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.