title: Identifying patients with problematic drug use in the emergency department: results of a multisite study.
abstract: OBJECTIVE
  Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. The present study aims to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment.
  
  
  METHODS
  Using previously validated tests, 15,224 adult ED patients across 6 academic institutions were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included. Self-reported variables related to demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use.
  
  
  RESULTS
  Of the 3,240 patients, 2,084 (64.3%) met criteria for problematic drug use (Drug Abuse Screening Test score ≥ 3). Age greater than or equal to 30 years, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary noncannabis drug use, resource-intense ED triage level, and perceived drug-relatedness of ED visit were highly correlated with problematic drug use. Among primary cannabis users, correlates of problematic drug use were age younger than 30 years, tobacco smoking, binge drinking, daily drug use, and perceived relatedness of the ED visit to drug use.
  
  
  CONCLUSIONS
  Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from comprehensive screening, intervention, and referral to treatment. A clinical decision rule is proposed. The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: wmacias@mgh.harvard.edu.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Macias Konstantopoulos
authors.affiliation: Department of Psychiatrys, Boston, MA; Harvard Medical School, Boston, MA; Behavioral Health Partial Program, McLean Hospital, Belmont, MA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Dreifuss
authors.affiliation: Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McDermott
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Blair Alden
authors.initials: BA
authors.lastname: Parry
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Howell
authors.affiliation: Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD.
authors.forename: Raul N
authors.initials: RN
authors.lastname: Mandler
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.affiliation: Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bogenschutz
authors.affiliation: Department of Psychiatrys, Boston, MA; Harvard Medical School, Boston, MA; Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000175:diagnosis; D063425:Binge Drinking / Q000175:diagnosis; D019970:Cocaine-Related Disorders / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis; D012307:Risk Factors; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D055815:Young Adult