SUBSTANCE-ABUSE AND THE EMERGENCY ROOM - PROGRAMMATIC IMPLICATIONS

A literature review (1984 to 1995) was conducted to identify cost effe ctive policy implications regarding substance use in the emergency roo m (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonl y marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and f urther assessment provided only when high risk factors have been ident ified. These include: males, younger patients, metropolitan centres, a fter midnight and on weekends, injury from violence, accidents includi ng MVAs, high acuity and psychiatric morbidity. Further, this screenin g should be complimented by an intervention, referral and treatment re source for those in need.