Community–wide Emergency Department Visits by Patients Suspected of Drug–seeking Behavior

Objective: To measure community–wide ED use by patients at high risk for drug–seeking behavior. Methods: A retrospective, observational study was performed to analyze a cohort of university hospital ED patients seen January 1 to June 30, 1990, for specific pain–related diagnoses (i.e., ureteral colic, toothache, back pain, abdominal pain, or headache) and either independently identified on at least one other local hospital's “patient alert” list or having a drug–related death during 1990. Patients with terminal illnesses were excluded. The frequency of ED (and affiliated urgent care clinic) visits and hospital admissions were determined for January 1 to December 31, 1990, at seven local hospitals. Detailed, supplemental chart review was performed for visits to three of these hospitals from 1990 to 1992. Results: Thirty patients were identified as being at risk for drug–seeking behavior (mean age: 34.3 years; range: 21–55 years; 50% males). We identified 379 visits for this cohort (86% ED visits, 9.8% urgent care visits, 4.7% hospital admissions), for an average of 12.6 visits (range: 2–33) per patient per year. On average, each patient visited 4.1 (range: 1–7) different hospitals and used 2.2 (range: 1–6) different aliases. Two patients died of drug overdose. Supplemental chart review revealed 28 episodes (among 17 different patients) in which a patient was told that he or she “would receive no further ‘narcotics’” from that facility; these patients subsequently received controlled substances from another hospital in 93% of these instances and from the same facility in 71%. Conclusions: Patients identified as being at high risk for drug–seeking behavior have high community–wide ED visit rates. Improving communication between and within hospitals may help identify patients who could benefit from more consistent community–wide care and appropriate treatment for addiction.