Substance-Related Disorders

Drug Abuse Bigger ER Problem Than Realized

By Pippa Wysong
The Medical Post, February 4, 1997

TORONTO - More patients have chronic substance abuse problems than suspected by emergency room (ER) staff.

In a retrospective study of three downtown Toronto emergency departments, it was found between 5% to 7% of patients who had used ER services recently are chronic substance abusers.

But follow-up interviews with more than 200 patients by social workers found 45% had failed to mention drug-related problems to ER staff.

This shows patients are more likely to open up to a social worker, than to admitting nurses or doctors, said Dr. Joyce Bernstein (PhD), epidemiologist, City of Toronto Department of Public Health.

The study also found some patients felt they might be discriminated against, or receive lower quality health care if they revealed their problem with substance abuse. Others felt mentioning their drug use had no relevance to the care they needed.

Data were attained by reviewing the charts of all patients who used the emergency rooms over a two-month period. Out of a total of 13,232 charts, 804 (6.1%) patients had stated their problem was related to a substance abuse problem.

The hospitals included in the study were the Wellesley, St. Joseph's, and St. Michael's hospitals. All three are located in the southeast region of downtown Toronto and have significant numbers of homeless people, and people living in poverty using their services.


Two of the hospitals cover an area in which about 50,000 people live in poverty. "Southeast Toronto is also associated with high rates of HIV infection, prostitution, tuberculosis and drug abuse," said the report summarizing the study.

Substances of abuse can interfere or interact with medications given in the ER. "You don't want to give morphine to someone who is on heroin," she said.

At the same time, these patients can be a real problem to staff. Patients can be hard to handle and there can be violence in the ER. Some studies have shown nurses can be at risk of assault in the ER she said.

While hospitals are undergoing restructuring and funding cuts, "no one is doing too much about this," Dr. Bernstein said.

One thing that might help dealing with patients and treating their substance abuse problems is having one person in the ER dedicated to talking to these patients. Either a social worker, or someone who has recovered from chronic drug use who can relate to these patients, she said.


At all three hospitals, alcohol was the biggest problem, with 64% to 80% of patients mentioning it. Cocaine was the next most commonly mentioned substance, and ranged from 8% to 14% of patients. Other drugs mentioned included everything from narcotics, benzodiazepams and Tylenol, to marijuana, solvents and mouthwash.

Most of the patients were aged between 20 to 49, and about three-quarters were male. Only 24 of the patients were under age 20, but most of these patients were female.

The number of under 20s is so small, it's hard to say if there is a trend with more teenaged girls running into drug problems, Dr. Bernstein said.

The key message for doctors is "these patients are seeking help. The ER can be an important source of outreach for these people."

Some medical schools are introducing more detailed sections on addiction and how to deal with addicted patients into their curriculum, she said.

Copyright 1997 Maclean Hunter Publishing Limited
Reprinted with permission.

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