Stephen Ling gave an interesting and thought-provoking perspective from the Emergency Departments (ED) in New South Wales hospitals. He painted the picture of ED presentations of methamphetamine users. Stephen explained that there has been a 7 fold increase of methamphetamine-related ED presentations in NSW hospitals from 2009 to 2014 from 394 to 2982 patients. 1.2% of all ED presentations are causally related to amphetamines. Out of those users, 57% were weekly users with 71% being male. Importantly a high rate (32.1%) required sedation.
An amphetamine user typically can present differing physical and mental health issues. They show a range of different physical symptoms, especially affecting the brain, liver, kidney and heart. There have been reports from a U.S. study of trauma patients who tested positive for methamphetamine having more problematic issues than other patients in hospitals. Methamphetamine-related presentations were involved with more assaults, altercations with law enforcement, stab wounds, gunshot wounds, higher chance of being victim of domestic violence and have prior suicide attempts. However it is important to note that during most methamphetamine-related presentations in EDs, patients are not aggressive and do not need to be restrained or sedated.
To effectively help patients in the ED who have used methamphetamine, emergency nurses are expected to follow the regular guidelines for any ED patient along with a few extra things to keep in mind just in case a patient is agitated.Things such as: remaining calm, using the patient’s name, using open ended questions for patients concerns, an even tone, respecting patient’s space, being careful of severe headache onset which may include bleeding in the brain.
The issue we need to address is that sometimes emergency nurses may struggle to deal with methamphetamine-affected patients who have a co-occurring mental health disorder or are agitated. This is a very challenging responsibility and emergency nurses may actually trigger aggressive behaviour unknowingly. Restraint should be a last option for methamphetamine-related patients which can be dangerous for staff and patients. We need to think about alternate solutions. It is a complicated issue, but additional training and dedicated peer support in EDs were suggested by audience members. What do you think?
National Drug and Alcohol Research Centre, UNSW
NHMRC CRE in Mental Health & Substance Use