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Why were the years 2006 and 2014 chosedn for comparison?
Too often the ED is used as a homeless shelter, especially in inclement weather. Intoxicated patients frequently say they want detox or that they are suicidal so they end up in a bed on a Behavioral Health unit. As soon as they sober up, they leave AMA (against medical advice), only to repeat the process several times a month. They have no intention of quitting drinking. Also, there is an increased number of people who exhibit this behavior at the end of each month, as they are out of money to buy booze. Disability checks arrive around the 3rd day of the month.
Somehow or other my first comment disappeared from the conversation. Here’s a short re-cap:
You may want to check out
Mueller RG, Lang GE, Alcohol levels in emergency room patients. Wis Med J 79, Nov 1980 pp29 ff, and
Lang GE, Mueller RG, Ethanol Levels in Burn Ptients, Wis Med J 75, January 1976, ppS5 ff
At that time we found 27% positives among the ER patients, 61% positives among the burns. The ER data may be skewed; on 2 of 25 Women in the study of 97 patients were positive.
Jägermeister is also a laxative, one of the many of the “Alpenkräuter” used by Germans for that purpose.
You might want to review
Mueller RG, Lang GE, Alcohol levels in emergency room patients, Wis Med J 79, November 1980, p29ff , and
Lang GE, Mueller RG, Ethanol Levels in Burn Patients, Wis Med J 75, January 1976, S5 ff
At that time we found 27% positives in the ER patients, 61% positive in the burn patients.
The ER data might be skewed by the low incidence of positives among women, only 2 of 25 in a total population of 97. Back calculating at this late date would indicate that 36% of men were positive.
Societal, social, and cultural changes might be involved. Alcohol is the one drug, legal or not, that is small enough in molecular size so that it can pass through the blood – brain barrier and make you drunk. Moreover, it absorbs straight to the bloodstream directly from the stomach with no metabolic change.
That said, people try amazingly stupid things with alcohol like pouring it into their eyes to be absorbed by the membranes and sinuses connected to them.
And when was the Jaeger Bomb invented? I hadn’t heard of it before about five years, but when I did, it was in connection with a girl who consumed four or more Jaeger Bombs(one source says ten), which are energy drinks with Jaegermeister shots in them. It’s often Red Bull but Monster has also been used as well as other energy drinks.
And if you are in a place where there is a special on Jaeger Bombs, you don’t spend any more on them than you do a beer.
And then there was a lady I knew who would give plasma and then later go out and get drunk. It was a very cheap drunk.
There is more to this story than come from numbers.
The lady who consumed the Jaeger Bombs collapsed in her bathroom and had three heart attacks, and required a defibrillator to be implanted.
“Even people who drink in moderation should talk about their alcohol use with physicians and other health care workers to avoid any dangerous interactions with medications.” Expect to see the requirement for ‘alcohol counseling’ in MIPS/MACRA (or its successor)
This question could be answered by any one of thousands of ED physicians, of which I am one. Simply put, cities have had “incidents’ in their “Drunk Tanks” and now in most cities patients who are simply highly intoxicated, even if they have no injury and no issues managing their airways or secretions, are taken to the ED to “Sober up”. The press tends to assasinate the police in the court of public opinion whenever the rare event of a person deteriorating in a “drunk tank” occurs.
In other words, there is not much difference across the years in beverage sales, and probably not much difference in numbers of pts with public intoxication, but many more are taken to the hospital in a “liability dodge”.
The problem with this police tactic is that they have the power to hold patients in a locked facility, under arrest, til the patient has someone come to get them or til they demonstrate sobriety. On the other hand, in the ED, if a person is apparently able to make competent decisions for themselves and they demand to leave, we must release them. If we stop them forcibly we can be arrested for battery.
This peculiarity has resulted in patients having avoidable deaths, as they have been able to demonstrate competence before they are no longer alcohol-impaired.
This study also shows a weakness of a “big data” approach. To have numbers to report without being able to explain the context can easily lead to misleading or misstated results.
Simply stated, the authors have confirmed that local police are getting out of the “drunk tank” business and depositing the drunk patients in the ED, so they won’t have to be botherred with them and so that they won’t be blamed, if the rare event of a patient deterioration occurs.
There is a better way. Transport those with injuries, inability to maintain an airway, or suppression of respiration to the ED, but take those who are just drunk to the drunk tank!
My thought is it is multifactorial. However, there are probably some contributing factors. One is the decline in resources for mental health – individuals with a dual diagnosis of mental health and substance misuse disorder have a significant challenge getting meaningful assistance. There may also be a liability issue. Many years ago someone found intoxicated would be brought to jail. Today, an individual found intoxicated, sleeping on a park bench is brought to the emergency department. Likewise, many college campuses have a lower threshold for transporting intoxicated students to EDs. I am not saying this is right or wrong, but something we see on a daily basis.
Has anyone thought to relate this to the opioid crisis? People that are coming down off of opioids will often use alcohol to stem the tide