STUDY: ERS MISS DRUG-ABUSE CASES

1-in-4 Tenn. patients found needing help

One of four people entering Tennessee 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 in Morgantown, W.Va. "But I don't think they are truly
aware of the extent of it."

One reason for concern 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 these patients "do not go to primary care,"
said Dr. Gail D'Onofrio, a Yale University associate professor of surgery in
emergency medicine 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 was published in the June issue of Annals of Emergency Medicine.

Researchers studied 1,502 adults at seven unidentified large and small
hospitals across Tennessee from June 1996 to January 1997.

Through interviews and follow-up screening of saliva and urine, they
determined 27 percent 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 some time in their lives, but only 3 percent of
those determined to need treatment at that moment were getting it.

Dr. Larry Alexander, a spokesman for the 28,000-member American College of
Emergency Physicians, said, "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.

"The emergency department was never designed to be a family-practice clinic;
it is a stopgap measure," he said.

But Rockett said the emergency room may be the most appropriate place for
many of these patients. "The ER is the front line for diagnosis and
treatment," he said. "Going there frequently represents a personal crisis.
If an emergency is exacerbated by substance abuse, the patient may be more
responsive to a brief intervention or to seeking appropriate treatment."

Testing and treatment for substance abuse doesn't have to be hugely
expensive or time-consuming for ER doctors, D'Onofrio said. She cited a
community-funded program at Yale New Haven Hospital using trained outreach
workers.

"We send around 650 people a year to specialized treatment centers and
thousands to brief intervention or referrals to primary care," D'Onofrio
said. Follow-up calls found 93 percent of the patients referred to treatment
programs enrolled in them. "We know that it works and found that it works,"
she said. "Patching them up and just doing episodic care (in the ER) doesn't
help."