The feasibility of substance misuse screening in referrals from accident and emergency to an inner-city fracture clinic: results from a pilot study

Objectives: To assess the prevalence of problem drinking, excessive alcohol consumption and illicit drug use among patients referred to a fracture clinic from Accident and Emergency (A&E). Design: Prospective self-completion questionnaire study. Setting: An inner-city outpatient fracture clinic in South London. Subjects: New referrals from an A&E department (n = 73).
Outcome measurements: The AUDIT questionnaire was used to assess problem drinking, while the subjects' report of weekly alcohol consumption was used to identify excessive alcohol consumption. Illicit drug use was measured with the substance misuse section of the Maudsley Addiction Profile (MAP).
Results: Forty-one per cent of the sample scored over 8 (a positive AUDIT result), indicating problem drinking. This was significantly associated with male gender and with not being married. Twenty-three per cent of the sample consumed above recommended weekly limits of alcohol consumption. The only illicit drug that was used by any of the subjects over the month preceding interview was cannabis: 19% of the patients had used cannabis at least weekly over the month preceding interview. Cannabis use was associated with a positive AUDIT result and with belonging to a white non-UK ethnic group.
Conclusions: The rates of problem drinking resemble those found in the small number of previous fracture clinic studies and in A&E and orthopaedic in-patient population studies. A high incidence of cannabis use was also found in this patient group and this is the first study of drug use among fracture clinic attendees in the UK. Fracture clinics present an under-utilized opportunity to screen, engage and deliver brief interventions for the treatment of drug and alcohol problems.