Reduction in Emergency Presentations by Adolescent Poly-Drug Users: A Case-Series

The objectives were, firstly, to describe the frequency and type of hospital emergency department (ED) admissions in a small number of alcohol and other drug (AOD) using adolescents who accounted for a high number of ED and other hospital presentations. Secondly, to identify interventions that impacted on these repeat ED presentations. An earlier 12-month review of hospital presentations identified a cohort of 55 AOD using adolescents with 236 repeat presentations. Six adolescents accounted for 47% (n = 112) of these presentations. A case review of these six adolescents was conducted over 24-months across the four major public hospitals in Perth. AOD treatment during this period was identified from hospital case notes and patient notes at the major opiate treatment service. There were 172 hospital presentations of which 98 were overdoses (ODs) (75% opiate). There were 24 other AOD related and 50 non-AOD presentations. ED treatment focused on acute care. Four adolescents were referred to an external treatment agency and two, a residential psychiatric hospital. Five of the six attended a specialist opiate treatment centre. Of these, one opted for unsupervised home detoxification and continued to represent to ED, primarily with opiate ODs. Four underwent rapid opiate detoxification (ROD), with three commencing oral naltrexone maintenance. Three cases with continuing ODs were further treated with slow-release naltrexone implants. In 91 weeks post implant follow-up (range 8-42) there were no opiate or non-opiate OD presentations compared with 14 in the corresponding pre-implant period. The sixth adolescent had representations primarily related to psychiatric problems. ED based interventions, including intensive case management had little impact on repeat ED presentation in these "high-risk" adolescents. Preliminary results however, suggest that treatment with naltrexone implants dramatically reduces repeat OD presentations.