Epidemic increases in cocaine and opiate use by trauma center patients: Documentation with a large clinical toxicology database

Background Although reports have documented alcohol and other drug use by t rauma patients, no studies of long-term trends have been published. We asse ssed substance use trends in a large cohort of patients admitted to a regio nal Level I adult trauma center between July 1984 and June 2000. Methods. Positive toxicology results, collected via retrospective database review, were analyzed for patients admitted directly to the center. Data we re abstracted from a clinical toxicology database for 53,338 patients. Resu lts were analyzed for alcohol, cocaine, and opiates relative to sex, age (< 40/<greater than or equal to> 40 years), and injury type (nonviolence/viol ence). Positive toxicology test result trends were assessed for the 3 years at the beginning and end of the period (chi (2)). Testing biases were asse ssed for sex, race, and injury type. Results. The patient profile was as follows: men, 72%; age < 40 years, 69%; nonviolence victims, 77%. Alcohol-positive results decreased 37%, but coca ine-positive and opiate-positive results increased 212% and 543%, respectiv ely (all p < 0.001). Cocaine-positive/opiate-positive results increased 152 %/640% for nonviolence and 226%/258% for violence victims, respectively (al l p < 0.001). In fiscal year 2000, cocaine-positive and opiate-positive res ults were highest among violence victims (27.4% for both drugs). Cocaine-po sitive and opiate-positive results among nonviolence victims were 9.4% and 17.6%, respectively. Patients who were minorities or victims of violence we re not tested more frequently than other patients. Conclusion. Epidemic increases in cocaine and opiate use were documented in all groups of trauma patients, with the greatest increases being in violen ce victims. Alcohol use decreased for all groups.