20: Addressing Substance Use in Kids (ASK): A Study of Drug-Related Emergencies

Abstract

Background: Substance use is a prevalent behaviour in adolescents and is associated with acute and long-term health risks. The 2011 Ontario Student Drug Use and Health Survey found that 54.9% of high school students reported using alcohol in the 12 months prior to the survey while 37.4% reported using a drug other than alcohol or tobacco. The current study is part of a multi-centre project examining emergency department (ED) visits relating to alcohol or other drug use Objectives: To determine the prevalence of adolescents presenting to a tertiary care pediatric ED with substance-use associated conditions, and to identify associated patient variables, including chronic health conditions. Design/Methods: A retrospective chart review was performed of visits to the ED between September 1, 2010 and August 31, 2011. Inclusion criteria were: patients 12 to 18 years, visits coded with 'alcohol/substance use/ abuse', 'overdose/accidental', 'overdose/intentional', and 'overdose/undetermined'. Data was collected and reviewed by two independent researchers. Simple descriptive statistics were used to summarize the findings. Results: A total of 149 patient encounters were identified that met inclusion criteria. Of these, 41 involved no evidence of substance use on history or toxicology screen, and were excluded. Of the 108 remaining, substance use was identified by history and toxicology screen in 88 and on history alone in the remaining 20 visits. The mean patient age was 15 years (range 12 to 17) with 66% identified as female. A pre-existing mental health condition was identified in 27 cases (25%). Twenty-three patients (21%) were followed in the past 12 months for a chronic health condition other than substance use (eg, T1DM, asthma). The most commonly used substance was alcohol (n=68 [63%]). The second most common substance was cannabis (n=26 [24%]), followed by MDMA (n=16 [15%]) and OTC cough/cold medication components (n=6 [5%]). Other substances identified included ketamine, methamphetamine, cocaine, and opioids. Polysubstance use was identified in 30 encounters (28%). Conclusions: Consistent with provincial data, alcohol was the most commonly used substance among adolescents presenting to a pediatric ED with substance-use related conditions. One quarter of patients had a preexisting mental health condition, while 21% of patients were already connected with the institution for treatment of a chronic disease. These findings have implications for both the assessment and management of adolescents across a variety of health care settings. Future research should explore additional ways of identifying those adolescents at increased risk for morbidity relating to the use of alcohol and other substances.