Epidemiology of hospitalizations with hallucinogen use disorder: a 17-year U.S. National study

This long-term study (17 years) assessed time-trends and outcomes of hallucinogen use disorder per 100,000 in the US. Hallucinogen use disorders hospitalizations were common and increased from 1998-2014. Modifiable patient and hospital factors can reduce this burden.

Abstract

“Objective: To assess time-trends and outcomes of hallucinogen use disorder hospitalizations.

Methods: The U.S. National Inpatient Sample (NIS) data from 1998 to 2014 were used. People hospitalized with hallucinogen use disorder as primary or secondary diagnosis were assessed. Rates were calculated per 100,000 NIS claims. Multivariable-adjusted logistic regression analyses assessed the association of patient and hospital characteristics with outcomes.

Results: The national U.S. rates per 100,000 total NIS claims for hallucinogen use disorder hospitalizations increased from 1998-2000 to 2013-2014 and outcomes worsened over time:¹ hospitalizations, from 22.8 to 40.4 (1.8-fold);² in-hospital mortality rate, from 0.3 to 0.6 (2.3-fold); and³ non-home discharge, from 4.2 to 6.3 (1.5-fold), respectively. Various patient and hospital characteristics were associated with worse healthcare utilization outcomes and in-hospital mortality.

Conclusions: Hallucinogen use disorder hospitalizations were common and increased from 1998 to 2014 in the U.S. interventions targeting modifiable patient and hospital factors can potentially reduce this burden.”

Authors: Jasvinder A. Singh

Summary

ABSTRACT

The rate of hallucinogen use disorder hospitalizations increased from 1998 to 2014, and outcomes worsened over time. Various patient and hospital characteristics were associated with worse healthcare utilization outcomes and in-hospital mortality.

Introduction

Hallucinogens are drugs that induce changes in thought, perception, and mood to a greater extent than their other effects. Hallucinogen use disorder is an uncommon substance use disorder associated with significant healthcare burden.

In the last few years, there has been increased attention on hallucinogen use disorder due to significant associated morbidity and mortality and high prevalence in the USA. This study assessed the national time-trends in hospitalizations and outcomes, and factors associated with hospitalization outcomes for hallucinogen use disorder.

The prevalence of hallucinogen use disorder increased by 1.5- to 2.3-fold from 1998 – 2000 to 2013 – 2014, and non-inflation adjusted median hospital charges also increased 3.4-fold. Demographics, higher comorbidity, hospital factors, and non-private insurance were associated with higher utilization outcomes and/or mortality.

This study used ICD-9-CM codes for hallucinogen use disorder to identify the cohorts of interest. The study had several limitations, including misclassification bias due to the use of diagnostic code, the use of unadjusted hospital charges, and the lack of out-of-hospital mortality data.

This study showed that hallucinogen use disorder hospitalizations increased significantly across 17 years from 1998 to 2014 in the USA, and identified several modifiable and non-modifiable factors associated with healthcare utilization and in-hospital mortality.

AHRQ’s Healthcare Cost and Utilization Project (HCUP) data are available after completing an on-line Data Use Agreement training session and signing a Data Use Agreement.

There are no financial conflicts of interest related directly to this study. The author has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Practice Point Communications, and the National Institutes of Health.

Hallucinogen use disorders are described in Chapter 54 of Current Diagnosis and Treatment: Psychiatry, 3rd edition, by Addy PH, D’Souza DC, and Grant BF. The HCUP database contains information on hospitalizations for mental and substance use disorders, as well as data on drug and opioid overdose deaths. The data are also used to inform the therapeutic potential of classic and novel phenethylamine, tryptamine, and lysergamide psychedelics.