CHSU Discovery

Abstract:

Introduction/Background: Methamphetamine use disorder (MUD) is a growing public health concern. MUD is associated with extensive comorbidities including homelessness/incarceration, concurrent substance use, life-threatening infections, and early mortality. In the inpatient setting, methamphetamine-associated cardiomyopathy (MACM) represents an especially high burden of disease. Optimal management of patients with MUD is made challenging by frequent sign-outs against medical advice (AMA) in the setting of acute intoxication/withdrawals, and likely provider hesitancy in administering validated interventions such as benzodiazepines due to concern for patient “drug-seeking.” These issues are compounded by the lack of established inpatient protocol specifically geared towards MUD. Here we quantify the disproportionate impact of MUD on SVMC’s patient population in order to highlight the potential benefit of a proposed standardized protocol.

Methods: Retrospective aggregate data spanning six years from February 1, 2018–January 31, 2024 was collected from SVMC’s Meditech EMR system using the Business and Clinical Analytics (BCA) tool and in-house Structured Query Language (SQL) code. IRB approval was not required. Patients with a positive urine drug screen, and/or relevant ICD10 codes and/or Meditech
“problem list” diagnoses were included in our MUD cohort, with no distinction made between current or past methamphetamine use, or duration thereof. Remaining patients were placed in the non-MUD cohort. All patients had at least one Emergency Department (ED) visit and/or inpatient stay. Minors <18 years and obstetric admissions were excluded.

Results: 3,190 patients met our MUD criteria within the given six-year period, corresponding to 5.3% of the total patient population, 11.7% of all visits and 10.4% of admissions, 17.1% of total patient costs, and a staggering 46.4% of in-hospital deaths (41.1% of the MUD cohort expired during the given period, of whom 66.7% were <60 years, compared to 2.6% of non-MUD, of whom 24.6% were <60). A heart failure/cardiomyopathy diagnosis was 2.1x more prevalent amongst the MUD cohort than non-MUD (13.1% vs. 6.2%), with an associated 5.3x greater in-hospital mortality (81.1% vs. 15.4%). Patients in our MUD cohort were also 8.4x more likely to sign out AMA compared to non-MUD (44.5% vs. 5.3%); however, in any given visit, MUD patients who received benzodiazepines at least once (either in the ED or upon admission) were 7.4x less likely to sign out AMA than MUD patients who did not (2.3% vs. 16.7%). 

Discussion/Conclusion: These results underscore the enormous impact of MUD on our community, and the urgent need for a comprehensive and standardized approach towards treating these patients.