TY - JOUR
T1 - Substance use and homelessness among emergency department patients
AU - Doran, Kelly M.
AU - Rahai, Neloufar
AU - McCormack, Ryan P.
AU - Milian, Jacqueline
AU - Shelley, Donna
AU - Rotrosen, John
AU - Gelberg, Lillian
N1 - Funding Information:
RPM has conducted research and clinical demonstration projects unrelated to the present paper with funding from the NIH (NIAAA, NIDA) and NYC Department of Health and Mental Hygiene. He has received study medication without funding or restrictions from Alkermes for research unrelated to the present paper. DS reports having funding from Pfizer for research unrelated to this paper. JR discloses that he has been an investigator or principal investigator on studies that have received support (financial or medication or both) from Indivior (formerly Reckitt-Benckiser) and from Alkermes and from NIDA/NIH and from NIAAA/NIH. As a principal investigator in NIDA’s Clinical Trials Network he collaborates extensively with organizations that seek to provide help with or promote recovery from addiction. He does not have equity in these entities and is not a paid consultant or advisory board member. He is an employee of New York University and formerly of the Department of Veterans Affairs. He sees none of these activities as presenting a conflict of interest with the present paper.
Funding Information:
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health ( K23DA039179 , PI Doran), the United Hospital Fund (PI Doran) , and the Doris Duke Charitable Trust—NYULMC (PI Doran) . The content is solely the responsibility of the authors and does not represent the official views of any funder.
Publisher Copyright:
© 2018 Elsevier B.V.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Alcohol
KW - Drugs
KW - Emergency service
KW - Homelessness
KW - Opioids
KW - Overdose
KW - Vulnerable populations
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U2 - 10.1016/j.drugalcdep.2018.04.021
DO - 10.1016/j.drugalcdep.2018.04.021
M3 - Article
C2 - 29852450
AN - SCOPUS:85047609184
VL - 188
SP - 328
EP - 333
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -