Cocaine Delivers Extra Burden to Nation’s Emergency Rooms

It’s 8 o’clock on a holiday evening and about a dozen people wait in the lobby of Boston City Hospital’s emergency room, some slumped in the vinyl-covered chairs, some pacing fretfully.

Behind the swinging doors, emergency chief Dr. Peter Moyer is called to the puzzling case of a car accident victim who has only slight injuries but slips so deeply into unconsciousness he can barely be roused by two physicians.

“Have you taken any drugs?” doctors ask. “Cocaine, heroin, marijuana?”

It’s a question that has become more and more commonplace in emergency rooms already burdened by increased patient loads.

“There is an emergency in the emergency room right now in not only New York and Boston but around the country and for a variety of reasons,” said Ken Raske, president of the Greater New York Hospital Assn.

Drugs, and their side effects of AIDS, violence and psychiatric disorders, play a role in the problems plaguing big-city emergency rooms, Raske said.

From 1986 to 1987, according to the National Institute on Drug Abuse, cocaine-related cases in emergency rooms increased 122% in the District of Columbia; 86% in both Boston and Atlanta; 80% in Detroit; 73% in Chicago; 53% in Minneapolis; 50% in Texas, and 39% in New York City.

Heroin-related cases also increased in many cities but not as dramatically.

“The principal reason is the change in the typical cocaine user and the changes that have occurred within the cocaine epidemic,” said Dr. Mark Gold, director of research at Fair Oaks Hospital in Summit, N.J.

The typical cocaine user in 1983 was a college-educated man in his 30s who earned more than $25,000 a year and snorted the drug, Gold said. By 1987, only 16% were college-educated, most took the drug by the more potent methods of sniffing vapors or injection, and most were unemployed and under 30.

In New York, from 1985 to 1987, hospital stays increased 15% for substance abuse patients, according to a study by the United Hospital Fund and the Bigel Institute for Health Policy at Brandeis University.

Counting the number of overdoses is only half the picture. There are also accidents caused by clouded senses and violence associated with soured drug deals, Gold said. “Some of the coroners report cocaine-related deaths and include a person who has cocaine in his blood and a bullet in his head.”

At Boston City, most of the cocaine abuse is intravenous, Moyer said. The emergency department also treats a high percentage of violent trauma, largely due to its inner-city location, about half of it believed to be drug-related.

About 40% of the intravenous drug users seen at Boston City’s emergency room have tested positive for the AIDS virus, Moyer said.

Efforts to stem the rising tide of drug abuse comes at a time when emergency rooms already face increased patient loads, partly because of the reduced role of the traditional family doctor and partly because there are more people who can’t afford a private doctor.

“It’s really providing a major backlog in the emergency department system,” said Diane Howard, director of the American Hospital Assn. division of ambulatory care and health promotion.

Emergency departments are caught between a growing number of patients and a shrinking number of hospital beds due to pressures to lower hospital stays and decrease insurance costs, said Dr. Charlotte Yeh, a member of the board of directors of the American College of Emergency Physicians.

“We in the emergency department . . . basically, we never say ‘No.’ We’re caught in the position where we will always see patients and even though we can do the initial care, the initial stabilization, we don’t always have a place where we can turn that patient over to. There’s a growing bulge in the system,” said Yeh, chief of the emergency department of Newton-Wellesley Hospital in the Boston suburb of Newton.

“The bottom line is that emergency care is being squeezed,” Raske said. “The real loser here is the patient.”