Intravenous drug misusers presenting to the accident and emergency department of a large teaching hospital. A failure of clinical management?

The records of all 77,686 attendances at or via the accident and emergency department of the Glasgow Royal Infirmary in 1986 were examined. Of these, 488 (0.6%) contained evidence of intravenous drug misuse (IDM). Most (68%) of the 354 attenders were male. The mean age of attenders in both sexes was 22 years. Over half of the presenting conditions were 'surgical' (mainly abscesses), while 'psychiatric' (including explicitly drug-related) conditions comprised about 30%. In almost two-thirds of cases, patients were discharged without specialist follow-up or care. Only 5% were referred for specialist assessment of their drug misuse. About a fifth were admitted. It is argued that these findings appear to represent a serious a serious failure of clinical management requiring an urgent remedy, particularly in the light of the growing problem of HIV transmission in this group.