» AOD Monitoring » Research Components » Emergency Departments
Component Summary

The Emergency Departments component of the BC Alcohol and Other Drug Monitoring Project seeks to identify and monitor emerging trends in patterns of alcohol and other drug use that increase the risk of injury, overdose, poisoning, and other acute harms.

This emergency department study is one component of the BC Alcohol and Other Drug Monitoring Project. It is an ongoing emergency department study that is currently recruiting patients who come into the ED on one Friday and one Saturday evening per month between 9 p.m. and 4 a.m. at two EDs in British Columbia (Royal Jubilee Hospital in Victoria and Vancouver General Hospital in Vancouver). A pilot study was conducted on 97 patients early in 2008 to test the survey instruments and protocol. As a result, improvements were made to the sampling strategy, the survey instruments, the study protocol and the consent form.

Currently this monitoring study is using ICD-9 because one of our study sites is still using this version of the diagnostic categories in their emergency department. In addition, information obtained from patients in a busy ED is not specific enough to code for the more detailed ICD-10 conditions.

Inclusion Criteria

Interviewees who are between 17 to 75 years of age, can speak and understand English and can provide informed consent are asked to participate. Each respondent completes an interviewer-administered survey, a breathalyzer test and a saliva test for drugs of abuse.

Demographics

Approximately 460 patients participated in between April 2008 and June 2009 (234 in Vancouver and 228 in Victoria). Just over half (51.7%, n=234) of respondents were female compared with 48.1% (n=218) who were male. Respondents were predominately Caucasian (n =296, 67.4%), followed by Aboriginal respondents (n=34, 7.7 %). Just over half of the respondents (n=227, 51.8%) had either full- or part-time employment. Mean age was 39.7 years (range 17-75 years). Almost three quarters of the respondents were born in Canada (n=321, 74.1%). For more information see demographic tables for Vancouver, Victoria and both sites.  

Instruments

Patients who consent to be in the study are interviewed using a standardized survey instrument. The survey consists of questions pertaining to the reason for visit, the participant’s drug use history (lifetime use, past 12 months, one month, one week, and yesterday use), including specific alcohol use, cannabis use, and injection drug use. There are questions pertaining to drug-related harms and to alcohol or drug use in the six hours prior to onset of symptoms/injury. Survey instruments were developed for each site: Royal Jubilee Hospital and Vancouver General Hospital.

BAC and Saliva Tests

Participants also consent to a breathalyzer test and a saliva drug test. The breath test used is either the Alco-Sensor IV - Blue Dot or the Alco-Sensor IV FST breathalyzer. For the breathalyzer test, a subject blows into a sterile disposable mouthpiece for 5 to 10 seconds and the machine automatically estimates the BAC.  A saliva/sweat drug test is administered, using a Securetec Detektions-Systeme AG Drugwipe5 five-drug sensing test strip. This is a self-contained testing strip which displays the presence of metabolites of drugs via the development of coloured lines in the strip's detection zone: amphetamine-like substances (including amphetamine, methamphetamine, ecstasy), cocaine, opiates (heroin and morphine) and cannabis.

Most respondents consented to the breath alcohol test (n=399, 86.7%) and saliva drug tests (n=400, 88.1 %). Of the 88.1% of respondents that consented to the saliva drug tests, approximately 50.4% (n=195) of them reported using drugs, illicit and or pharmaceutical in the 6 hours prior to their injury or illness; 5.4% (n=21) reported using cannabis in the 6 hours prior to their injury or illness. Of the 86.7% of respondents that consented to a breathalyzer test approximately 25.8% (n=100) reported using alcohol in the 6 hours prior to their injury or illness.

Locations and Partnerships

Two locations are used for this study – Vancouver General Hospital (VGH) in Vancouver and Royal Jubilee Hospital (RJH) in Victoria. VGH is the largest hospital in British Columbia and the major tertiary referral centre for the province. Services in all adult areas of medicine except obstetrics are provided at this site. RJH is one of two tertiary hospitals serving Vancouver Island (Victoria General Hospital is the other). These hospitals operate as one large facility across two sites, providing high-level trauma care and specialized services.

Securing these locations has been made possible by having direct collaboration with key ED medical staff at each site. Drs. Andrew MacPherson at RJH and Jeff Brubacher at VGH have been instrumental in moving this project forward. Other possible sites for expansion include St. Paul’s Hospital in Vancouver and Victoria General Hospital as both sites have shown interest.

Kate Vallance

Kate Vallance
Research Associate, Centre for Addictions Research of BC

Kate is responsible for the coordination of the Centre’s Alcohol and Other Drug Monitoring Project. She is also responsible for the coordination and administration of the Emergency Department population study in Victoria and Vancouver.She completed her Masters degree in Sociology at the University of Victoria in 2009. Prior to her work at CARBC, Kate was a Site Coordinator for the Uvic hub of the Women’s Health Research Network and has also worked at the Sandy Merriman House Women’s Emergency Shelter in downtown Victoria. Her research interests include health and health care access of marginalized populations as well as substance use and addictions issues.

Dr. Tim StockwellDr. Tim Stockwell
Director, Centre for Addictions Research of BC; Professor, Department of Psychology, University of Victoria.

Dr. Stockwell directs the Centre for Addictions Research of BC (CARBC), a multi-site and multi-campus network dedicated to research, knowledge exchange and the advancement of public policy on substance use issues. He also holds a position as Professor in the Department of Psychology at the University of Victoria, and is Co-Leader of the BC Mental Health and Addictions Research Network. Dr. Stockwell has published over 200 research papers, book chapters and monographs, plus several books on prevention and treatment issues. Dr. Stockwell is a qualified clinical psychologist who accomplished both clinical and research work in the UK before spending 16 years with Australia’s National Drug Research Institute as Deputy Director and then Director. Dr. Stockwell studied Psychology and Philosophy at Oxford University and obtained a PhD at the Institute of Psychiatry, University of London, in 1980. He is currently President of the international Kettil Bruun Society for Social and Epidemiological Research on Alcohol.

Andrew IvsinsMr. Andrew Ivsins
Research Assistant, Centre for Addictions Research of BC.

Mr. Ivsins is responsible for the coordination and administration of the high-risk population component in Victoria. He is currently an M.A. candidate in Sociology at the University of Victoria. Prior to joining CARBC, Andrew worked at the Centre for Addiction and Mental Health in Toronto, where he was involved in various research projects related to illicit substance use and public health. His research interests and experience include street-involved adults and youth, marginalized populations, injection and other illicit substance use and public health.

Emergency Departments


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.
Project Reports & Findings
Trends

Trends

Between 2008 and June 2009, the amount of alcohol and cannabis that has been used in the six hours prior to the emergency department attendee's injury or illness event has decreased 6% and 3% respectively. Illicit drugs have increased during this same time period from 2 to 4%, while pharmaceutical drugs have stayed the same (14%).
Risky Use in Past Year

Risky Use in Past Year

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.

Recent AOD Use

Recent AOD Use

This data from the Emergency Departments component of the Alcohol and Other Drug Monitoring project provides information on very recent alcohol and other drug use (last six hours) as well as in the past month and year. The recent alcohol and other drug use data helps link self-report data with the interviewee’s saliva drug test and breathalyzer results.

Reason for Visit

Among people attending the two emergency departments on the late weekend nights sampled 21% were given a diagnosis for conditions often caused by substance use. In 14% of cases these were diagnoses often attributable to alcohol (mostly injuries), in 5.6% the diagnoses were those often attributable to tobacco and in only 1.3% were they conditions often attributable to illicit drug use.
Data Tables
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