Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis

Dan Lewer*, Joseph Freer, Emma King, Sarah Larney, Louisa Degenhardt, Emily J. Tweed, Vivian D. Hope, Magdalena Harris, Tim Millar, Andrew Hayward, Dan Ciccarone, Katherine I. Morley

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

23 Citations (Scopus)


Aims: To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. Design: Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). Setting and participants: People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of ‘substance use disorder’; or use drug treatment services. Measurements: Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED). Findings: Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114–201] and 41 (95% CI = 30–57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. Conclusions: People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Original languageEnglish
Pages (from-to)1011-1023
Number of pages13
Issue number6
Publication statusPublished - 1 Jun 2020
Externally publishedYes

Bibliographical note

Funding Information:
D.L. and M.H. are funded by the National Institute for Health Research (NIHR) (DRF-2018-11-ST2?016, CDF-2016-09-014). This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. L.D. and S.L. are supported by NHMRC Research Fellowships (GNT1041742, GNT1135991, GNT1091878, GNT1140938) and NIDA R01DA1104470. The National Drug and Alcohol Research Centre at UNSW Australia is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. E.J.T. is funded by the Medical Research Council [MC_UU_12017/13 & MC_UU_12017/15) and Chief Scientist Office (SPHSU13 and SPHSU15), and by a Chief Scientist Office Clinical Academic Fellowship (CAF/17/11). A.H. is an NIHR Senior Investigator and is funded by the Central and North West London NHS Trust. D.C. is supported by the US National Institutes of Health, National Institute of Drug Abuse Grant DA037820. K.I.M. is funded by the Wellcome Trust (109823/Z/15/Z).

Publisher Copyright:
© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction


  • Health services
  • Hospitals
  • Opiates
  • Primary Health Care
  • Stimulants
  • Substance-Related Disorders


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