Emergency Departments (EDs) are ideal settings to identify and monitor emerging trends in risky patterns of alcohol and other substance use that increase the risk of injury, overdose or poisoning, and many of the acute harms caused by excessive substance use. Such acute effects contribute to the bulk of alcohol- and drug-caused deaths in Canada but are not systematically monitored. A great proportion of trauma is found in EDs where alcohol and other drugs have been shown as a major risk factor for injury.
Main Findings
Forty-nine percent of people attending two major BC emergency departments (EDs) between 9 p.m. and 4 a.m. on weekends report having used alcohol and/or other drugs in the six hours prior to their presenting injury or illness. This is one finding from a study of patients who present at Victoria and Vancouver EDs late at night on weekends to monitor the role of alcohol and other drugs in presentations. Starting in April 2008, the study involves interviews with approximately 400 patients a year.
By June 2009, approximately 87% of interviewees had consented to two objective tests: a breathalyzer test and a saliva drug test. For the breathalyzser test there were 87 positive results out of 382 (22.7%) who consented with blood alcohol concentrations ranging from range from 0.013-0.097 mgs/100 mls.
There were 40 interviewees (10.5%) who had positive saliva tests. This included eight positive amphetamine tests, 12 positive cocaine tests, eight positive cannabis tests, ten positive opiates tests and two positive benzodiazepine tests. These results also included one interviewee with positive results for both benzodiazepines and cocaine and one interviewee with positive results for cannabis, amphetamines and cocaine.
Approximately 10% (9.7%) of people attending the emergency room on a late weekend night have a diagnosis of injury caused by alcohol, followed by 5.4% attributed to cardiovascular diseases caused by alcohol and/or tobacco. Sixteen interviewees (3.6%) were given diagnoses that were linked to mental and behavioural problems due to alcohol. There were lower rates of attribution for cardiovascular and pulmonary diseases caused by tobacco 1.8% and 1.6% respectively.
Fourteen percent of the sample nights had a diagnosis that could be attributed to alcohol and 5.6% were attributable to both tobacco and alcohol. Illicit drugs were only attributed in 1.3% of presentations.
Thirty-two percent of interviewees attending the emergency department on a late weekend nights had either a moderate or high risk of using alcohol as assessed by AUDIT.
Forty-two percent of interviewees attending the emergency department on late weekend nights have either a moderate or high risk of using tobacco over the last three months as assessed by the ASSIST, while 48% were abstainers.
Twenty-two percent of the ED attendees interviewed were assessed on the WHO ASSIST as having moderate or severe problems from their use of cannabis, compared with 9.6% for cocaine, 5.6% for opiates, 4% for sedatives and 4.4% for amphetamines.