Reasons for emergency department visits of patients with opioid use disorder at an urban safety-net hospital: A retrospective records review

Shawkut Ali; Shona Lowe; James S. George; Christopher Brown; Gloria Sanchez; Bernadette Pendergraph

doi:10.5055/jom.0810

Authors

Shawkut Ali, MD
Shona Lowe, MD
James S. George, MD
Christopher Brown, MD
Gloria Sanchez, MD
Bernadette Pendergraph, MD

DOI:

https://doi.org/10.5055/jom.0810

Keywords:

opioid-related disorders, emergency service, hospital, substance-related disorders, diabetes mellitus, primary healthcare

Abstract

Objectives: The purpose of this study was to describe the emergency department (ED) visit chief complaints and discharge diagnoses of patients with an opioid use disorder (OUD) empaneled to a primary care clinic.

Design: ED visits were retrospectively reviewed through electronic health records. Patients with a history of using multiple substances and medical or psychiatric conditions were compared to those without these conditions.

Setting: This study was conducted at Harbor-UCLA ED, a safety-net level one trauma center.

Patients and participants: Eligible participants were empaneled to the Harbor-UCLA Family Health Center with a diagnosis of OUD between January 1, 2018, and December 31, 2020.

Main outcome measures: The primary outcome measures included number of ED visits, hospital admissions, chief complaints, and discharge diagnoses.

Results: The total number of patients was 59. The most common chief complaints were musculoskeletal (34 percent), gastrointestinal (18 percent), general (13 percent), and skin (8.6 percent). The most common discharge diagnoses were musculoskeletal (27 percent), gastrointestinal (20 percent), infectious (11 percent), substance use disorder related (11 percent), psychiatric (7 percent), and cardiovascular (7 percent). Co-occurring alcohol use was associated with a higher number of visits, 3.18 versus 1.15 (p = 0.021), and a higher percentage of patients with frequent visits, 46 percent versus 8 percent (p = 0.008). Patients with diabetes had more frequent visits, 40 percent versus 10 percent (p = 0.036), and were more likely to be admitted, 43 percent versus 15 percent (p = 0.010).

Conclusions: This study highlights the importance of screening and the management of alcohol use and diabetes among patients with OUD.

Author Biographies

Shawkut Ali, MD

Addiction Medicine Fellow, Augusta University, Psychiatry and Health Behavior, Augusta, Georgia

Shona Lowe, MD

Addiction Medicine Fellow, Harbor-UCLA Family Medicine, Harbor City, California

James S. George, MD

Resident Physician, Advocate Lutheran General Hospital, Park Ridge, Illinois

Christopher Brown, MD

Assistant Professor of Medicine, Harbor-UCLA Internal Medicine, Torrance, California

Gloria Sanchez, MD

Associate Clinical Professor of Family Medicine, Harbor-UCLA Family Medicine, Harbor City, California

Bernadette Pendergraph, MD

Associate Clinical Professor of Family Medicine, Harbor-UCLA Family Medicine, Harbor City, California

References

Moore B, Liang L: Costs of emergency department visits in the United States. Agency for Healthcare Research and Quality. 2017. Available at www.hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf. Accessed October 10, 2022.

National Institute on Drug Abuse: Part 1: The connection between substance use disorders and mental illness. 2020. Available at https://www.drugabuse.gov/publications/researchreports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness. Accessed January 10, 2021.

National Institute on Drug Abuse: Part 2: Co-occurring substance use disorder and physical comorbidities. 2020. Available at https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-2-cooccurring-substance-use-disorder-physical-comorbidities. Accessed January 10, 2021.

Choi S, Biello KB, Bazzi AR, et al.: Age differences in emergency department utilization and repeat visits among patients with opioid use disorder at an urban safety-net hospital: A focus on young adults. Drug Alcohol Depend. 2019; 200: 14-18. DOI: 10.1016/j.drugalcdep.2019.02.030.

Bahorik AL, Satre DD, Kline-Simon AH, et al.: Alcohol, marijuana, and opioid use disorders: 5-Year patterns and characteristics of emergency department encounters. Subst Abus. 2018; 39(1): 59-68. DOI: 10.1080/08897077.2017.1356789.

National Institute on Drug Abuse: Overdose death rates. 2022. Available at https://nida.nih.gov/research-topics/trendsstatistics/overdose-death-rates. Accessed January 10, 2021.

Fleury MJ, Cao Z, Grenier G, et al.: Predictors of frequent emergency department use and hospitalization among patients with substance-related disorders recruited in addiction treatment centers. Int J Environ Res Public Health. 2022; 19(11): 6607. DOI: 10.3390/ijerph19116607.

Schwarz R, Zelenev A, Bruce RD, et al.: Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat. 2012; 43(4): 451-457. DOI: 10.1016/j.jsat.2012.03.008.

Mark TL, Parish WJ, Zarkin GA: Association of formulary prior authorization policies with buprenorphine-naloxone prescriptions and hospital and emergency department use among Medicare beneficiaries. JAMA Netw Open. 2020; 3(4): e203132. DOI: 10.1001/jamanetworkopen.2020.3132.

Kingston REF, Marel C, Mills KL: A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev. 2017; 36(4): 527-539. DOI: 10.1111/dar.12448.

Giovanni D, Di Martino P, Zecca G, et al.: Trend in hospital admissions of drug addicts and associated factors from 2006 to 2015: An observational study on the hospitals' discharge registries from a region of Central Italy. Ann Ig. 2020; 32(4): 376-384. DOI: 10.7416/ai.2020.2361.

Penzenstadler L, Gentil L, Huynh C, et al.: Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend. 2020; 207: 107817. DOI: 10.1016/j.drugalcdep.2019.107817.

Armoon B, Grenier G, Cao Z, et al.: Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy. 2021; 16(1): 89. DOI: 10.1186/s13011-021-00421-7.

Zhang X, Wang N, Hou F, et al.: Emergency department visits by patients with substance use disorder in the United States. West J Emerg Med. 2021; 22(5): 1076-1085. DOI: 10.5811/westjem.2021.3.50839.

Suen LW, Makam AN, Snyder HR, et al.: National prevalence of alcohol and other substance use disorders among emergency department visits and hospitalizations: NHAMCS 2014-2018. J Gen Intern Med. 2022; 37(10): 2420-2428. DOI: 10.1007/s11606-021-07069-w.

Harbor-UCLA Department of Emergency Medicine: Diversity and inclusion. Available at https://emedharbor.edu/applicants/diversity/. Accessed January 10, 2021.

Harbor-UCLA Department of Family Medicine: Our training sites. Available at https://www.harbor-ucla.org/family-medicine/our-training-sites/. Accessed January 10, 2021.

Clarke TC, Schiller JS: Early release of selected estimates based on data from the January-June 2019 National Health Interview Survey. National Center for Health Statistics. May 2020.

Office of the Surgeon General: US surgeon general's advisory on naloxone and opioid overdose. 2022. Available at https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-naloxone/index.html. Accessed January 10, 2021.

Montgomery L, Burlew AK, Haeny AM, et al.: A systematic scoping review of research on Black participants in the national drug abuse treatment clinical trials network. Psychol Addict Behav. 2020; 34(1): 117-127. DOI: 10.1037/adb0000483.

Saloner B, Le Cook B: Blacks and Hispanics are less likely than Whites to complete addiction treatment, largely due to socioeconomic factors. Health Aff (Millwood). 2013; 32(1): 135-145. DOI: 10.1377/hlthaff.2011.0983.

Mennis J, Stahler GJ: Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. J Subst Abuse Treat. 2016; 63: 25-33. DOI: 10.1016/j.jsat.2015.12.007.

Sahker E, Pro G, Sakata M, et al.: Substance use improvement depends on race/ethnicity: Outpatient treatment disparities observed in a large US national sample. Drug Alcohol Depend. 2020; 213: 108087. DOI: 10.1016/j.drugalcdep.2020.108087.

Windsor LC, Jemal A, Alessi EJ: Cognitive behavioral therapy: A meta-analysis of race and substance use outcomes. Cult Divers Ethnic Minor Psychol. 2015; 21(2): 300-313. DOI: 10.1037/a0037929.

Burlew K, McCuistian C, Szapocznik J: Racial/ethnic equity in substance use treatment research: The way forward. Addict Sci Clin Pract. 2021; 16(1): 50. DOI: 10.1186/s13722-021-00256-4.

Bazargan M, Cobb S, Assari S: Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. Ann Fam Med. 2021; 19(1): 4-15. DOI: 10.1370/afm.2632.