Urine Amphetamine Screening and Suicidality: A 5-Year Retrospective Analysis of Emergency Department Patients

Suicidal patients in the emergency department commonly undergo immunoassay-based urine drug screening prior to psychiatry evaluation. Amphetamine use is common and can increase the risk of psychosis, depression, and suicidality.

To characterize the prevalence of positive amphetamine screening in suicidal emergency department patients and assess the impact of this on disposition planning.

We performed a retrospective observational study of suicidal adult patients who presented to 2 academic emergency departments between May 1, 2015 to April 30, 2020. Demographic, urine drug screening results, and disposition details were collected.

Of 388,931 encounters, 11,885 were included and 3,225 (27.1%) had a positive amphetamine urine screen. Of the 3,158 who underwent confirmatory testing, 94.7% were confirmed methamphetamine. Of the screen positives, 17.9% were admitted and 74.5% were discharged. 29.7% of screen negatives were admitted and 59.2% were discharged. The median emergency department length of stay for admitted patients was 18 hours, 29 minutes for screen positives and 16 hours, 54 minutes for screen negatives; for discharged patients, the median was 14 hours, 26 minutes (IQR 9:01-20:33) for screen positives and 11 hours, 48 minutes (IQR 6:52-18:08) for screen negatives. 48.0% of discharged screen positives had lengths of stay exceeding 15 hours, compared with 36.5% of screen negatives. Differences in admission and discharge rates and lengths of stay were statistically significant (p < 0.001).

In this patient population, positive amphetamine screening resulted in more frequent emergency department discharge when compared to those with negative amphetamine screens. Extended lengths of stay were more common for screen positive patients compared with screen negative patients. These findings are consistent with prior literature. Larger studies are needed to fully assess the impact of urine amphetamine screening on emergency psychiatric care and disposition.