Incidence and correlates of opioid-related psychiatric emergency care: A retrospective, multiyear cohort study

Anees Bahji, MD

doi:10.5055/jom.2020.0572

Authors

Anees Bahji, MD

DOI:

https://doi.org/10.5055/jom.2020.0572

Keywords:

opioids, emergency room, psychiatry, admission, predictors, epidemiology

Abstract

Background: In 2018, nearly 4,000 Canadian lives were claimed by the opioid epidemic. To date, only a few studies have reviewed shifts in emergency department (ED) utilization for opioid-related psychiatric presentations.

Aims: To describe the characteristics of patients seeking ED care for opioid-related psychiatric presentations and to identify demographic and clinical characteristics that were associated with psychiatric inpatient admission for such presentations.

Methods: Retrospective cohort study with multivariate logistic regression.

Findings: Over a 4-year period, 555 opioid-related presentations were recorded (50 percent female, mean age 40.0 years). Time trend analysis showed a nonsignificant increase in the number of visits by fiscal year. The most common reason for ED presentation relevant to opioids was opioid withdrawal (49 percent). Nearly 20 percent of all visits required psychiatric admission; predictors of psychiatric admission were arrival by ambulance (adjusted odds ratio (AOR) = 2.03), older age (AOR = 1.05), longer length of ED stay (AOR = 1.10), and more severe triage score (AOR = 0.4). Sex and referring service were not associated with disposition in the ED. Admissions were more likely for opioid intoxication and withdrawal.

Conclusion: EDs are serving increasing numbers of patients in psychiatric crisis related to opioid-use. A decision support tool could be developed and validated in the future to provide reliable, clinically relevant information to providers and case managers relevant to opioid-related ED presentations.

Author Biography

Anees Bahji, MD

Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada; MSc Candidate, Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada

References

Degenhardt L, Charlson F, Mathers B, et al.: The global epidemiology and burden of opioid dependence: Results from the global burden of disease 2010 study. Addiction. 2014; 109(8): 1320-1333.

Bahji A, Bajaj N: Opioids on trial: A systematic review of interventions for the treatment and prevention of opioid overdose. Can J Addict. 2018; 9(1): 26.

Nielsen S, Larance B, Degenhardt L, et al.: Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database of Systematic Reviews [Internet]. 2016. Available at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011117.pub2/full. Accessed November 4, 2019.

Bahji A: An epidemic of incompetence: A critical review of addictions curriculum in Canadian residency programs. MedEdPublish [Internet]. 2019. Available at https://www.mededpublish.org/manuscripts/2076. Accessed November 4, 2019.

Health Quality Ontario: Opioid prescribing for chronic pain [Internet]. 2018. Available at http://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-all-Quality-Standards/Opioid-Prescribing-for-Chronic-Pain.

Kumar T, Rosenberg H: Take-home naloxone. CMAJ. 2017; 189(37): E1192. Accessed November 4, 2019.

Goldman-Hasbun J, DeBeck K, Buxton JA, et al.: Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: A cohort study. Harm Reduct J. 2017; 14: 79.

Canada PHA of National Report: Apparent opioid-related deaths in Canada (released June 2018) [Internet]. 2018. Available at https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-relateddeaths-released-june-2018.html. Accessed November 4, 2019.

Public Health Ontario: Interactive opioid tool: Opioid-related morbidity and mortality in Ontario [Internet]. Canada; 2019. Available at https://www.publichealthontario.ca/en/dataand-analysis/substance-use/interactive-opioid-tool. Accessed November 4, 2019.

Dyer O: Canada’s prescription opioid epidemic grows despite tamperproof pills. BMJ. 2015; 351: h4725.

Alam A, Juurlink DN: The prescription opioid epidemic: An overview for anesthesiologists. Can J Anaesth. 2016; 63(1): 61-68.

Bahji A, Camiré D: Letter to the Editor: A case for opioid education and training for medical students, residents, and allied health staff: Response to “Educational Intervention for Physicians to address the risk of Opioid Abuse.” J Opioid Manag. 2018; 14(3): 157.

Baird J, Faul M, Green TC, et al.: A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients. Drug Alcohol Depend. 2017; 178: 130-135.

Bruneau J, Ahamad K, Goyer M-É, et al.: Management of opioid use disorders: A national clinical practice guideline. CMAJ. 2018; 190(9): E247-E257.