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Heroin Addiction and Related Clinical Problems: 2017, 19, N6 (pages: 21 - 30)

Substance Use Typology in Psychiatric Patients Admitted to an Emergency Room, in Italy

Falchi S., Spera V., Maiello M., Gazzarrini D., Belcari I., Ceglie R., Ciapparelli A., and Maremmani I.

Summary: Background: In the USA, emergency room (ER) visits for Substance Use Disorders with or without Dual Diagnosis become more frequent in the last decade. This is particularly true of opioid overdoses and opioid withdrawal symptomatology, and also of psychotic episodes related to the use of cannabinoids and stimulants. Methods: To verify the degree to which this phenomenon is valid for Italy, we assessed, in an observational comparative study, substance use and psychopathological symptoms in patients admitted to an Italian psychiatric emergency room over during a six-month period. We divided subjects into Substance Use Disorder patients with (DD patients) and those without (SUD patients) dual disorder. As control group we used subjects with all other kinds of psychiatric diagnosis (NSUD patients). Results: We evaluated 54 patients (23 males and 31 females, mean age 45.69±13.2, 19-77 ranged). Ten patients were classified as DD patients, 8 as SUD patients and 36 as NSUD patients. Tobacco proved to be the main substance abused (81.5%), followed by caffeine (51.9%), alcohol (46.3%), SNC stimulants and depressants (both at 27.8%). The use of opioids (7.4%) and energizers (7.4%) appeared to be much less common. 13 subjects showed the prevalently combined use of stimulants, cannabinoids, alcohol and opioids; 24 subjects showed a more frequent social drug use and 17 subjects most frequently used a combination of SNC depressors (BDZs) and energizers. SUD patients were characterized by the more frequent use of alcohol and stimulants. Cannabinoid use was more frequent in DD patients. A strongly polyabuse typology was observed both in SUD and DD patients, whereas a higher frequency of social drug use was found in DD patients. Regarding psychopathology, DD patients showed more severe excitement and activation. Conclusions: In this study, what commonly happens in the USA does not seem to apply to Italy. The majority of psychiatric urgencies are not due to a Substance Use Disorder, with or without DD, and opiate use is not predominant in ER SUD patients. Only excitement and activation sustained by cannabinoid use seemed to be present in DD patients.