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Home > Topics > Hospital

Detroit study: 77 percent of frequent ED patients are addicts

The hospital studied 255 "super-frequent users" and created individual care plans to better manage the patients

Henry Ford Hospital 

DETROIT — A vast majority of so-called “super-frequent user” patients who seek care in the Emergency Department (ED) have a substance abuse addiction, according to a Henry Ford Hospital study.

A patient is considered a super-frequent user who visits the ED at least 10 times a year.

ED physicians have long theorized that patients who frequent the ED for their care have a substance abuse addiction. Few studies have actually measured the rate of addiction of these patients.

The study’s key findings:

  • 77 percent of patients had a substance abuse addiction.
  • 47 percent were addicted to pain-relief narcotics such as Vicodin and Dilaudid.
  • 44 percent were addicted to “other” illicit drugs such as cocaine or marijuana.
  • 35 percent were addicted to alcohol.

Researchers also found that super-frequent users seeking pain-relief narcotics were more common with women.

The findings were presented Saturday at the Society for Academic Emergency Medicine (SAEM) annual meeting in Dallas.

“Emergency Departments cannot address the super-frequent users problem without addressing the underlying reason they’re here – their substance abuse problem,” says Jennifer Peltzer-Jones, R.N., Psy.D., a clinical psychologist at Henry Ford’s Department of Emergency Medicine and the study’s lead author. “Boosting federal and state funding for substance abuse programs could help alleviate some of the frequent use of Emergency Departments as sources of addiction care.”

According to the federal Drug Abuse Warning Network, an estimated 2.5 million ED visits involved drug misuse or abuse in 2011. ED visits involving drug misuse or abuse increased 19 percent from 2009-11.

Dr. Peltzer-Jones and her team of researchers sought to examine the level of addiction of 255 super-frequent users who sought care at Henry Ford’s Emergency Department from 2004-2013 and determine whether imposing prescribing guidelines for narcotics in their ED impacted the level of patients seeking pain-relief narcotics.

In 2004, Henry Ford created the Community Resources for Emergency Department Overuse (CREDO) to more effectively manage the increased frequent users in the ED with individual care plans.

After reviewing and collecting data from each of the patients’ electronic medical record, researchers found that CREDO had a significant impact. Before CREDO was initiated, the super-frequent users sought care in the ED 32.4 times a year.

Since then, rate of super-frequent users who sought pain-relief narcotics in Henry Ford’s ED dropped to 13.8 visits a year from 32.5. For other super-frequent users, their visits dropped to 11.6 visits a year from 33.

“Emergency Departments that implement case management initiatives can make meaningful progress in addressing their frequent-user patient population,” Dr. Peltzer-Jones says. “As our study showed, the number of frequent users visiting the ED for narcotics is alarming. A successful remedy to curtailing that problem is implementing case management strategies such as ours. However, if Emergency Departments don’t have the resources to create a program, instituting narcotic prescribing guidelines may lead to decreased visits by frequent users.”

The study was funded by Henry Ford Hospital.

The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Kim Miller Kim Miller Monday, May 19, 2014 8:16:37 PM For once, I'm almost too mad to comment. To have the medical community assume you are an addict when you show up at an emergency department, not only is unfair and demeaning to legitimate patients, but what does it say about the way things ae going to be in the future. The Hippocratic Oath has taken another major hit, folks. Lord help you if you show up at an ER and are in some super pain and the addicto-doctors are on staff, because you are going to suffer and suffer in a big way. See Link to Opposition to Kentucky House Bill 1-aka “Pill Mill Bill”
Char Manley Char Manley Monday, May 19, 2014 9:42:08 PM And
Kathleen Standke Kathleen Standke Monday, May 19, 2014 10:17:06 PM As a medical professional member of the ed I also have major health issues. It does get very aggravating to see the same patients coming in over and over. It makes you want to scream. More often than not these patients are difficult, demanding and dramatic. Many times we can not find anything wrong and we are forced to repeat test over and over. It's hard to argue with back or neck pain and the patients know this. I have been treated that way with documented serious health issues in the very ed I work in. What people don't understand is that you see that all day and all night. Many patients try telling the doctor what meds they want, the strength and the amount, not to mention refills which our hospital does not do through the ed. Since computers are now connected all over the world, that has stopped many patients from going to a different hospital/clinic many times a week. Pharmacies are also connected to stop this. There are patients that actually go to different ed' s several times a week. This struggle with frequent flyers has cut down a lot since computers merged. There is also a huge amount of patients that get narcotics strictly to sell on the street and are making lots of money doing it. If a patient has issues that require that many visits then they need to have family practice doctors and/or specialist. The emergency room is for emergencies, not for chronic pain issues. It's ridiculous to see patients with back pain that they have had for months! Make an appointment with your regular doctor or get a pain doctor.
Jennifer Paulek-Bieszczad Jennifer Paulek-Bieszczad Tuesday, May 20, 2014 9:38:37 AM Until we change the idea that patient satisfaction ratings are tied to reimbursement the opiate dependence will continue and grow. 20 years ago people only received Dilaudid if they were dying. Now we hand it out like candy and people are asking for it by name! And I'm sure the frequent fliers from this study just went to another hospital for their fix. This study didn't change a thing

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