Drug related admissions to intensive care: the role of illicit drugs and self poisoning.

OBJECTIVE Drug related problems are a major consumer of healthcare, although little is known about the impact of self-poisoning and illicit drug use on the provision of intensive care. We wished to quantify the number of admissions to our intensive care unit that were attributable to self-poisoning and illicit drug use, and to identify issues related to recognition, follow-up, prevention and cost. METHODS A retrospective review of all admissions to Liverpool hospital intensive care unit for the year 2000. All admissions with non-alcohol drug-related causes or associations were reviewed and data relating to demographics, reason for admission, drugs taken, length of intensive care unit stay, interventions by Drug and Alcohol and Psychiatry services, follow-up and outcome were obtained. RESULTS Of the 1790 patients admitted to the intensive care unit during the study period, 108 (6%) were non-alcohol drug-related. These admissions accounted for 407 intensive care unit bed days (5% of total intensive care unit bed days) and approximated to 10% of the intensive care unit budget for the year 2000. The majority of patients were male (66%), with a mean age of 33 years. Drug overdose was the most common reason for admission (80%), followed by drug related traumatic injury (16%). The most common drug classes involved were the benzodiazepines, followed by the opiates and tricyclic antidepressants. The majority of patients (65%) had used more than one drug. Thirty-two patients (30%) did not return to their previous functioning level by the time of their discharge from hospital, and 13 of these (12% overall) required full-time nursing care. There were two deaths (2%) as a direct result of illicit drug use or self-poisoning. The hospital Drug and Alcohol or Psychiatry services reviewed 78 patients (72%) as inpatients, and 3 patients (3%) after discharge. Self-discharge or patient refusal to be reviewed by these services occurred in 13 (12%) cases. Twelve patients (11%) were not assessed by these services and were either reviewed by the admitting team or returned to the care of their family practitioner. CONCLUSIONS Drug related problems account for a significant number of preventable admissions to intensive care unit every year. The mortality is low, but the cost to the community is high, as represented by the high level of morbidity and dependence on medical care.