Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis
Aims To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs. Design Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We con...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2020-06, Vol.115 (6), p.1011-1023 |
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| container_title | Addiction (Abingdon, England) |
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| creator | Lewer, Dan Freer, Joseph King, Emma Larney, Sarah Degenhardt, Louisa Tweed, Emily J. Hope, Vivian D. Harris, Magdalena Millar, Tim Hayward, Andrew Ciccarone, Dan Morley, Katherine I. |
| description | Aims
To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs.
Design
Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525).
Setting and participants
People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services.
Measurements
Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED).
Findings
Ninety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.
Conclusions
People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population. |
| doi_str_mv | 10.1111/add.14892 |
| format | Article |
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To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs.
Design
Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525).
Setting and participants
People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services.
Measurements
Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED).
Findings
Ninety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.
Conclusions
People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/add.14892</identifier><identifier>PMID: 31705770</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Amphetamines ; Australia - epidemiology ; Cannabis ; Clinical outcomes ; Cocaine ; Crack Cocaine ; Demography ; Diagnosis ; Drug abuse ; Drug dependence ; Drug development ; Drug Users - statistics & numerical data ; Drugs ; Ecstasy ; Ecstasy drug ; Emergency medical care ; Emergency Service, Hospital - statistics & numerical data ; Emergency services ; Female ; Hallucinogens ; Health care ; Health problems ; Health services ; Health services utilization ; Heroin ; Hospitalization ; Hospitalization - statistics & numerical data ; Hospitals ; Housing ; Humans ; Illicit Drugs ; Male ; Marijuana ; MDMA ; Medical treatment ; Mental disorders ; Mental health ; Meta-analysis ; Methamphetamine ; North America ; Observational studies ; Opiates ; Opioids ; Patient Acceptance of Health Care - statistics & numerical data ; Patients ; Primary Health Care ; Recruitment ; Review ; Reviews ; Stimulants ; Substance abuse ; Substance abuse treatment ; Substance-Related Disorders - epidemiology ; Substance‐Related Disorders ; Systematic review</subject><ispartof>Addiction (Abingdon, England), 2020-06, Vol.115 (6), p.1011-1023</ispartof><rights>2019 The Authors. published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction</rights><rights>2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.</rights><rights>2019. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4432-e87cfbe62916ab3fab0a6defec77da38e47e50b8c302a2ee81c2a4d777bed0da3</citedby><cites>FETCH-LOGICAL-c4432-e87cfbe62916ab3fab0a6defec77da38e47e50b8c302a2ee81c2a4d777bed0da3</cites><orcidid>0000-0002-2725-5535 ; 0000-0001-5712-5734 ; 0000-0001-8718-8226 ; 0000-0002-8513-2218 ; 0000-0001-6659-812X ; 0000-0003-3698-7196</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fadd.14892$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fadd.14892$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31705770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lewer, Dan</creatorcontrib><creatorcontrib>Freer, Joseph</creatorcontrib><creatorcontrib>King, Emma</creatorcontrib><creatorcontrib>Larney, Sarah</creatorcontrib><creatorcontrib>Degenhardt, Louisa</creatorcontrib><creatorcontrib>Tweed, Emily J.</creatorcontrib><creatorcontrib>Hope, Vivian D.</creatorcontrib><creatorcontrib>Harris, Magdalena</creatorcontrib><creatorcontrib>Millar, Tim</creatorcontrib><creatorcontrib>Hayward, Andrew</creatorcontrib><creatorcontrib>Ciccarone, Dan</creatorcontrib><creatorcontrib>Morley, Katherine I.</creatorcontrib><title>Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>Aims
To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs.
Design
Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525).
Setting and participants
People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services.
Measurements
Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED).
Findings
Ninety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.
Conclusions
People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.</description><subject>Adult</subject><subject>Amphetamines</subject><subject>Australia - epidemiology</subject><subject>Cannabis</subject><subject>Clinical outcomes</subject><subject>Cocaine</subject><subject>Crack Cocaine</subject><subject>Demography</subject><subject>Diagnosis</subject><subject>Drug abuse</subject><subject>Drug dependence</subject><subject>Drug development</subject><subject>Drug Users - statistics & numerical data</subject><subject>Drugs</subject><subject>Ecstasy</subject><subject>Ecstasy drug</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Emergency services</subject><subject>Female</subject><subject>Hallucinogens</subject><subject>Health care</subject><subject>Health problems</subject><subject>Health services</subject><subject>Health services utilization</subject><subject>Heroin</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Housing</subject><subject>Humans</subject><subject>Illicit Drugs</subject><subject>Male</subject><subject>Marijuana</subject><subject>MDMA</subject><subject>Medical treatment</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Meta-analysis</subject><subject>Methamphetamine</subject><subject>North America</subject><subject>Observational studies</subject><subject>Opiates</subject><subject>Opioids</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patients</subject><subject>Primary Health Care</subject><subject>Recruitment</subject><subject>Review</subject><subject>Reviews</subject><subject>Stimulants</subject><subject>Substance abuse</subject><subject>Substance abuse treatment</subject><subject>Substance-Related Disorders - epidemiology</subject><subject>Substance‐Related Disorders</subject><subject>Systematic review</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kbtuFDEUhi0EIkug4AWQJSqKSY49s-NZCqQoF0CKlAZq64x9JuvIOw62J6uh4hF4xjwJDhsiUsTNKfzpO5efsbcCDkR5h2jtgWi6lXzGFqJuoYKmqZ-zBazaZSVFA3vsVUpXAKC6VfOS7dVCwVIpWLBwFunHRKOZeRj4mtDn9e2v3wYj8Sk7735idmHk_czRTj4nvl0HPiXizntnXOY2TpfpI0ee5pRpU3DDI9042nIcLd9QxiLEEf2cXHrNXgzoE725r_vs-9npt-Mv1fnF56_HR-eVKaPLijplhp5auRIt9vWAPWBraSCjlMW6o0bREvrO1CBREnXCSGysUqonC4XYZ5923uup35A1NOaIXl9Ht8E464BOP_4Z3VpfhhutpADooAje3wtiKAdKWV-FKZYtkpYNtEqWO9eF-rCjTAwpRRoeOgjQd9noko3-m01h3_0_0gP5L4wCHO6ArfM0P23SRycnO-UfVE6ePw</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Lewer, Dan</creator><creator>Freer, Joseph</creator><creator>King, Emma</creator><creator>Larney, Sarah</creator><creator>Degenhardt, Louisa</creator><creator>Tweed, Emily J.</creator><creator>Hope, Vivian D.</creator><creator>Harris, Magdalena</creator><creator>Millar, Tim</creator><creator>Hayward, Andrew</creator><creator>Ciccarone, Dan</creator><creator>Morley, Katherine I.</creator><general>Blackwell Publishing Ltd</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2725-5535</orcidid><orcidid>https://orcid.org/0000-0001-5712-5734</orcidid><orcidid>https://orcid.org/0000-0001-8718-8226</orcidid><orcidid>https://orcid.org/0000-0002-8513-2218</orcidid><orcidid>https://orcid.org/0000-0001-6659-812X</orcidid><orcidid>https://orcid.org/0000-0003-3698-7196</orcidid></search><sort><creationdate>202006</creationdate><title>Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis</title><author>Lewer, Dan ; Freer, Joseph ; King, Emma ; Larney, Sarah ; Degenhardt, Louisa ; Tweed, Emily J. ; Hope, Vivian D. ; Harris, Magdalena ; Millar, Tim ; Hayward, Andrew ; Ciccarone, Dan ; Morley, Katherine I.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4432-e87cfbe62916ab3fab0a6defec77da38e47e50b8c302a2ee81c2a4d777bed0da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Amphetamines</topic><topic>Australia - epidemiology</topic><topic>Cannabis</topic><topic>Clinical outcomes</topic><topic>Cocaine</topic><topic>Crack Cocaine</topic><topic>Demography</topic><topic>Diagnosis</topic><topic>Drug abuse</topic><topic>Drug dependence</topic><topic>Drug development</topic><topic>Drug Users - statistics & numerical data</topic><topic>Drugs</topic><topic>Ecstasy</topic><topic>Ecstasy drug</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Emergency services</topic><topic>Female</topic><topic>Hallucinogens</topic><topic>Health care</topic><topic>Health problems</topic><topic>Health services</topic><topic>Health services utilization</topic><topic>Heroin</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Housing</topic><topic>Humans</topic><topic>Illicit Drugs</topic><topic>Male</topic><topic>Marijuana</topic><topic>MDMA</topic><topic>Medical treatment</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Meta-analysis</topic><topic>Methamphetamine</topic><topic>North America</topic><topic>Observational studies</topic><topic>Opiates</topic><topic>Opioids</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patients</topic><topic>Primary Health Care</topic><topic>Recruitment</topic><topic>Review</topic><topic>Reviews</topic><topic>Stimulants</topic><topic>Substance abuse</topic><topic>Substance abuse treatment</topic><topic>Substance-Related Disorders - epidemiology</topic><topic>Substance‐Related Disorders</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lewer, Dan</creatorcontrib><creatorcontrib>Freer, Joseph</creatorcontrib><creatorcontrib>King, Emma</creatorcontrib><creatorcontrib>Larney, Sarah</creatorcontrib><creatorcontrib>Degenhardt, Louisa</creatorcontrib><creatorcontrib>Tweed, Emily J.</creatorcontrib><creatorcontrib>Hope, Vivian D.</creatorcontrib><creatorcontrib>Harris, Magdalena</creatorcontrib><creatorcontrib>Millar, Tim</creatorcontrib><creatorcontrib>Hayward, Andrew</creatorcontrib><creatorcontrib>Ciccarone, Dan</creatorcontrib><creatorcontrib>Morley, Katherine I.</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lewer, Dan</au><au>Freer, Joseph</au><au>King, Emma</au><au>Larney, Sarah</au><au>Degenhardt, Louisa</au><au>Tweed, Emily J.</au><au>Hope, Vivian D.</au><au>Harris, Magdalena</au><au>Millar, Tim</au><au>Hayward, Andrew</au><au>Ciccarone, Dan</au><au>Morley, Katherine I.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2020-06</date><risdate>2020</risdate><volume>115</volume><issue>6</issue><spage>1011</spage><epage>1023</epage><pages>1011-1023</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><abstract>Aims
To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs.
Design
Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525).
Setting and participants
People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services.
Measurements
Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED).
Findings
Ninety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.
Conclusions
People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>31705770</pmid><doi>10.1111/add.14892</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-2725-5535</orcidid><orcidid>https://orcid.org/0000-0001-5712-5734</orcidid><orcidid>https://orcid.org/0000-0001-8718-8226</orcidid><orcidid>https://orcid.org/0000-0002-8513-2218</orcidid><orcidid>https://orcid.org/0000-0001-6659-812X</orcidid><orcidid>https://orcid.org/0000-0003-3698-7196</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0965-2140 |
| ispartof | Addiction (Abingdon, England), 2020-06, Vol.115 (6), p.1011-1023 |
| issn | 0965-2140 1360-0443 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7210080 |
| source | MEDLINE; Wiley Journals |
| subjects | Adult Amphetamines Australia - epidemiology Cannabis Clinical outcomes Cocaine Crack Cocaine Demography Diagnosis Drug abuse Drug dependence Drug development Drug Users - statistics & numerical data Drugs Ecstasy Ecstasy drug Emergency medical care Emergency Service, Hospital - statistics & numerical data Emergency services Female Hallucinogens Health care Health problems Health services Health services utilization Heroin Hospitalization Hospitalization - statistics & numerical data Hospitals Housing Humans Illicit Drugs Male Marijuana MDMA Medical treatment Mental disorders Mental health Meta-analysis Methamphetamine North America Observational studies Opiates Opioids Patient Acceptance of Health Care - statistics & numerical data Patients Primary Health Care Recruitment Review Reviews Stimulants Substance abuse Substance abuse treatment Substance-Related Disorders - epidemiology Substance‐Related Disorders Systematic review |
| title | Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis |
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