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  • Print publication year: 2013
  • Online publication date: May 2013

Chapter 4 - Managing substance abuse in the acute setting

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1. New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. DHHS, Final Report, Publication no. SMA-03–3832. Rockville, MD: DHHS, 2003.
2. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2011). Drug Abuse Warning Network, 2008. National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. SMA 11–4618. Rockville, MD: HHS, 2011
3. Accessed September, 2011.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM- IV-TR). Arlington, VA: American Psychiatric Association, 2000.
5. Le FollB, Gallo, A, Le Strat, Y, LuL. GorwoodP. Genetics of dopamine receptors and drug addiction: a comprehensive review. Behav Pharmacol. 2009;20(1):1–17.
6. HeidbrederCA, GardnerEL, XiZX, et al. The role of central dopamine D3 receptors in drug addiction: a review of pharmacological evidence. Brain Res Rev. 2005;49(1):77–105.
7. BernsteinSL. The clinical impact of health behaviors on emergency department visits. Acad Emerg Med. 2009;16(11):1054–1059.
8. NewtonAS, GokiertR, MaboodN, et al. Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review. Pediatrics. 2011;128(1):e180–e192.
9. VacaF, WinnD, AndersonC, KimD, ArcilaM. Feasibility of emergency department bilingual computerized alcohol screening, brief intervention, and referral to treatment. Subst Abus. 2010;31(4):264–269.
10. TaylorB, IrvingHM, KanteresF, et al. The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend. 2010;110(1–2):108–116.
11. OpreanuRC, KuhnD, BassonMD. Influence of alcohol on mortality in traumatic brain injury. J Am Coll Surg. 2010;210(6):997–1007.
12. Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007;50(6):699–710.
13. LuceH, SchragerS, GilchristV. Sexual assault of women. Am Fam Physician. 2010;81(4):489–495.
15. Du MontJ, MacdonaldS, RotbardN, AsllaniE, BainbridgeD, CohenMM. Factors associated with suspected drug-facilitated sexual assault. CMAJ. 2009;180(5):513–519.
16. OtahbachiM, CevikC, BagdureS, NugentK. Excited delirium, restraints, and unexpected death: a review of pathogenesis. Am J Forensic Med Pathol. 2010;31(2):107–112.
17. PollanenMS, ChiassonDA, CairnsJT, YoungJG. Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. CMAJ. 1998;158(12):1603–1607.
18. TakeuchiA, AhernTL, HendersonSO. Excited delirium. West J Emerg Med. 2011;12(1):77–83.
19. VaszariJM, BradfordS, O’LearyCC, ArbiBA, CottlerLB. Risk factors for suicidal ideation in a population of community-recruited female cocaine users. Compr Psychiatry. 2011;52(3):238–246.
20. BuckleyPF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry. 2006;67 (Suppl 7):5–9.
21. KhalsaJH, TreismanG, McCance-KatzE, TedaldiE. Medical consequences of drug abuse and co-occurring infections: research at the National Institute on Drug Abuse. Subst Abus. 2008;29(3):5–16.
22. RavenMC, CarrierER, LeeJ, BillingsJC, MarrM, GourevitchMN. Substance use treatment barriers for patients with frequent hospital admissions. J Subst Abuse Treat. 2010;38(1):22–30.
23. VonghiaL, LeggioL, FerrulliA, et al. Acute alcohol intoxication. Eur J Intern Med. 2008;19:561.
24. PletcherMJ, MaselliJ, GonzalesR. Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey. Am J Med 2004; 117:863.
25. LaValleeRA, WilliamsGD, YiH. Alcohol Epidemiologic Data System. Surveillance Report #87: Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1970–2007. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research, 2009.
26. MarcoCA, KelenGD. Acute intoxication. Emerg Med Clin North Am. 1990;8:731.
27. YostDA. Acute care for alcohol intoxication. Be prepared to consider clinical dilemmas. Postgrad Med. 2002;112:14.
28. BobaA. Management of acute alcoholic intoxication. Am J Emerg Med. 1999;17:431.
29. MorseRM, FlavinDK. The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism. JAMA. 1992;268:1012.
30. HasinDS, StinsonFS, OgburnE, GrantBF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2007;64:830.
31. EckardtM, HarfordT, KaelberC. Health hazards associated with alcohol consumption. JAMA. 1981;246(6):648–666.
32. O’ConnorPG, SchottenfeldRS. Patients with alcohol problems. N Engl J Med. 1998;338:592.
33. GilbertsonR, CeballosNA, PratherR, NixonSJ. Effects of acute alcohol consumption in older and younger adults: perceived impairment versus psychomotor performance. J Stud Alcohol Drugs. 2009;70:242.
34. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2005.
35. D’OnofrioG, BernsteinE, BernsteinJ, et al. Patients with alcohol problems in the emergency department. Part 1: Improving detection. Acad Emerg Med. 1998;5:1200–1209.
36. Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007 Dec;50(6):699–710.
37. NewtonAS, GokiertR, MaboodN, et al. Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review. Pediatrics. 2011;128(1):e180–e192.
38. PilonR, LeonardL, KimJ, et al. Transmission patterns of HIV and hepatitis C virus among networks of people who inject drugs. PLoS One. 2011;6(7):e22245.
39. DegenhardtL, BucelloC, MathersB, et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction. 2011;106(1):32–51.
40. CDC. Vital signs: Overdoses of prescription opioid pain relievers – United States, 1999–2008. MMWR 2011;60:1–6.
41. HarrisonLM, KastinAJ, ZadinaJE. Opiate tolerance and dependence: receptors, G-proteins, and antiopiates. Peptides. 1998;19(9):1603–1630.
42. WaldhoerM, BartlettSE, WhistlerJL. Opioid receptors. Annu Rev Biochem. 2004;73:953.
43. StanleyTH. The history and development of the fentanyl series. J Pain Symptom Manage. 1992;7(3 Suppl):S3–S7.
44. Centers for Disease Control and Prevention. Overdose deaths involving prescription opioids among Medicaid enrollees – Washington 2004–2007. MMWR 2009;58(42):1171–1175.
45. SporerKA. Acute heroin overdose. Ann Intern Med. 1999;130(7):584–590.
46. ChamberlinJM, KleinBL. A comprehensive review of naloxone for the emergency physician. Am J Emerg Med. 1994;12(6):650–660.
47. BuajordetI, NaessAC, JacobsenD, BrørsO. Adverse events after naloxone treatment of episodes of suspected acute opioid. Eur J Emerg Med. 2004;11(1):19–23.
48. AndreeRA. Sudden death following naloxone administration. Anesth Analg. 1980;59(10):782–784.
49. van DorpEL, YassenA, DahanA. Naloxone treatment in opioid addiction: the risks and benefits. Expert Opin Drug Saf. 2007;6(2): 125–132.
50.No authors listed. Effective medical treatment of opiate addiction. National Consensus Development. JAMA. 1998;280(22):1936–1943.
51. ZealbergJJ, BradyKT. Substance abuse and emergency psychiatry. Psychiatr Clin North Am. 1999;22(4):803–817.
52. JoransonD, GilsonA. Policy issues and imperatives in the use of opioids to treat pain in substance abusers. J Law Med Ethics. 1994:22(3):215–223.
53. JaffeJH, O’KeeffeC. From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003;70(2 Suppl):S3–S11.
54. McKeown NathanielTA. Withdrawal syndromes clinical presentation.
55. BruntonL, ParkerK (Eds.). Goodman and Gilman’s The Pharmacologic Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill, 2006.
56. GoldMS, PottashAL, ExteinI, KleberHD. Clonidine and opiate withdrawal. Lancet. 1980;2(8203):1078–1079.
57. ConnrockM, Juarez-GarciaA, JowettS, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic. Health Technol Assess. 2007;11(9):1–171.
58. KrantzMJ, KutinshyIB, RobertsonAD, MehlerPS. Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes. Pharmacotherapy. 2003;23(6):802–805.
59. NordtSP, ZilbersteinJ, GoldB. Methadone-induced torsade de pointes. Am J Emerg Med. 2011;29(4):1.
60. Sporer, KA. Buprenorphine: a primer for emergency physicians. Ann Emerg Med. 2004;43(5):580–584.
61. MaremmaniI, GerraG. Buprenorphine-based regimens and methadone for the medical management of opioid dependence: selecting the appropriate drug for treatment. Am J Addict. 2010;19(6):557–568.
62.No authors listed. Buprenorphine replacement therapy: a confirmed benefit. Prescrire Int. 2006;15(82):64–70.
63. ReynaudM, PetitG, PoterdD, CourtyP. Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction. 1998;93(9):1385–1392.
64. 2008 National Survey on Drug Use and Health (NSDUH).
65. Massachusetts Poison Control System. Cocaine poisoning: an update. Clin Toxicol Rev. 1995;17:1–3.
66. RobinsRJ, AbrahamTW, ParrAJ, EaglesJ, WaltonNJ. The biosynthesis of tropane alkaloids in datura stramonium: the identity of the intermediates between N-methylpyrrolinium salt and tropinone. J Am Chem Soc. 1997;119 (45):109.
67. HiestandBC, SmithSW. Cocaine chest pain: between a (crack) rock and a hard place. . .;Acad Emerg Med. 2011;18(1):68–71.
68. LeeteE, BjorklundJA, KimSH. The biosynthesis of the benzoyl moiety of cocaine. Phytochemistry. 1988;27(8):255.
69. MandavaN, ChangRS, WangJH, et al. Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules). Emerg Med J. 2011;28(2):98–101.
70. VorspanF, BlochV, BrousseG, et al. Prospective assessment of transient cocaine-induced psychotic symptoms in a clinical setting. Am J Addict. 2011;20(6):535–537.
71. PoznerCN, LevineM, ZaneR. The cardiovascular effects of cocaine. J Emerg Med. 2005;29(2):173–178.
72. LangeRA, HillisLD. Cardiovascular complications of cocaine use. N Engl J Med 2001;345:351–358.
73. HillisL, LangeRA. Sudden death in cocaine abusers. Eur Heart J 2010; 31(3):271–273.
74. VirmaniR, RobinowitzM, SmialekJE, SmythDF. Cardiovascular effects of cocaine: an autopsy study of 40 patients. Am Heart J. 1988;115:1068–1076.
75. ChangAM, WalshKM, ShoferFS, McCuskerCM, LittHI, HollanderJE. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary syndrome. Acad Emerg Med. 2011;18(1):1–9.
76. American Heart Association. Toxicology in emergency cardiovascular care. In FieldJM. Advanced Cardiovascular Life Support Resource Text for Instructors and Experienced Providers. AHA, Dallas. 2008.
77. RivaE, MenniniT, LatiniR. The alpha- and beta-adrenoceptor blocking activities of labetalol and its RR-SR (50:50) stereoisomers. Br J Pharmacol. 1991;104(4):823–828.
78. McCordJ, JneidH, HollanderJE, et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008;117(14):1897–1907.
79. StevensJC, PollackMH. Benzodiazepines in clinical practice: consideration of their long-term use and alternative agents. J Clin Psych 2005;66(Suppl 2):21–27.
80. Devlin, JW, RobertsRJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin. 2009;25(3):431–449.
81. AshtonCH. Protracted withdrawal syndromes from benzodiazepines. J Subst Abuse Treat. 1991;8(1–2):19–28.
82. EbellMH. Benzodiazepines for alcohol withdrawal. Am Fam Phys. 2006;73(7):1191.
83. HarrisonPC, GelderMG, CowenP. The misuse of alcohol and drugs. In Shorter Oxford Textbook of Psychiatry. 5th ed. Oxford: Oxford University Press, 2006.
84. LongoLP, JohnsonB. Addiction: Part I. Benzodiazepines – side effects, abuse risk and alternatives. American Family Physician 2000;61(7):2121–2128.
85. FraserAD. Use and abuse of the benzodiazepines. Ther Drug Monit. 1998;20(5):481–489.
86. LaderM, TyleeA, DonoghueJ. Withdrawing benzodiazepines in primary care. CNS Drugs. 2009;23(1):19–34.
87. AshtonCH. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–255.
88. Mattila-EvendonM, FranckJ, BergmanU. A study of benzodiazepine users claiming drug-induced psychiatric morbidity. Nord J Psychiatry. 2001;55(4):271–278.
89. McIntoshA, SempleD, SmythR, BurnsJ, DarjeeR. Depressants. In Oxford Handbook of Psychiatry. 1st ed. Oxford: Oxford University Press, 2004.
90. CharlsonF, DegenhardtL, McLarenJ, HallW, LynskeyM. A systematic review of research examining benzodiazepine-related mortality. Pharmacoepidemiol Drug Saf. 2009;18(2):93–103.
91. ChouinardG. Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. J Clin Psychiatry. 2004;65 (Suppl 5):7–12.
92. National Institute on Drug Abuse. NIDA InfoFacts: Hallucinogens – LSD, Peyote, Psilocybin, and PCP.
93. CaravattiEM. Hallucinogenic drugs. In: DartRC, CaravattiEM, McGuiganMA, et al (Eds.). Medical toxicology. 3rd ed. Philadelphia, PA: Lippincott, Williams, and Wilkins, 2004.
94. HollandJ, NelsonL, RavikumarP. Embalming-fluid soaked marijuana: a new high or new guise for PCP?J Psychoactive Drugs. 1998;30:215–219.
95. LitovitzT, Klein-SchwartzW, CaravatiE. 2002 Annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med. 2003;22:517–575.
96. BoyerE, QuangL, WoolfA, ShannonM, MagnaniB. Dextromethorphan and ecstasy pills. JAMA 2001;285:409–410.
97. MisraA, PontaniR, BartolomeoJ. Persistence of phencyclidine and metabolites in brain and adipose tissue and implications for long-lasting behavioral effects. Pharmacol. 1979;24:431–435.
98. LiangI, BoyerE. Dissociative agents. In Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, PA: Saunders Elsevier, 2007.
99. CarlsKA. Ruehter Vl evaluation of PCP psychosis. Am J Drug Alcohol Abuse. 2006;32:673.
100. GianniniAJ, EighanMS, LoiselleRH, GianniniMC. Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis. J Clin Pharmacol. 1984;24(4):202–204.
101. National Institute on Drug Abuse. MDMA (Ecstasy) Research Report Series. Electronic Version.
102. Drug Abuse Warning Network (DAWN) Reports 2005. Accessed June 8, 2008.
103. FahalIH, SallomiDF, YaqoobM, BellGM. Acute renal failure after ecstasy. BMJ. 1992;305(6844):29.
104. BurgessC, O’DonohoeA, GillM. Agony and ecstasy: a review of MDMA effects and toxicity. Eur Psychiatry. 2000;15(5):287–294.
105. ChristophersenAS. Amphetamine designer drugs – an overview and epidemiology. Toxicol Lett. 2000;112–113:127–31.
106. SchwartzRH, MillerNS. MDMA (ecstasy) and the rave: a review. Pediatrics. 1997;100(4):705–708.
107. RenemanL, BooijJ, SchmandB, van den BrinkW, GunningB. Memory disturbances in “Ecstasy” users are correlated with an altered brain serotonin neurotransmission. Psychopharmacology (Berl). 2000;148(3):322–324.
108. AndreuV, MasA, BrugueraM, et al. Ecstasy: a common cause of severe acute hepatotoxicity. J Hepatol. 1998;29(3):394–397.
109. MaxwellDL, PolkeyMI, HenryJA. Hyponatraemia and catatonic stupor after taking “ecstasy”. BMJ. 1993;307(6916):1399.
110. DaftersRI, LynchE. Persistent loss of thermo-regulation in the rate induced by 3,4-methylene-dioxymethamphetamine (MDMA or “Ecstasy”) but not by fenfluramine. Psychopharmacology. 1998;138:207–212.
111. GrunauBE, WiensMO, BrubacherJR. Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review. CJEM. 2010;12(5):435–442.