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. 2022 Feb 4;22(1):19.
doi: 10.1186/s12873-022-00573-0.

Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008-2018

Leslie W Suen  1   2 , Thibaut Davy-Mendez  3 , Kathy T LeSaint  4 , Elise D Riley  5 , Phillip O Coffin  5   6
Affiliations

Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008-2018

Leslie W Suen et al. BMC Emerg Med. .

Abstract

Background: Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of ED visits related to cocaine and psychostimulant use, compared to opioid use, in the United States (US).

Methods: We used 2008-2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. To make visits mutually exclusive for analysis, we excluded visits related to 2 or more of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness.

Results: Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70-5.13; psychostimulant aOR 2.46, 95% CI 1.42-4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69, 95% CI 1.83-3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30-0.73) compared to opioid-related ED visits.

Conclusion: Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

Keywords: Amphetamines; Cocaine; Emergency department; Opioids; Overdose; Stimulants.

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Conflict of interest statement

KTL has received research funding unrelated to this work from the California Department of Health Care Services, Public Health Institute, Sierra Health Foundation, and Substance Abuse and Mental Health Services Administration. POC serves on the Board of Scientific Counselors, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. All other authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Annual trends in rates of national emergency department visits related to cocaine, psychostimulant, or opioid use, 2008–2018. Emergency department visits categorized by drug-type if any of the top three ICD9-CM/ICD10-CM diagnoses codes were related to opioid, cocaine, or psychostimulant use. Visits were mutually exclusive for drug type, as visits associated with two or more drug-categories were excluded. Rates were calculated by dividing weighted number of visits in each year by US Census Bureau estimates of civilian, noninstitutionalized adults aged 18 and older for that year. All rates per 10,000 population. Source: National Hospital Ambulatory Medical Care Survey
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