Intravenous drug users in Iceland: Use of emergency departments, hospital admissions and mortality.

INTRODUCTION: Drug abuse is a significant contributor to premature disease and mortality. Drug users are less likely to attend traditional Primary Health Care and more likely to present to Emergency Departments with their problems. Drug users often present late for treatment and find difficult ot engage and follow through treatment in standard models of health services. MATERIALS AND METHODS: The study is retrospective. 108 intravenous drug users were identified upon admission to one of three intpatient addiction treatment centres in Iceland in the years 2012-2013. Case notes for the two years leading to admission were examined. RESULTS: The study group had significantyl more contacts with Emergency Departments than a matched sample from the community (p<0.001). Mean number of visits for the study group per year was 4.8 (median 3.5) and 43% had four or more visits in a year. Majority of visits were for pshychiatric symptoms with a third considered serious. The two main medical reasons were infections from injecting and accidents/violence. There was no significant difference in study parameters between those who mainly use methylphenidate vs other substances. Mortality rate for the study group compared to the general population of same age was 26.4 (CI 16.7-41.5, p<0,001). CONCLUSION: Intravenous drug users are a vulnerable group with high level of psychiatric and medical problems and high mortality. It is important that this group has good access to evicence based addiction treatment, but also to medical and psychiatric services that are adapted to their needs.