Hsiao-Yuan Su, Zong-Shian Tsai, Yu-Chun Chen, Ding-Jun Huang, Chung-Hsun Lee
In this mixed urban-rural ED cohort with toxicology-confirmed illicit drug use, lower educational attainment and tattoo presence were commonly observed. Because the study lacked a drug-negative control group, these findings should be interpreted as descriptive rather than evidence of association. The very high prevalence of under-reporting indicates that history alone has limited sensitivity for detecting recent drug use and supports a low threshold for comprehensive toxicology testing, particularly in high-risk presentations and injured drivers. Methamphetamine predominance, frequent polysubstance exposure, and approximately one-in-five drug-positive presentations following traffic injuries highlight the need for clinical vigilance. These descriptive patterns warrant evaluation in multicenter prospective studies with quantitative toxicology capable of assessing impairment and causal relationships.
BACKGROUND: Substance abuse drives considerable emergency department (ED) demand and remains a major public-health issue. Although low educational attainment and tattoos are linked to high-risk behaviors, their relevance to drug-positive ED visits in Taiwan is unknown. Self-reported drug histories are also unreliable, with many patients denying use despite positive toxicology. We therefore examined these sociocultural markers in confirmed drug-positive cases to assess their value for ED risk stratification.
METHODS: This single-center descriptive cohort of ED patients with urine-confirmed illicit drug positivity summarized demographic/social characteristics, toxicology findings, and clinical presentations, with prespecified within-cohort contrasts (Fisher's exact and Mann-Whitney U; two-sided α = 0.05) across traffic injury, self-harm, and other presentations; no drug-negative control group was enrolled.
RESULTS: The cohort was predominantly male (83.3%) with a median age of 39 years (range, 17-74). Lower educational attainment (≤ upper secondary [senior/vocational high school; ISCED 0-3]) was observed in 40/54 (74.1%; 95% CI, 61.1-83.9), and visible tattoos in 32/54 (59.3%; 95% CI, 46.0-71.3) among drug-positive ED patients. Overall, 92.6% (95% CI, 82.4-97.1) of toxicology-confirmed drug-positive patients denied recent drug use, indicating approximately 13-fold under-detection by history alone. Methamphetamine was the leading substance (42.6%), and 85.0% had ≥ 2 psychoactive substances detected. These estimates are descriptive of the drug-positive cohort; no drug-negative comparator was enrolled.
CONCLUSION: In this mixed urban-rural ED cohort with toxicology-confirmed illicit drug use, lower educational attainment and tattoo presence were commonly observed. Because the study lacked a drug-negative control group, these findings should be interpreted as descriptive rather than evidence of association. The very high prevalence of under-reporting indicates that history alone has limited sensitivity for detecting recent drug use and supports a low threshold for comprehensive toxicology testing, particularly in high-risk presentations and injured drivers. Methamphetamine predominance, frequent polysubstance exposure, and approximately one-in-five drug-positive presentations following traffic injuries highlight the need for clinical vigilance. These descriptive patterns warrant evaluation in multicenter prospective studies with quantitative toxicology capable of assessing impairment and causal relationships.