Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jun 24;10(6):e0131324.
doi: 10.1371/journal.pone.0131324. eCollection 2015.

Medical diagnoses associated with substance dependence among inpatients at a large urban hospital

Humberto Choi  1 , Anne Krantz  2 , Jennifer Smith  3 , William Trick  4
Affiliations

Medical diagnoses associated with substance dependence among inpatients at a large urban hospital

Humberto Choi et al. PLoS One. .

Abstract

Background: There are limited data on reasons for hospital admission among patients dependent on substances other than alcohol. We compared primary discharge diagnoses for heroin- or cocaine-dependent patients to non-dependent patients.

Material and methods: We evaluated a cohort of patients admitted to a general medicine service at a public teaching hospital during July 2005-June 2008. Through bedside interviews, we identified patients who had substance-use disorders. We categorized patients by substance used, route of administration, and dependent or non-dependent use. We grouped diagnostic codes (i.e., ICD-9) using Healthcare Utilization Project categories. We excluded HIV-infected patients.

Results: Of 11,397 patients, 341 (3.0%) were dependent on inhalational heroin, 260 (2.3%) on non-injection cocaine, and 106 (0.9%) on injection heroin. Compared to non-dependent patients, inhalational heroin-dependent patients were over three-fold more likely to have been admitted for respiratory diseases (28% vs. 8%, p<0.01); this association was strongest for asthma exacerbation (OR=7.0; 95% CI, 4.7 to 70.4, p<0.01). Of the 225 admissions for an asthma exacerbation, 44 (19.6%) had co-occurrent heroin-dependence. The most frequent diagnostic category among cocaine-dependent patients was circulatory, which was similar to non-dependent patients (22% vs. 21%, p=0.92).

Discussion: There is a strong association between heroin dependence and hospital admission for an asthma exacerbation. Provision of specialized substance-use treatment for inhalational heroin users will be necessary to reduce the frequency of exacerbations and repeat hospital admissions.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exist.

Figures

Fig 1
Fig 1. Prevalence of ICD-9 discharge diagnoses that represent all respiratory diseases (gray) and asthma (white).
Odds ratios of asthma in drug dependent patients compared to low risk drug use: inhalational heroin (OR 7, 95% CI 4.7–10.4, p<0.001), cocaine (OR 1.7, 95% CI 0.8–3.7, p = 0.20) and injection heroin (OR 1.2, 95% CI 0.3–4.9, p = 0.68).
Fig 2
Fig 2. Prevalence of asthma, COPD, pneumonia and respiratory diagnoses among low risk and dependent drug use patients.
Fig 3
Fig 3. Prevalence of asthma exacerbation among patients with low risk and dependent drug use stratified by tobacco smoking status.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. March 10 2004;291(10):1238–1245. - PubMed
    1. Harwood HJ, Fountain D, Fountain G. Economic cost of alcohol and drug abuse in the United States, 1992: a report. Addiction. May 1999;94(5):631–635. - PubMed
    1. Krantz AJ, Hershow RC, Prachand N, Hayden DM, Franklin C, Hryhorczuk DO. Heroin insufflation as a trigger for patients with life-threatening asthma. Chest. February 2003;123(2):510–517. - PubMed
    1. Cygan J, Trunsky M, Corbridge T. Inhaled heroin-induced status asthmaticus: five cases and a review of the literature. Chest. January 2000;117(1):272–275. - PubMed
    1. Levine M, Iliescu ME, Margellos-Anast H, Estarziau M, Ansell DA. The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations. Chest. October 2005;128(4):1951–1957. - PubMed

Publication types

MeSH terms