Follow-up of young patients after acute poisoning by substances of abuse: A comparative cohort study at an emergency outpatient clinic

Abstract

Background: Young patients with acute poisoning by substances of abuse have increased mortality rates in the long term. In Oslo, Norway, most of these patients are treated at the Oslo Accident and Emergency Outpatient Clinic. The majority were discharged without follow-up. In 2010, the clinic implemented an intervention program for patients under the age of 23 presenting with acute poisoning by substances of abuse. The intervention was a brief motivational interview with a social worker before discharge, followed by a telephone consultation. Patients in need of further follow-up were identified and referred. Our objective was to study short-term effects of the intervention program on referrals to follow-up and repetition rates of acute poisoning. Methods: Comparative cohorts were derived from studies of acute poisoning at the Oslo Accident and Emergency Outpatient Clinic in 2003, 2008 and 2012. Two age groups of patients presenting with acute poisoning by substances of abuse were included: 16-22 years and 23-27 years. Patients in the pre-intervention cohorts of 2003 and 2008 were compared with patients of the same age in the post-intervention cohort of 2012. Repetition rates were estimated using survival analysis. In total, 1323 patients were included; 422 in the younger pre-intervention group, 366 in the younger post-intervention group, 288 in the older pre-intervention group, and 247 in the older post-intervention group. Overall, the major toxic agents were ethanol 823/1323 (62 %) and opioids 215/1323 (16 %). 719/1323 (54 %) patients were male. Results: In the younger groups referrals to follow-up increased from 86/317 (27 %) to 156/366 (43 %) (p < 0.001) after the implementation of the program. Among the older patients, who were not included in the program, there was no significant change in referrals. There was no change in the repetition rate of acute poisoning in either age group. The program established contact with 225/366 (61 %) of the eligible patients. Conclusion: More patients were referred to follow-up after the intervention. We expect this to have a beneficial effect on their substance use and reduce excess morbidity and mortality in the long term. There was no change in the repetition rate of poisoning.