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Perth, |
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Drug abusers strain hospitals
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An explosion in the number of people who abuse illicit drugs is putting a huge strain on hospital emergency departments, says a Perth emergency doctor. Patients admitted due to car crashes, stroke, chest pain, pneumonia or other non-drug symptoms are forced to wait while drug patients, in numbers that are "out of control", take priority because of the life-threatening effects of drug abuse. Dr Frank Daly, head of emergency at Royal Perth Hospital, said a quarter of all emergency department (ED) admissions at the hospital were for drug problems. Without them, hospitals would be quieter, safer and treating patients would be quicker. Delays in hospital emergency departments, the wait for beds and reported declines in patient care would decline dramatically. Dr Daly said amphetamines were causing a rise in mental disease, straining the system for psychiatrists and psychiatric care. A third of admissions to Graylands Hospital were related to amphetamine use. If this drug was taken away it would "immediately improve the strain on resources in psychiatry". Indirect problems related to drugs included domestic violence, sexual assault and car crashes. With an increase in the number of ice (methamphetamine) users and a report that indicated one in five believed it was acceptable to use cannabis, ecstasy and even cocaine, the problems at Perth hospitals could only get worse. Dr Daly said Perth topped the list of drug users in the country, with sometimes more than two patients with amphetamine-related problems a day admitted to RPH ED. He said 37% of drug-related patients needed to be referred to psychiatric services, and more than 800 patients a year at RPH were admitted with complications due to drugs. A study carried out last year at RPH concluded amphetamine users were having a major impact on hospitals. Chief investigator of the study, Dr Suzanne Gray, said 40% of people seen in emergency with amphetamine-related problems had to be admitted to the hospital, which had a significant impact on bed availability. Dr Gray said 46% of amphetamine-related patients had previous admissions for amphetamine problems. The study showed 71% used amphetamines intravenously, 57% used more than once a week. Dr Gray said this revealed that these people were "experienced, frequent users of amphetamines". She said 51% of these people were aged between 20 and 30 years and 30% were over 30, with their ages ranging up into their 50s. ages ranging up into their 50s. Dr Daly said the youngest patient he had seen was 14 years old. "Drugs have become part of the core business in ED and the impact on emergency services by drugs including alcohol has a sizeable impact on the emergency care of patients," Dr Daly said. "This means these patients need a disproportionate amount of resources, more than the average patient, and they are a big part of the patient group, making up 25% of the work. "There is some belief these patients only come in on a Friday or Saturday night. But they don't, they come in on a daily basis and it does strain the ED. "Approximately 150 patients are admitted into emergency a day at RPH, with the large percentage related to drugs. "When they come in they tend to be very ill and have a higher priority, and the large percentage requires admission and follow-up services. "This problem can't be fixed within the ED and there needs to be better ways of prevention. "That would ease the pressure on ED and divert the attention to other things." Dr Daly said this was just the tip of the iceberg. "The number of problems related to ice has grown enormously in the past 10 years. Before, it was heroin, and amphetamines were virtually unheard of," he said. He said 5% of amphetamine users had life-threatening medical problems and each time the drugs were used the chances of a major complication dramatically increased. He said illicit drugs were out of control. "This is rapidly becoming the biggest issue, and in the end these people end up with a psychiatric problem. "We are just seeing the tip of the iceberg." He said Perth led the way in drug use because of the big amount of disposable income among youth. "It's a young-person thing, from 18-35, but not as prevalent as alcohol or cannabis. But it is rapidly increasing." RPH is the only hospital to have conducted an ED survey indicating the problem. Sir Charles Gairdner Hospital sees about 140 patients each day in its ED, around 45% of whom are admitted into the hospital. The hospital does not give a breakdown of the patients with a drug-related problem. Dr Daly said there were 25 beds in ED at RPH. Overcrowding was due to an insufficient inpatient beds. This meant people were forced to stay in ED beds for longer, resulting in a bank-up of patients. He said 40% of people admitted to emergency were also admitted to the hospital and there would be more beds available if the number of drug-related patients decreased. RPH had a dedicated drug and alcohol liaison staff, a psychiatric team and a toxicology team reserved to manage drug and alcohol. He said some patients admitted without a drug problem were forced to watch violent scenes unfold. For some this was frightening. In 2004, there were 357 accidental deaths where opioids were determined as the underlying cause of death among Australians aged 15 to 54 years. This translated into a rate of 31.3 deaths per million people aged 15 to 54 years. Dr Daly said: "I believe to decrease drugs and alcohol-related incidents the questions need to be raised in society and through public policy rather than by an individual in ED."
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