Screening problematic use of substances among young subjects attending an emergency department, and subsequent treatment seeking.

INTRODUCTION: Young individuals constitute a key population for the screening of problematic use of substances (PUS), but they are not likely to seek support and are hard to reach. Targeted screening programs should thus be developed in the places of care they may attend for other reasons, including emergency departments (EDs). We aimed to explore the factors associated with PUS in young people attending an ED; we measured the subsequent access to addiction care after ED screening. METHODS: This was a prospective interventional single-arm study which included any individual aged between 16 and 25 years who attended the main ED of Lyon, France. Baseline data were sociodemographic characteristics, PUS status using self-report questionnaires and biological measures, level of psychological health, and history of physical/sexual abuse. Quick medical feedback was provided to the individuals presenting a PUS; they were advised to consult an addiction unit, and contacted by phone at three months to ask whether they had sought treatment. Baseline data were used to compare PUS and non-PUS groups using multivariable logistic regressions, to provide adjusted odds ratios (aORs) and 95% confidence intervals (95% CI), with age, sex, employment status, and family environment as the adjustment variables. The characteristics of PUS subjects who subsequently sought treatment were also assessed using bivariable analyses. RESULTS: In total, 460 participants were included; 320 of whom (69.6%) were presenting current substance use, and 221 (48.0%) with PUS. Compared to non-PUS individuals, PUS ones were more likely to be males (aOR=2.06; 95% CI [1.39-3.07], P<0.001), to be older (per one-year increase: aOR=1.09; 95% CI [1.01-1.17], P<0.05), to have an impaired mental health status (aOR=0.87; 95% CI [0.81-0.94], P<0.001), and to have a history of sexual abuse (aOR=3.33; 95% CI [2.03-5.47], P<0.0001). Only 132 (59.7%) subjects with PUS could be reached by phone at 3 months, among whom only 15 (11.4%) reported having sought treatment. Factors associated with treatment seeking were social isolation (46.7% vs. 19.7%; P=0.019), previous consultation for psychological disorders (93.3% vs. 68.4%; P=0.044), lower mental health score (2.8±1.6 vs. 5.1±2.6; P<0.001), and post-ED hospitalization in a psychiatric unit (73.3% vs. 19.7%; P<0.0001). DISCUSSION/CONCLUSION: EDs are relevant places to screen PUS in youth, but the level of seeking further treatment needs to be substantially improved. Offering systematic screening during an emergency room visit could allow for more appropriate identification and management of youth with PUS.

Could reasons for admission help to screen unhealthy alcohol use in emergency departments? A multicenter French study.

Background: Many patients admitted to general emergency departments (EDs) have a pattern of drinking that could lead to future alcohol-related complications. However, it is often difficult to screen these patients in the context of emergency. The aim of this study is to analyze whether reasons for admission could help to screen patients who have an unhealthy alcohol use. Method: Patients were recruited among six public hospital ED in France, between 2012 and 2014. During a one-month period in each hospital, anonymous questionnaires including sociodemographic questions, AUDIT-C and RAPS4-QF were administered to each patients visiting the ED. The reason for admission of each patient was noted at the end of their questionnaire by the ED practitioner. Results: Ten thousand Four hundred twenty-one patients were included in the analysis. Patients who came to the ED for injuries and mental disorders were more likely to report unhealthy alcohol use than non-harmful use or no use. Among male patients under 65 years old admitted to the ED for a mental disorder, 24.2% drank more than four drinks (40 g ethanol) in typical day at least four time a week in the last 12 months. Among these patients, 79.7% reported daily or almost daily heavy episodic drinking (HED, 60 g ethanol), and all were positive on the RAPS4-QF. Conclusion: This study highlights that unhealthy alcohol use is frequent among ED patients and particularly among those who come for injuries or mental disorders. Men under 65 years old with a mental disorder require special attention because of their increased prevalence of daily or almost daily HED.

Proportion and conditions of use of intranasal take-home naloxone kits: A retrospective study in two French outpatient addiction centers, 2016-2020.

BACKGROUND: Take-home naloxone (THN) helps to revert the medical consequences of an opioid overdose among people who use drugs (PWUD). In France, an intranasal THN was available from July 2016 to Dec 2020, which was directly dispensed in addiction centers, after a specific education program. However, this intranasal THN was subsequently removed from the market. OBJECTIVE: To retrospectively explore the post-dispensing proportion and conditions of use of intranasal THN kits, as well as the preferences for intranasal or intramuscular THN among French PWUD. METHODS: Based on medical records, all PWUD who benefit from a dispensation of at least one intranasal THN kit in two French outpatient addiction centers, between July 2016 and Dec 2020, were recontacted by phone in April-May 2021, and asked if they used their kits, and, if yes, how. An additional question also explores whether French PWUD preferred being provided with intranasal or intramuscular THN kits. RESULTS: Five hundred thirty-four (534) PWUD were provided a THN kits, but only 188 (35.2%) could be joined by phone. Of them, 26 (13.8%) did not remember being trained for and dispensed with a THN kit. Of the 160 PWUD interviewed, only six (3.7%) reported having used their kits because of an overdose, in three cases for themselves, and in three cases for someone else. In all the six situations, the victim of the overdose survived. One hundred and eleven (111; 59.0%) PWUD declared preferring intranasal THN form, while 30 (16.0%) preferred intramuscular kits, and 47 (25.0%) had no preference. CONCLUSIONS: Compared to what was found in other countries, the proportion of use of THN was low among treatment-seeking French PWUD. This might be due to a reduced likelihood of overdose in this population, or more possibly to an insufficient interest in THN benefits by French PWUD.

Tobacco use and related behaviors among staff and students in a university hospital: A large cross-sectional survey.

INTRODUCTION: Smoking prevalence in the overall population in France was 27% in 2017. There are few data about smoking prevalence in hospital workers. The aim of this study was to assess prevalence of current smoking in student and staff populations at Lyon University Hospital. Secondary objectives were to identify main variables associated with current smoking and willingness to quit. METHODS: We designed a single center, cross-sectional survey, using printed questionnaires. During one day, all registered staff and students were surveyed. We used optical reading to extract information from questionnaires. We performed univariate and multivariate analysis adjusted on most relevant factors. RESULTS: We analyzed 9712 questionnaires. The participating rates were high: 40.6% in the student cohort and 51.5% in the staff cohort. The proportion of current cigarette users was 26% in students and 25% in staff. In multivariate analysis, current smoking was significantly associated with: younger age, male sex, occupation type (e.g. logistical staff, and paramedical students), overnight work, and e-cigarette use. Among smokers, 53% reported a willingness to quit. In multivariate analysis, number of quit attempts, and feeling symptoms from tobacco were associated with willingness to quit. CONCLUSIONS: Current smoking is less frequent in our cohorts of hospital staff and students than in the general French population. However, there are deep disparities in current smoking prevalence underlining a heterogeneous population. Among smokers, the majority reported a willingness to quit and some predictive factors may help to target this audience.

[Feedback from two French addiction centers and national survey on the intranasal naloxone (Nalscue®) in the prevention of opioid overdoses]. / Retour d'expérience de deux CSAPA et enquête nationale sur la naloxone intranasale (Nalscue®) dans la prévention des overdoses aux opioïdes.

OBJECTIVE: France has temporarily authorized addictology centers to use a form of intranasal naloxone (Nalscue®) to prevent opioid overdoses. The objectives of this work are to present both the characteristics of the patients included in this device in two hospitals centers and the results of the national survey on addiction center's contribution to this new risk reduction tool. METHODS: Patient data are those requested under Nalscue® study (inclusion period July 2016 to January 2018). The survey is an online questionnaire distributed to all addiction centers with an email address. RESULTS: Over this period, in the two addiction centers, 370 kits (35% of the national total) were distributed to 330 patients including 312 opioid users. Of these users, 15% report injecting and 85% are poly-consumers. In 14% of the cases, a patient's relative was formed to administrate the Nalscue®. Forty kits (30 given away, 6 lost, 4 administered) were renewed to 35 users. Of the 462 addiction centers contacted, 82 (18%) responded. Among 76 structures specialized in opioid addictions, two did not feel concerned and one had no knowledge of the antidote. Fifty-five structures were formed by the pharmaceutical firm. Nine hundred forty-seven patients (58% of the total) were included by 37 centers. Forty-four centers ordered 2458 kits and dispensed 1116 (including kits given out of study). Thirteen structures reported use of Nalscue®. CONCLUSION: The interest of intranasal naloxone is no longer to be demonstrated in a context of opioid overdose, but the preauthorized framework did not allow a major diffusion of the antidote within the population most at risk. Let us hope that the availability in pharmacy can promote its distribution and thus reduce the number of deaths.

Comparison between the WHO and NIAAA criteria for binge drinking on drinking features and alcohol-related aftermaths: Results from a cross-sectional study among eight emergency wards in France.

BACKGROUND: Binge drinking (BD) consists of heavy episodic alcohol use. Whereas the World Health Organization (WHO) defines BD as 60g of alcohol or more per occasion, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) conceives BD as drinking 70g (men) or 56g (women) in less than two hours. We compared the subjects delineated by each definition. METHODS: Eight-center cross-sectional study among 11,695 subjects hospitalized in emergency wards. Participants completed the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), CAGE and Rapid Alcohol Problem Screen 4 (RAPS4-QF) questionnaires. The WHO criteria were investigated using the RAPS4-QF. Independent questions assessed the NIAAA criteria. The main medical admission motive was noted. The characteristics of subjects meeting respectively: 1) the exclusive WHO criteria (BD1); 2) the NIAAA criteria (BD2); and 3) no BD criteria (noBD) were compared using multinomial regression analyses. Binary age- and gender-adjusted regression analyses directly compared BD1 and BD2. Subjects with at least four drinking occasions per week were excluded from the analyses, to withdrawn regular heavy drinking. RESULTS: Compared to BD1, BD2 subjects were more frequently males (OR=1.67 [1.39-2.0]), single (aOR=1.64 [1.36-1.98]) and unemployed (aOR=1.57 [1.27-1.90]). BD2 reported significantly more drinks per occasion, and higher heavy drinking frequencies. Previous alcohol-related remarks from family (aOR=3.00 [2.53-3.56]), ever drinking on waking-up (aOR=2.05 [1.37-2.72]), and admission for psychiatric motive (aOR=2.27 [1.68-3.07]) were more frequent among BD2 subjects. CONCLUSIONS: Compared to WHO criteria, NIAAA criteria for BD delineate subjects with more concerning drinking patterns and alcohol aftermaths.