Department of Emergency Medicine, NYU School of Medicine, 462 1st Avenue Room A-345, New York, NY, 10016, USA; Department of Population Health, NYU School of Medicine, 227 E. 30th Street, New York, NY, 10016, USA.
Department of Emergency Medicine, NYU School of Medicine, 462 1st Avenue Room A-345, New York, NY, 10016, USA.
Drug Alcohol Depend. 2018 Jul 1;188:328-333. doi: 10.1016/j.drugalcdep.2018.04.021. Epub 2018 May 22.
Homelessness and substance use often coexist, resulting in high morbidity. Emergency department (ED) patients have disproportionate rates of both homelessness and substance use, yet little research has examined the overlap of these issues in the ED setting. We aimed to characterize alcohol and drug use in a sample of homeless vs. non-homeless ED patients.
A random sample of urban hospital ED patients were invited to complete an interview regarding housing, substance use, and other health and social factors. We compared substance use characteristics among patients who did vs. did not report current literal (streets/shelter) homelessness. Additional analyses were performed using a broader definition of homelessness in the past 12-months.
Patients who were currently homeless (n = 316, 13.7%) versus non-homeless (n = 1,993, 86.3%) had higher rates of past year unhealthy alcohol use (44.4% vs. 30.5%, p < .0001), any drug use (40.8% vs. 18.8%, p < .0001), heroin use (16.7% vs. 3.8%, p < .0001), prescription opioid use (12.5% vs. 4.4%, p < .0001), and lifetime opioid overdose (15.8% vs. 3.7%, p < .0001). In multivariable analyses, current homelessness remained significantly associated with unhealthy alcohol use, AUDIT scores among unhealthy alcohol users, any drug use, heroin use, and opioid overdose; past 12-month homelessness was additionally associated with DAST-10 scores among drug users and prescription opioid use.
Patients experiencing homelessness have higher rates and greater severity of alcohol and drug use than other ED patients across a range of measures. These findings have implications for planning services for patients with concurrent substance use and housing problems.
无家可归和物质使用通常同时存在，导致高发病率。急诊科 (ED) 患者无家可归和物质使用的比例过高，但很少有研究在 ED 环境中研究这些问题的重叠。我们旨在描述无家可归和非无家可归 ED 患者样本中的酒精和药物使用情况。
随机抽取城市医院 ED 患者，邀请他们完成一项关于住房、物质使用和其他健康和社会因素的访谈。我们比较了报告当前字面（街头/避难所）无家可归和不报告当前字面无家可归的患者之间的物质使用特征。还使用过去 12 个月内更广泛的无家可归定义进行了额外分析。
目前无家可归的患者（n=316，13.7%）与非无家可归的患者（n=1993，86.3%）相比，过去一年不健康饮酒的比例更高（44.4%比 30.5%，p<0.0001），任何药物使用（40.8%比 18.8%，p<0.0001），海洛因使用（16.7%比 3.8%，p<0.0001），处方类阿片类药物使用（12.5%比 4.4%，p<0.0001），以及终生阿片类药物过量（15.8%比 3.7%，p<0.0001）。在多变量分析中，目前的无家可归状态与不健康饮酒、不健康饮酒者的 AUDIT 评分、任何药物使用、海洛因使用和阿片类药物过量之间仍然存在显著关联；过去 12 个月的无家可归状态还与药物使用者的 DAST-10 评分和处方类阿片类药物使用相关。
与其他 ED 患者相比，经历无家可归的患者在一系列措施中，酒精和药物使用的比例更高，严重程度更高。这些发现对计划同时存在物质使用和住房问题的患者的服务具有重要意义。
