Correlates of drug use problems among substance users presenting in emergency departments: Results of a multi-site study

Aims: Drug-related emergency department (ED) visits have steadily risen over the years, 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 pre-screened for drug use as part of a large randomized prospective trial. Data for 3240 participants who reported using their primary drug of use in the past 30 days were included. Self-reported variables related to patient demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use. Results: Of the 3240 patients, 2084 (64.3%) met criteria for problematic use (Drug Abuse Screening Test score ≥3). Age >30, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary non-cannabis 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 similar with the exception of age, with younger adults more likely to have problematic use, and ED triage level, which had no correlative value. Conclusions: Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from intervention. While cannabis users report problems with their drug use the least, there are some indicators useful in identifying those for whom cannabis use may be causing problems. 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 among a population less likely to access primary care may help decrease overall health care costs.