Addiction Medicine Consultation and Harm Reduction Among Adolescents Presenting to the Emergency Department

Abstract

Introduction: According to the Center for Disease Control and Prevention, overdose deaths increased by only 0.5% in 2022 for the general population. However, adolescent overdose deaths increased 94% from 2019 to 2020 and 20% from 2020 to 2021. Addiction medicine consultation teams can help alleviate this disparity and other consequences of substance use. This study assessed how frequent addiction medicine consultations, harm reduction, or counseling/education on substance use disorders was provided to adolescents with a substance use disorder presenting to an emergency department.

Methods: A retrospective cohort study of adolescents 19 years or younger with an International Classification of Disease, tenth edition (ICD-10) diagnosis of a substance use disorder noted in their medical record when visiting the emergency department from 2019 to 2021.

Results: Three hundred and fifteen emergency department visits were made by 286 adolescents with substance use disorders. An addiction medicine consultation was completed in 1.2% of all visits. Harm reduction was provided at 8.5% of substance use-related visits and naloxone prescribed at 3.4% of substance use-related visits. Counseling/education was provided at 39% of substance use related visits. Patients with a substance use related involuntary hold were more likely to receive harm reduction (28.6% vs. 3.7%, p = .003). Patients that received an addiction medicine or psychiatry consultation were more likely to receive counseling/education (45.8% vs. 22.8%, p < .001).

Conclusions: Future studies need to examine hospital providers' reasons for not consulting addiction medicine specialists or providing harm reduction services for adolescents with substance use disorders.

Keywords: Naloxone; adolescent; drug overdose; emergency service; harm reduction; hospital; substance-related disorders.