STUDY FINDS WIDESPREAD SUBSTANCE ABUSE IN ER PATIENTS

KNOXVILLE, Tenn. -- One of four people entering Tennessee hospital
emergency rooms has a drug or alcohol abuse problem, but it's rarely
diagnosed or treated, a study published by the American College of
Emergency Physicians concludes.

That translates into as many as 22 million patients a year in emergency
rooms across the country, according to the report written by Dr. Ian
Rockett and colleagues at the University of Tennessee.

"I think people who work in emergency rooms are well aware that many
patients have drug problems," said Rockett, who recently left UT for West
Virginia University. "But I don't think they are truly aware of the extent
of it."

Why is drug and alcohol abuse among ER patients a concern? One reason is
the effect on treatment -- masking symptoms of head injury, for instance,
or leading to bad interactions with prescribed medicines, experts say.

But it's also a concern because "this group of patients do not go to
primary care," said Dr. Gail D'Onofrio, an associate professor of surgery
in emergency medicine at Yale University who has written extensively on the
subject.

"If you don't pick them up (in the ER), they are going to come back and
with more injuries and more problems," she said.

The study, published in the June issue of Annals of Emergency Medicine, is
described as the first to assess both alcohol and psychoactive drug use,
abuse and dependence in a statewide population.

The researchers studied 1,502 adults seeking emergency care at seven
unidentified large and small hospitals across Tennessee from June 1996 to
January 1997.

Through patient interviews and follow-up screening of saliva and urine, the
researchers determined 27 percent of the patients needed substance abuse
treatment.

Yet "a diagnosis of an alcohol or other drug-related problem was recorded
in the charts of only 1.1 percent of the . . . patients," the researchers
wrote.

Eight percent of the 1,502 patients surveyed said they received substance
abuse treatment at some point in their lives, but only 3 percent of the
patients determined to need treatment at that moment were getting it.

"We all see the same things. We all have the same concerns and we all feel
our hands are tied, many times," said Dr. Larry Alexander, a spokesman for
the 28,000-member American College of Emergency Physicians.

"The study was excellent and it pointed out a problem. But until there is
money poured into offering a solution, the problem is going to continue,"
said Alexander, who also is medical director for Central Florida Regional
Hospital near Orlando.