Mentally ill drug abusers have more ER visits

NEW YORK (Reuters Health) - Drug abusers with mental illness visit emergency rooms more often than their counterparts without mental illness, according to a study published in BMC Emergency Medicine.

"Psychiatric and substance use problems are commonly found to be contributing factors to frequent ER use," Dr. Geoffrey M. Curran, of the University of Arkansas for Medical Sciences, Little Rock, and colleagues write. Little research, however, has examined the impact on ER usage when both drug abuse and mental illness are present.

The researchers studied 6865 patients diagnosed with substance use disorders in the ER of a large community hospital over a 54-month period. Substance abuse was classified as alcohol dependence, alcohol abuse, cocaine dependence/abuse, and polysubstance/mixed use.

If a psychiatric diagnosis appeared during any of the ED visits, the patient was classified has having a mental illness. Psychiatric diagnoses included schizophrenia/psychoses, bipolar disorder, depression, anxiety, and dementia.

Patients with mental illness had an average of 5.2 ER visits, compared to 2.5 visits for those without mental illness, the investigators found.

The association was particularly evident with cocaine use. For instance, cocaine users with mental illness were 3.5-times more likely to visit the ER 4 or more time compared with users without mental illness.

If these findings can be verified in other ER settings, they could have important treatment implications for drug abusers who also have mental illness, the authors conclude.

SOURCE: BMC Emergency Medicine, December 2008.