Abstract

AimsTo summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs.DesignSystematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525).Setting and participantsPeople who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services.MeasurementsPrimary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED).FindingsNinety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.ConclusionsPeople who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Highlights

  • The use of illicit drugs is associated with health, social and economic problems

  • The search strategy included people using any illicit drugs, studies focused on people who used illicit drugs associated with dependence

  • Eight studies focused on cannabis users, seven focused on stimulant users and five focused on opiate users

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Summary

Introduction

The use of illicit drugs is associated with health, social and economic problems. People who are dependent on illicit drugs generally have poor health outcomes, with cohort studies finding mortality rates of up to 15 times the general population, this varies widely by population and setting [1,2]. There is excess risk of cancers, cardiovascular, respiratory and liver diseases [3,4,5]. Excess disease may be due to both the direct effects of illicit drugs and accompanying life circumstances. People who use illicit drugs are vulnerable to homelessness, imprisonment and other forms of social. Author manuscript; available in PMC 2020 June 01

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