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Frequency of healthcare utilisation by adults who use illicit drugs: a systematic review and meta-analysis

Lewer, D; Freer, J; King, E; Larney, S; Degenhardt, L; Tweed, EJ; Hope, VD; ... Morley, KI; + view all (2020) Frequency of healthcare utilisation by adults who use illicit drugs: a systematic review and meta-analysis. Addiction 10.1111/add.14892. (In press). Green open access

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Abstract

Aims: To summarize evidence on the frequency and predictors of health‐care utilization among people who use illicit drugs. Design: Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health‐care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta‐analysis following a registered protocol (identifier: CRD42017076525). Setting and participants People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4‐methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services. Measurements: Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in‐patient) and emergency department (ED). Findings: Ninety‐two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta‐analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person‐years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health‐care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health‐care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. Conclusions: People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Type: Article
Title: Frequency of healthcare utilisation by adults who use illicit drugs: a systematic review and meta-analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/add.14892
Publisher version: https://doi.org/10.1111/add.14892
Language: English
Additional information: Copyright © 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Health services. Hospitals, Opiates Primary Health Care, Stimulants, Substance‐Related, Disorders
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/10086286
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