First EDition: News for and about the practice of Emergency Medicine
Psychiatric comorbidities magnify migraineurs’ medical interventions
Study: Excedrin “good choice” as first-line therapy for migraine in ED
ED a “profit center”; ACA may drive higher profits
Marked shift seen in demographics of heroin users seeking treatment
Hypertonic saline indications for bronchiolitis lack evidence for clear guidance
Dr Fields said he was a little skeptical that more Medicaid coverage would increase revenues or profits. Some studies have shown that people who gain Medicaid coverage often are high utilizers of EDs, he said. More use means adding more staff, which is one of the biggest costs for hospitals.
Marked shift seen in demographics of heroin users seeking treatment
By MARY ANN MOON
FROM JAMA PSYCHIATRY
The demographics of heroin users have shifted profoundly in recent years, according to a retrospective analysis involving more than 2,700 people.
Heroin has migrated out of young minority populations in lower-class city neighborhoods, and users are now far more likely to be white, middle-class men and women in their late 20s living in suburban, small-town, or rural areas, wrote Theodore J. Cicero, PhD, of the department of psychiatry, Washington University, St. Louis (JAMA Psychiatry 2014 May 28 [doi:10.1001/jamapsychiatry.2014.366]).
Noting the paucity of systematic studies of the demographics of today’s heroin users, Dr Cicero and his colleagues analyzed data from the ongoing Survey of Key Informants’ Patients (SKIP) program, in which 150 publicly and privately funded treatment centers (the key informants) recruit patients/clients to complete anonymous surveys about their substance use. The surveys cover all 48 contiguous states.
Dr Cicero and his colleagues reviewed the survey responses of 2,797 self-reported heroin users entering treatment in 2010-2013. Most (86.4%) said they used heroin at least once a day, and many (66%) said they had concurrently abused prescription opioids during the preceding month.
Three-fourths of the respondents who began heroin use during the past decade said they had begun by abusing a prescription opioid, usually OxyContin. In contrast, about 80% of those who began using heroin in the 1960s and 1970s said they initiated their drug use with heroin itself. Fifty years ago, the average age at first use of heroin was 16 years; now it is 23 years.
A subset of 54 respondents who agreed to more detailed online interviews explained why they progressed from prescription opioids to heroin. A total of 98% said they considered the “high” from heroin to be superior to that from prescription opioids, and 94% said that heroin was far less expensive and far easier to obtain. In addition, one-third of this subgroup said that inhalation or injection is easier with heroin because it doesn’t require extraction, as prescription opioids do.
Nevertheless, if the cost, availability, and ease of use of the two agents were comparable, half of the 54 respondents said they would switch back to prescription opioids, which they described as offering a “cleaner” high and averting the legal problems associated with heroin, the investigators said.
Nearly 83% of the respondents who began heroin use in the 1960s or 1970s were men. In contrast, those who began heroin use during the past decade were approximately equally divided between men and women. Similarly, most who began using heroin in the 1960s and 1970s were nonwhite, while 90% of those who began use more recently were white.
It is important to note that this study population was not randomly selected and might not be representative of all current heroin users. These study subjects were entering treatment and had Internet access that enabled them to participate, so factors such as financial status, education level, family support, and court pressure affected their participation, Dr Cicero and his associates said.
The SKIP database is supported by the Denver Health and Hospital Authority, which is funded by fees from 14 pharmaceutical firms.
Dr Cicero and his associates reported no financial conflicts of interest
Hypertonic saline indications for bronchiolitis lack evidence for clear guidance
By TARA HAELLE
FROM JAMA PEDIATRICS
The therapeutic value of hypertonic saline in treating bronchiolitis in young children remains unclear, based on the findings of two randomized controlled trials with conflicting results.
While one found no significant improvements in outcomes between hypertonic and normal saline, the other found a lower risk of hospitalization in children receiving hypertonic saline.
