Increased imaging utilization an ‘underrecognized’ facet of America’s substance use epidemic
Rising imaging utilization is an “underrecognized” facet of America’s ongoing substance abuse epidemic, according to new research published in Academic Radiology [1].
As of 2017, about 30.5 million (or 1 in 9) Americans had used an illicit drug within the past month. Marijuana was the largest driver of this number, followed by prescription pain pills, cocaine, hallucinogens, meth and heroin. Consumption of opioids has skyrocketed, with the numbers only exacerbated by the pandemic.
Researchers with Montefiore Medical Center in the Bronx sought to better understand how these numbers have impacted imaging. They discovered a clear correlation, with patients who use such substances undergoing more imaging compared to others, even when accounting for their higher comorbidities.
“The present study, in a diverse urban ED cohort with up to 30 months accrued imaging utilization data, demonstrates significantly higher imaging utilization and costs among patients who were substance users…compared to nonsubstance users,” lead author Rachel Blinick, MD, and colleagues wrote April 5. “Results of the present study highlight an additional underrecognized strain of the substance use epidemic on healthcare resources, increased imaging utilization and costs, which are important public health considerations,” they added later.
Montefiore researchers defined substance users as individuals 12 and older who presented to their emergency department between 2017 and 2019 with a positive urine toxicology test and an associated ICD code. The search turned up a total of 3,191 patients, whom they compared against 3,200 more individuals without positive screening tests, selected at random, to serve as the control group.
The substance use cohort was older (at an average age of 46 vs. 44), more often male (63% vs. 39%) and had an average score on the Charlson comorbidity index 88% higher (3.33 vs. 1.78). Those who tested positive for drug use also underwent significantly more imaging at a total of over 36,000 exams (or an average of 11.41 per patient) versus to 12,000 (3.87 per patient) in the comparison group.
Higher imaging consumption among substance users persisted across all modalities except for mammography, the authors noted. Radiography was the most utilized exam type, followed by CT in the substance use cohort versus ultrasound in the comparison group. On average, imaging costs per patient were almost 300% higher in the substance-use group versus the other cohort (at $1,287 versus $435). A secondary analysis, excluding cannabis users, revealed that “other substance users” utilized more imaging compared to those who solely consumed marijuana.
“While previous literature has demonstrated increased health risks associated with marijuana, the associated imaging utilization is significantly lower than with other forms of drug use,” Blinick et al. noted. “When exclusive cannabis users were compared to the comparison group, cannabis users had increased imaging utilization, which is an important consideration in the context of legalization.”
Read more at the link below, including potential study limitations.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.