Abstract
BackgroundDrug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US).MethodsWe used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness.ResultsCocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits.ConclusionPresentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.
Highlights
Emergency department (ED) visits related to drug overdose are escalating, especially during the COVID-19 pandemic [1]
Rates of psychostimulant-related emergency department (ED) visits increased from 2.2 visits per 10,000 population (95%CI 0.8–3.7) to 12.9 visits per 10,000 population (95%CI 7.3–18.4) (p < 0.001)
The increase in ED visits was greatest for opioids, where rates of opioidrelated ED visits increased from 6.0 visits per 10,000 population (95%CI 3.7–8.2) in 2014 to 24.8 visits per 10,000 population (95%CI 18.0–31.5) in2018 (p < 0.001) (Fig. 1)
Summary
Emergency department (ED) visits related to drug overdose are escalating, especially during the COVID-19 pandemic [1]. ED visits are largely attributed to the use of substances such as cocaine and psychostimulants (e.g., methamphetamine) [6,7,8,9]. Acute stimulant toxicity is not always recognized as an overdose [12], and these studies do not address visits related to chronic complications of drug use. Few studies elucidate the prevalence of presenting concerns for psychostimulant-related ED visits or how they may vary compared to opioid-related ED visits. Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US)
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