October 7, 2010

Emergency Department Visits Involving Patients Discharged Back into Police Custody

Emergency room personnel treat individuals triaged by the severity of their medical condition, regardless of who accompanies them. Some individuals are brought to the emergency department (ED) by police either for medical evaluations or for immediate medical care. For example, depending on the individual's physical or mental condition upon arrest, police might take an intoxicated arrestee to the ED for a medical clearance to ensure that he or she is fit to spend a night in jail. Also, police may bring to the ED an arrestee who requires immediate medical attention following a drug-related emergency or accident. Medical personnel do not typically make determinations about the custodial status of these patients. Nevertheless, individuals in the custody of police provide a unique window to understanding the types of drugs used by patients who subsequently were discharged from the ED back into police custody and how these patients might vary by demographic characteristics such as gender and age.

Data for this study were drawn from the Drug Abuse Warning Network (DAWN), which is a public health surveillance system that monitors drug-related ED visits in the United States. One potential disposition within DAWN is discharge back into police custody. This issue of The DAWN Report focuses on visits by patients who were discharged back into police custody in 2008. These cases include patients who were brought to the ED by police and subsequently were released back into police custody (hereafter referred to as "discharge/d into police custody").

During 2008, there were nearly 4.4 million drug-related ED visits; of these, 1.8 percent (79,400 visits) resulted in discharge into police custody. One quarter (25.1 percent) of these visits were made by patients aged 18 to 24, one quarter (24.9 percent) were made by patients aged 25 to 34, and one fifth (20.7 percent) were made by patients aged 35 to 44 (Figure 1). About 1 in 10 visits (9.8 percent) were made by patients aged 12 to 17. Nearly three quarters (70.7 percent) of the visits resulting in discharge into police custody were made by male patients (data not shown).

Figure 1. Drug-Related Emergency Department (ED) Visits Resulting in Discharge Back into Police Custody, by Age Group: 2008

Illicit drugs were involved in about three fifths (61.6 percent) of the ED visits made by patients who were discharged into police custody (Table 1). The three illicit drugs most commonly involved were cocaine (24.1 percent), heroin (18.1 percent), and marijuana (17.4 percent).

Alcohol was involved in about one third (34.7 percent) of the visits. However, the number of alcohol-related ED visits resulting in discharge into police custody was probably higher. The alcohol category includes visits involving alcohol taken in combination with other drugs for all patients and visits involving only alcohol for patients younger than 21. DAWN does not track alcohol only visits for patients aged 21 or older.

Pharmaceuticals were involved in nearly half (45.3 percent) of the ED visits made by patients discharged into police custody. Pain relievers were involved in 21.1 percent of these visits, with narcotic pain relievers accounting for 16.8 percent. Drugs that treat anxiety or insomnia were involved in 16.7 percent of visits, with benzodiazepines accounting for 15.3 percent.

The drugs involved in the ED visits made by patients who were discharged into police custody varied by age (Figure 2). Visits made by patients aged 21 or older were more likely than those made by patients younger than 21 to involve cocaine (29.0 vs. 7.9 percent) or pharmaceuticals (49.4 vs. 32.1 percent) and were less likely to involve marijuana (12.3 vs. 33.9 percent). Among visits made by patients younger than 21, 61.4 percent involved alcohol.

Figure 2. Emergency Department (ED) Visits Resulting in Discharge Back into Police Custody, for Selected Drugs, by Age: 2008

The drugs involved in ED visits made by patients who were discharged into police custody did not vary by gender (Figure 3). Specifically, 51.3 percent of visits made by females involved pharmaceuticals, and 56.8 percent involved illicit drugs. Among visits made by males, 42.8 percent of those visits involved pharmaceuticals, and 63.5 percent involved illicit drugs.

Figure 3. Selected Drugs Involved in Emergency Department (ED) Visits Resulting in Discharge Back into Police Custody, by Gender: 2008

The ED presents a unique opportunity to conduct a screening, brief intervention, and/or treatment referrals for individuals with substance use disorders. This report shows that over three in five drug-related ED visits made by patients who were discharged into police custody involved illicit drugs and nearly half involved pharmaceuticals. In addition to informing police of clinical findings, specific drugs, and possible indications of side effects, ED treatment staff may wish to document information that can help ensure that the patients receive appropriate and timely follow-up care either during or beyond their criminal justice system involvement.

Accurate and complete information about the drugs that individuals use prior to being discharged into police custody may also help treatment providers to monitor emerging drugs, forecast future treatment needs among the criminal justice population, and plan and develop programs tailored to specific demographic groups within this population.