Profiling patients suspected of drug seeking in an adult emergency department.

OBJECTIVES

(i) To profile ED consultations where drug seeking is considered; (ii) to clarify if an Australian patient cohort shares the characteristics identified in the literature, that is, high rate of psychiatric, chronic pain and drug dependency problems; and (iii) to quantify the extent of missed organic disease in suspected drug-seeking presentations.

METHODS

Prospective descriptive study with an initial enrolment period of 3 months, follow up at 3 and 5 years. Tertiary hospital ED doctors voluntarily identified suspected drug-seeking behaviour. Patients' demographic information, past history, presenting features, investigations, management and missed diagnoses of organic pathology were collected. Recurrent presentations of drug seeking, self-harming, psychiatric, chronic pain and drug dependency complaints were documented.

RESULTS

Thirty-seven presentations (31 patients) of 10,958 total attendances were analysed. All patients were less than 65 years. Twenty-one patients (68%, 95% confidence interval [CI 49.7-85.8]) were on unemployment or disability pension. Twenty-six presentations (70% [95% CI 54.2-86.3]) described psychiatric problems, whereas three presentations (8% [95% CI 0.0-18.3]) had chronic pain and 10 presentations (27% [95% CI 11.4-42.7]) had drug dependency problems. Twenty-six patients (84% [95% CI 69.3-98.4]) recurrently presented with self-harming and drug-seeking behaviour at 3 years. The risk of missing organic pathology was 8/37 (22% [95% CI 7.0-36.2]).

CONCLUSIONS

Further characterization of this population would help accurate diagnosis of this aberrant behaviour and decrease the risk of missing organic pathology. The management of frequently presenting patients should prompt formulation of departmental plans to effectively assess and manage these people.