesses; there was a 3-fold reduction in request for drugs and a 2-fold rise in public intoxication. These data help better define management conditions for drug users attending emergency rooms.
authors.affiliation: Service des Urgences, Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris Cedex 04. pierre.espinoza@hop-egp.ap-hop-paris.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Espinoza
authors.forename: Fabrice
authors.initials: F
authors.lastname: Mathy
authors.forename: Véronique
authors.initials: V
authors.lastname: Massari
authors.forename: Philippe
authors.initials: P
authors.lastname: Nuss
authors.forename: Catherine
authors.initials: C
authors.lastname: Caron
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D003710:Demography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D012189:Retrospective Studies; D012923:Social Class; D019966:Substance-Related Disorders / Q000534:rehabilitation / Q000628:therapy*
chemical_list: D009294:Narcotics; D008691:Methadone