Department of Psychiatry, Mental Health Innovations, Services, and Outcomes program, University of Michigan, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; Veterans Affairs Center for Clinical Management Research, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; University of Michigan Injury Center, 2800 Plymouth Rd, Suite B10-G080, Ann Arbor, MI 48109, United States.
University of Michigan Injury Center, 2800 Plymouth Rd, Suite B10-G080, Ann Arbor, MI 48109, United States; Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
Addict Behav. 2018 Nov;86:66-72. doi: 10.1016/j.addbeh.2017.11.030. Epub 2017 Nov 16.
Overdose is a leading cause of injury and death in the United States. Emergency Department (ED) patients have an elevated prevalence of substance use. This study describes overdose/adverse drug event experiences among adult ED patients to inform strategies to address overdose risk.
Patients seeking care at a large ED in the city of Flint, Michigan participated in a computerized self-assessment during 2011-2013 (n=4571). Overdose was assessed with a broad definition and included occurrences that could be considered adverse drug events. Among those with this type of experience, additional items assessed symptoms, outcomes, and intent.
12% reported an overdose history. Of participants' most serious overdoses, 74% were without clear intent for self-harm, although this was true of only 61% of overdoses involving opiates or sedatives, and 52% had symptoms present that indicated that it was life-threatening. Binge drinking on a monthly basis (ORs=1.4) was associated with a medically serious overdose compared to never having an overdose. Compared to no drug use in the last year, use of one drug was associated with an OR of 1.8, two drugs was associated with an OR of 5.8, three drugs was associated with an OR of 8.4, and four or more drugs was associated with an OR of 25.1 of having had a medically serious overdose (all p<0.05).
Most overdose experiences among ED patients were without clear intent of self-harm. The ED may be an appropriate setting for efforts to reduce overdose risk, especially among polysubstance users.
在美国，过量用药是导致受伤和死亡的主要原因。急诊部（ED）的患者有更高的药物使用问题发生率。本研究描述了成年 ED 患者的过量用药/药物不良事件经历，以提供信息来制定解决过量用药风险的策略。
2011-2013 年期间，密歇根州弗林特市的一家大型急诊部的患者参与了一项计算机化的自我评估（n=4571）。过量用药采用广义定义，包括可能被视为药物不良事件的情况。在有这种经历的人群中，还有其他项目评估了症状、结果和意图。
12%的患者报告有过量用药史。在患者最严重的过量用药中，74%没有明确的自我伤害意图，尽管只有 61%涉及阿片类药物或镇静剂的过量用药是这种情况，并且 52%的患者有表明危及生命的症状。与从未有过过量用药相比，每月狂饮（ORs=1.4）与严重的医疗性过量用药有关。与去年没有使用任何药物相比，使用一种药物的 OR 为 1.8，使用两种药物的 OR 为 5.8，使用三种药物的 OR 为 8.4，使用四种或更多药物的 OR 为 25.1（所有 p<0.05）。
ED 患者的大多数过量用药经历都没有明确的自我伤害意图。ED 可能是减少过量用药风险的合适场所，特别是针对多药物使用者。
