Hospitals face urgent need for addiction treatment in emergency departments

An increasing percentage of emergency visits and hospitalizations in the United States before the pandemic involved patients with alcohol and other substance use disorders, according to a study by UC San Francisco researchers. The authors say hospitals need to develop better ways to identify and treat those patients.

The study, led by Leslie Suen, MD, MAS, of the UCSF Department of Medicine, found that from 2014 to 2018, emergency department (ED) visits made by adults with alcohol and substance use disorders increased by 30 percent. Hospitalizations among patients with those disorders increased by 57 percent.

The authors found that during the study period, one out of 11 ED visits and one out of nine hospitalizations each year involved an individual with an alcohol or another substance use disorder.

"These statistics are comparable to common conditions like heart failure, but hospitals and EDs are rarely as equipped to treat addiction as they are to treat cardiovascular diseases," said Suen, a fellow in the National Clinician Scholars Program at the UCSF Philip R. Lee Institute of Health Policy Studies.

"These data suggest that there is an urgent need for hospitals to develop systems of hospital-based interventions to provide addiction treatment for those accessing emergency and inpatient care. Models providing hospital-based addiction services already exist, including UCSF's Addiction Care Team at San Francisco General Hospital."

The study was published on Sept. 13, 2021, in the Journal of General Internal Medicine.

The researchers found that patients with alcohol and other substance use disorders who came into the emergency department were more likely to have Medicaid health insurance, have depression, be experiencing homelessness, have received mental health treatment and present with injury and trauma.

"Illness and death from complications of alcohol and other substance use are increasing nationally," noted Suen. "Hospitals are one place where we can begin to reverse that trend, but we must be prepared to identify and treat these patients while they are in the hospital and continue following and treating them after they are discharged, as well."

For the study, the researchers analyzed data from the National Hospital Ambulatory Medical Care Survey, an annual survey administered by the National Center for Health Statistics. Alcohol use disorder and other substance use disorders were identified based on patients' medical charts.

"Our estimate of alcohol and substance use disorders among ED visits is higher than in some other recent studies," said Suen. "This is possibly because our study is the first to use comprehensive medical chart reviews, which are more likely to reflect true prevalence of these disorders, rather than relying solely on billing diagnosis codes."