The results of a new survey released by the Australasian College for Emergency Medicine (ACEM; the College) provide new insights into the burden of alcohol and methamphetamine harm in Aotearoa New Zealand’s emergency departments (EDs) during the busy summer period.
The sixth annual Alcohol and Methamphetamine Harm in Emergency Departments snapshot survey, recorded the proportion of alcohol- and methamphetamine-related presentations at 19 EDs in New Zealand and 113 EDs in Australia at 2am on Saturday 21 December 2019.
The report shows that at the time of the survey 16% of patients in New Zealand’s EDs were receiving treatment for alcohol-associated issues, compared to an Australian average of 13%. This represented a continuation of the worrying trend identified in previous reports of the country recording higher percentages of alcohol-fuelled harm among ED patients.
ACEM President Dr John Bonning said alcohol harm remains one of the biggest preventable public health issues facing EDs.
“Emergency doctors are still far too frequently facing the terrible, short- and long-term aftermath of high-risk drinking,” said Dr Bonning.
“This includes seeing patients with injuries related to assaults or fights, vehicle crashes, acute intoxication and mental health issues. These impacts can also extend beyond an individual patient, with other patients, their family or carers, and ED staff feeling unsafe and at risk of physical or psychological harm when disruptive or violent intoxicated patients are present.
“As we head in to what is normally a busy summer period for alcohol-fuelled harm in our EDs, not only do we urge individuals to avoid risky drinking, but we must ensure the alcohol industry is held to account with stronger governance and regulation to stem the harm done by the relentless promotion and marketing of their products.
“This survey again confirms that EDs in New Zealand continue to bear a significant, and higher burden as a result of alcohol-fuelled harm relative to much of Australia. An extremely frustrating aspect of this is that so many of these presentations are preventable with stronger regulation and harm minimisation measures.”
For the second time, the survey also quantified the burden of methamphetamine presentations to EDs. Its results again showed that while overall methamphetamine continues to remain a secondary issue in New Zealand compared to alcohol, of concern, the proportion and number of methamphetamine-related presentations to the country’s EDs at the time of the survey had more than doubled, from 0.7% in 2018 to 1.9% in 2019.
Dr Bonning said although presentation rates to EDs for methamphetamine were not as high as for alcohol harm, this patient group is highly resource-intensive and requires complex care. The snapshot survey highlights the need for more specialised and integrated models of care that address these needs.
Changes are also needed to the design and resourcing of EDs to better prevent, minimise and manage violent behaviours that often accompany alcohol and other drug (AOD) presentations, including methamphetamine‐related psychosis.
“Within our hospital EDs there need to be options for and linkages with a range of care options, including – mental health, general medical and AOD/toxicological care,” said Dr Bonning.
“In particular, EDs in regional and rural areas often struggle to find the capacity needed to appropriately treat drug and alcohol presentations, and find linkages to other services.”
ACEM has recently released its updated Position Statement on Alcohol Harm, as well as its new Position Statement on Harm Minimisation Related to Drug Use which further outlines the issues, and measures needed.
The College continues to support trialling and evaluating alcohol demand and supply reduction strategies, such as minimum unit pricing and volumetric tax; greater regulation on alcohol promotion and advertising; and more active enforcement on off-licence and online alcohol outlets.
ED settings also provide valuable opportunities to identify AOD-related problems in patients, so must also be resourced with dedicated AOD staff to provide specialised screening and early intervention.
Additionally, current ED data collection systems do not accurately capture the true extent of AOD harm. Compulsory AOD data collection would help better understand the burden across the health system, and resourcing needs.
Overall, more than 3677 patients (422 in New Zealand and 3255 in Australia) were receiving emergency medical care in the participating EDs at the time of the survey, with 13% (Aus) to 16% (NZ) of those presentations found to be related to alcohol and 1.9% (NZ) to 2.8% (Aus) related to methamphetamine use.
Background:
ACEM is the peak body for emergency medicine in New Zealand and Australia, responsible for training emergency physicians and advancement of professional standards. www.acem.org.au