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Emerg Med J. 2007 September; 24(9): 685.
PMCID: PMC2464668

Substance use among those attending an accident and emergency department

We read with interest the letter from Patton et al on “Substance use among patients attending an accident and emergency department”.1 We have cross‐sectional survey data from 2488 patients who attended one of eight accident and emergency departments in Wales. Individuals aged 18–40 years were sent a questionnaire after attending, following an injury at work, a road traffic accident, sports or home injury, or for a non‐trauma reason, in the previous 6 months.

Levels of heavy alcohol and illicit drug use were similar to those reported by Patton et al1: 33% reported drinking more than the sensible weekly limit (14 and 21 units per week for women and men, respectively); 23% reported drug use in the previous year, and 14% in the previous month. There were also univariate associations between reporting three or more injuries requiring medical attention in the previous year and both recent drug and heavy alcohol use (previous month drug use: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.21 to 2.62; previous year drug use: OR 1.64, 95% CI 1.16 to 2.30; alcohol: OR 1.53, 95% CI 1.11 to 2.10). Injuries have multiple aetiologies, and further analyses of this2 and a community based dataset,3 controlling for other potential confounding influences, suggest independent associations between drug use and non‐work related injuries, particularly among those with higher levels of other injury risk factors.

We therefore concur with Patton et al's recommendation of a brief screening of accident and emergency department attendees.1 However, since our data also suggest associations between drug use and minor injuries,2,3 screening those attending the general practitioner and/or practice nurse following a more minor injury might also be appropriate.


Competing interests: None declared.


1. Patton R, Smythe W, Kelsall H. et al Substance use among patients attending an accident and emergency department. Emerg Med J 2007. 24146
2. Smith A P, Wadsworth E J K, Moss S C. et alThe scale and impact of drug use by workers. London: HSE Books, Health and Safety Executive Research Report 192, 2004
3. Wadsworth E J K, Moss S C, Simpson S A. et al A community based investigation of the association between cannabis use, injuries and accidents. J Psychopharm 2006. 201, 5–1,13.1,13

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