PMID- 31705770 OWN - NLM STAT- MEDLINE DCOM- 20210318 LR - 20240329 IS - 1360-0443 (Electronic) IS - 0965-2140 (Print) IS - 0965-2140 (Linking) VI - 115 IP - 6 DP - 2020 Jun TI - Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. PG - 1011-1023 LID - 10.1111/add.14892 [doi] AB - 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. CI - (c) 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. FAU - Lewer, Dan AU - Lewer D AUID- ORCID: 0000-0003-3698-7196 AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, London, UK. AD - National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. FAU - Freer, Joseph AU - Freer J AD - Centre for Primary Care and Public Health, Queen Mary University of London, London, UK. FAU - King, Emma AU - King E AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, London, UK. FAU - Larney, Sarah AU - Larney S AD - National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick,, NSW, Australia. FAU - Degenhardt, Louisa AU - Degenhardt L AUID- ORCID: 0000-0002-8513-2218 AD - National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick,, NSW, Australia. FAU - Tweed, Emily J AU - Tweed EJ AUID- ORCID: 0000-0001-6659-812X AD - MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. FAU - Hope, Vivian D AU - Hope VD AUID- ORCID: 0000-0001-5712-5734 AD - Public Health Institute, Liverpool John Moores University, Liverpool, UK. FAU - Harris, Magdalena AU - Harris M AUID- ORCID: 0000-0001-8718-8226 AD - Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, , London, UK. FAU - Millar, Tim AU - Millar T AD - Centre for Mental Health and Safety, The University of Manchester, Manchester, UK. FAU - Hayward, Andrew AU - Hayward A AD - UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, London, UK. FAU - Ciccarone, Dan AU - Ciccarone D AD - Department of Family and Community Medicine, University of California, San Francisco, CA, USA. FAU - Morley, Katherine I AU - Morley KI AUID- ORCID: 0000-0002-2725-5535 AD - National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. AD - Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Australia. LA - eng GR - MC_UU_12017/13/MRC_/Medical Research Council/United Kingdom GR - SPHSU15/CSO_/Chief Scientist Office/United Kingdom GR - 109823/WT_/Wellcome Trust/United Kingdom GR - R01 DA044170/DA/NIDA NIH HHS/United States GR - CDF-2016-09-014/DH_/Department of Health/United Kingdom GR - R01 DA037820/DA/NIDA NIH HHS/United States GR - MC_UU_00022/2/MRC_/Medical Research Council/United Kingdom GR - SPHSU13/CSO_/Chief Scientist Office/United Kingdom GR - DRF-2018-11-ST2-016/DH_/Department of Health/United Kingdom GR - WT_/Wellcome Trust/United Kingdom GR - CAF/17/11/CSO_/Chief Scientist Office/United Kingdom GR - SPHSU17/CSO_/Chief Scientist Office/United Kingdom GR - MC_UU_12017/15/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Meta-Analysis PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20200210 PL - England TA - Addiction JT - Addiction (Abingdon, England) JID - 9304118 RN - 0 (Amphetamines) RN - 0 (Crack Cocaine) RN - 0 (Illicit Drugs) RN - 70D95007SX (Heroin) SB - IM MH - Adult MH - Amphetamines MH - Australia/epidemiology MH - Crack Cocaine MH - Drug Users/*statistics & numerical data MH - Emergency Service, Hospital/statistics & numerical data MH - Female MH - Heroin MH - Hospitalization/statistics & numerical data MH - Humans MH - *Illicit Drugs MH - Male MH - North America MH - Patient Acceptance of Health Care/*statistics & numerical data MH - Substance-Related Disorders/*epidemiology PMC - PMC7210080 MID - EMS85124 OTO - NOTNLM OT - Health services OT - Hospitals OT - Opiates OT - Primary Health Care OT - Stimulants OT - Substance-Related Disorders EDAT- 2019/11/11 06:00 MHDA- 2021/03/19 06:00 PMCR- 2020/06/26 CRDT- 2019/11/10 06:00 PHST- 2019/02/05 00:00 [received] PHST- 2019/06/04 00:00 [revised] PHST- 2019/11/04 00:00 [accepted] PHST- 2019/11/11 06:00 [pubmed] PHST- 2021/03/19 06:00 [medline] PHST- 2019/11/10 06:00 [entrez] PHST- 2020/06/26 00:00 [pmc-release] AID - ADD14892 [pii] AID - 10.1111/add.14892 [doi] PST - ppublish SO - Addiction. 2020 Jun;115(6):1011-1023. doi: 10.1111/add.14892. Epub 2020 Feb 10.