Tracking Assaultâ injured, Drugâ using Youth in Longitudinal Research: Followâ up Methods

ObjectivesViolence is one of the leading causes of death among youth ages 14 to 24. Hospitalâ and emergency department (ED)â based violence prevention programs are increasingly becoming a critical part of public health efforts; however, evaluation of prevention efforts is needed to create evidenceâ based best practices. Retention of study participants is key to evaluations, although little literature exists regarding optimizing followâ up methods for violently injured youth. This study aims to describe the methods for retention in youth violence studies and the characteristics of hardâ toâ reach participants.MethodsThe Flint Youth Injury (FYI) Study is a prospective study following a cohort of assaultâ injured, drugâ using youth recruited in an urban ED, and a comparison population of drugâ using youth seeking medical or nonâ violenceâ related injury care. Validated survey instruments were administered at baseline and four followâ up time points (6, 12, 18, and 24 months). Followâ up contacts used a variety of strategies and all attempts were coded by type and level of success. Regression analysis was used to predict contact difficulty and followâ up interview completion at 24 months.ResultsA total of 599 patients (ages 14â 24) were recruited from the ED (mean ± SD age = 20.1 ± 2.4 years, 41.2% female, 58.2% African American), with followâ up rates at 6, 12, 18, and 24 months of 85.3%, 83.7% 84.2%, and 85.3%, respectively. Participant contact efforts ranged from two to 53 times per followâ up time frame to complete a followâ up appointment, and more than 20% of appointments were completed off site at community locations (e.g., participantsâ homes, jail/prison). Participants who were younger (p < 0.05) and female (p < 0.01) were more likely to complete their 24â month followâ up interview. Participants who sought care in the ED for assault injury (p < 0.05) and had a substance use disorder (p < 0.01) at baseline required fewer contact attempts to complete their 24â month followâ up, while participants reporting a fight within the immediate 3 months before their 24â month followâ up (p < 0.01) required more intensive contact efforts.ConclusionsThe FYI study demonstrated that achieving high followâ up rates for a difficultâ toâ track, violentlyâ injured ED population is feasible through the use of established contact strategies and a variety of interview locations. Results have implications for followâ up strategies planned as part of other violence prevention studies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146571/1/acem13495_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146571/2/acem13495.pd

Patient Preference for Pain Medication in the Emergency Department Is Associated with Non-fatal Overdose History

Introduction: Opioid overdose is a major public health problem. Emergency physicians need information to better assess a patient’s risk for overdose or opioid-related harms. The purpose of this study was to determine if patient-reported preference for specific pain medications was associated with a history of lifetime overdose among patients seeking care in the emergency department (ED).Methods: ED patients (18-60 years) completed a screening survey that included questions on overdose history, ED utilization, opioid misuse behaviors as measured by the Current Opioid Misuse Measure (COMM), and analgesic medication preferences for previous ED visits for pain with specific responses for preference for Dilaudid®, morphine, Toradol®, “no preference” or “never visited the ED for pain.” We compared individuals who reported a lifetime history of overdose descriptively to those without a lifetime history of overdose. Logistic regression was used to determine factors associated with a history of overdose.Results: We included 2,233 adults in the analysis (71.5% response rate of patients approached) with 532 reporting at least one lifetime overdose. In the univariate analysis, medication preference was significantly associated with overdose history (p &lt; .001); more patients in the overdose group reported preferring morphine and Dilaudid® and those without a history of overdose were more likely to have no preference or say they had never visited the ED for pain. In the logistic regression analysis, patients with higher odds of overdose included those of Caucasian race, participants with a higher COMM score, preference for Toradol®, morphine or Dilaudid®. Those who were younger, female and reported never having visited the ED for pain had lower odds of reporting a lifetime overdose. Having “any preference” corresponded to 48% higher odds of lifetime overdose.Conclusion: Patients with a pain medication preference have higher odds of having a lifetime overdose compared to patients without a specific pain medication preference, even after accounting for level of opioid misuse. This patient-reported preference could cue emergency physicians to identifying high-risk patients for overdose and other substance-related harms

Patient Preference for Pain Medication in the Emergency Department Is Associated with Non-fatal Overdose History

Introduction: Opioid overdose is a major public health problem. Emergency physicians need information to better assess a patient’s risk for overdose or opioid-related harms. The purpose of this study was to determine if patient-reported preference for specific pain medications was associated with a history of lifetime overdose among patients seeking care in the emergency department (ED).Methods: ED patients (18-60 years) completed a screening survey that included questions on overdose history, ED utilization, opioid misuse behaviors as measured by the Current Opioid Misuse Measure (COMM), and analgesic medication preferences for previous ED visits for pain with specific responses for preference for Dilaudid®, morphine, Toradol®, “no preference” or “never visited the ED for pain.” We compared individuals who reported a lifetime history of overdose descriptively to those without a lifetime history of overdose. Logistic regression was used to determine factors associated with a history of overdose.Results: We included 2,233 adults in the analysis (71.5% response rate of patients approached) with 532 reporting at least one lifetime overdose. In the univariate analysis, medication preference was significantly associated with overdose history (p &lt; .001); more patients in the overdose group reported preferring morphine and Dilaudid® and those without a history of overdose were more likely to have no preference or say they had never visited the ED for pain. In the logistic regression analysis, patients with higher odds of overdose included those of Caucasian race, participants with a higher COMM score, preference for Toradol®, morphine or Dilaudid®. Those who were younger, female and reported never having visited the ED for pain had lower odds of reporting a lifetime overdose. Having “any preference” corresponded to 48% higher odds of lifetime overdose.Conclusion: Patients with a pain medication preference have higher odds of having a lifetime overdose compared to patients without a specific pain medication preference, even after accounting for level of opioid misuse. This patient-reported preference could cue emergency physicians to identifying high-risk patients for overdose and other substance-related harms

Emergency Department Visits by Patients with Substance Use Disorder in the United States

Introduction: We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons. Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD.&nbsp; Results: Of all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66-1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09-1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14-1.43) and intensive care unit (aOR 1.40, CI, 1.05-1.85). Conclusion: Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD

Piloting a statewide emergency department take-home naloxone program: Improving the quality of care for patients at risk of opioid overdose

BackgroundEmergency department (ED) patients with nonfatal opioid overdose are at high risk for subsequent fatal overdose, yet ED programs aimed at reducing harm from opioid use remain underdeveloped.ObjectivesThe objective was to pilot a statewide ED take-home naloxone program and improve the care of patients with opioid use disorder (OUD) and risky drug use through training and interprofessional network building.MethodsNine hospital EDs with pharmacy, nurse, and physician champions were recruited, surveyed, and trained. Take-home naloxone rescue kits were developed, disseminated, and tracked. Two overdose prevention summits were convened prior to the COVID pandemic, and two X-waiver training courses aimed at emergency physicians and advanced practice providers were arranged, both in person and virtual.ResultsA total of 872 naloxone rescue kits were distributed to ED patients at risk of opioid overdose during the first phase of this project, and more than 140 providers were trained in the use of medications for OUD in acute care settings.ConclusionsA statewide ED take-home naloxone program was shown to be feasible across a range of different hospitals with varying maturity in preexisting OUD resources and capabilities. Future work will be aimed at both expanding and measuring the effectiveness of this work.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172246/1/acem14435.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172246/2/acem14435-sup-0001-DataS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172246/3/acem14435_am.pd

Trajectories of driving after drinking among marijuana-using youth in the emergency department: substance use, mental health, and peer and parental influences

Background: The psychosocial correlates and longitudinal trajectories of driving after drinking (DAD) among youth remain understudied in at-risk populations. Objectives: We investigated the relationships of DAD trajectories and negative peer and parental influences, substance use, and mental health among predominantly marijuana-using youth seeking emergency department (ED) treatment. Methods: Data were from a 2-year prospective cohort study of drug-using patients (97.4% used marijuana) ages 14-24 seeking ED care for assault injury, or as part of a non-assaulted comparison group. Validated surveys measured DAD behaviors and correlates at baseline, 6, 12, 18, and 24 months. Latent class growth analysis identified characteristic DAD trajectory groups; baseline predictors were analyzed descriptively and using multinomial logistic regression. Results: Three DAD trajectory groups were identified among driving-age youth (n = 580): no DAD (NDAD; 55.2%), low-steady (LDAD; 29.0%), and high-declining (HDAD; 15.9%). In unadjusted analyses, HDAD youth were older, but otherwise similar to other groups demographically. Compared to NDAD, LDAD and HDAD group members had higher rates of drug and alcohol use disorders (p < .001). Further, HDAD group members had higher rates of anxiety symptoms and were more likely to be diagnosed with PTSD or depression than NDAD or LDAD youth (p < .05). Negative peer and parent influences were significantly higher in progressively more severe trajectory groups (p < .01). Adjusted effects from the multinomial model were analogous for peer and parental influences and substance use disorders, but not mental health. Conclusion: DAD is strongly associated with negative social influences and substance use disorders among marijuana-using youth, reinforcing their importance when developing interventions

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Introduction: Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.Methods: Participants (aged 25-60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.Results: Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p&lt;0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55-9.17), daily opioid use (OR = 3.81, 95% CI, 1.64-8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07-2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses.Conclusion: Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving