Drug users more likely to end up in costly ICUs

People who abuse drugs or alcohol are twice as likely to be admitted to intensive care, according to a joint BYU-LDS Hospital study published in the journal Intensive Care Medicine. And that likely drives overall medical costs higher.

Treatment in an intensive care unit is considerably more costly than that in a regular hospital ward, driving overall medical costs up. That aspect becomes a societal, not just an individual problem, the researchers said.

And knowing that someone has a problem with alcohol or drug dependence provides an opportunity to tailor planning to avoid substance abuse-related complications and improve outcomes, said lead author Dr. Mary Suchyta, a physician at Intermountain Medical Center and LDS Hospital. It can even help with discharge planning. But substance abuse screening, common when someone comes to the emergency department, is often lacking in the ICU.

Suchyta gave the example of someone who is on a ventilator and must be kept sedated so they don't pull the ventilator out. Do you want to give those same sedating drugs to someone with substance abuse issues?

The researchers examined 724 ICU admissions at LDS Hospital over the course of a year, looking for people who had drug and alcohol abuse problems at the time of hospitalization. They were not examining a direct link between cause of admission and the substance dependence. Substance dependence was tightly defined using stringent and well-accepted criteria. And a past history a year or more before hospitalization was not counted.

Of those patients, 19 percent had a history of recent drug and alcohol dependence — twice the rate of the general LDS Hospital population.

Those patients with substance abuse issues were also an average of six years younger than the rest of ICU patients. If those younger ICU patients don't recover completely and go back to their jobs, there's a large potential societal cost as well, said Ramona Hopkins, a psychology professor at Brigham Young University and a researcher at IMC and LDS Hospital.

Suchyta and Hopkins said that detecting substance dependence earlier would allow doctors to address issues and improve recovery.

"With a medical system that's going broke, we should use preventive strategies," said Suchyta, adding that "when a known diabetic comes in, we certainly watch blood sugar. If someone has heart disease, we make sure we don't stress the heart."

People should be encouraged to get treatment for substance abuse, said Hopkins, who would also like to see outcomes research to track recovery. She's hoping for a study that would match people by age, medical disease and other factors to see how substance abuse affects their outcomes. And she's hoping to see screening on the front end, when people come into the ICU.

BYU undergrad Callie Beck is a co-author on the study.

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