Illicit drug use—including use of stimulants like methamphetamine, amphetamines, and cocaine—continues to be a growing problem throughout the United States. Research has shown that the misuse of illicit stimulants can lead to a variety of negative health consequences, including vasoconstriction, endothelial dysfunction, and hypertension. In addition, chronic use of these stimulants may lead to accelerated atherosclerosis and cardiac dysfunction. “In patients with burns, these factors can reduce the body’s ability for wound healing,” says Justin Gillenwater, MD, MS, FACS.

According to recent national estimates, as many as 5% of patients with burns have a history of illicit drug abuse, including with stimulants. “Given the prevalence of stimulant abuse in patients with burns, it’s important to determine the role that these substances play in clinical outcomes for this population,” Dr. Gillenwater says. Patients with burns and a history of stimulant abuse may need to be monitored more closely by clinicians because they could be at higher risk for complications and may require more interventions and resources.

Stimulant Vs No Stimulant Use

For study published in the Journal of Burn Care Research, Dr. Gillenwater and colleagues presented data on the experiences and clinical outcomes of patients presenting with positive urine toxicology results for illicit stimulants at a burn center. Specifically, investigators compared differences in outcomes between 130 patients with burns who tested positive for stimulants with a control group of 133 patients with burns who tested negative for stimulant use. Patients testing positive for stimulants were matched to the control group by age, sex, and total body surface area burned. The primary outcome was mortality, while secondary outcomes included total length of stay (LOS) and need for grafting surgery.

No significant differences were seen with regard to mortality, ICU length of stay, wound infections, or wound conversion. “However, while we didn’t see a statistically significant difference in mortality between groups, we saw that LOS for those who tested positive for stimulant use was 5 days longer than for those testing negative for stimulants,” Dr. Gillenwater says (Table).  “We also found that patients with burns who used stimulants had a greater need for skin grafting surgery.” In addition, he says there was a trend toward deeper burn injuries seen among patients using illicit stimulants. Overall, patients testing positive for stimulants required more hospital resources.

Linking Patients With the Resources They Require

Dr. Gillenwater says the study findings highlight the importance of burn centers and clinicians being prepared to link patients who use illicit stimulants to the resources they will likely require. “Since patients who use illicit stimulants are more likely to require surgery and have a longer LOS, it’s important to address these disposition factors early,” he says. “These patients will likely need healthcare resources that go beyond the initial care of their burn injuries. Of note, many of these patients have more complex psychosocial needs. They may be homeless or have a poor home life, which are factors that can impact discharge plans after their wounds are managed. As clinicians, we should not only help these patients recover from their burns but also use the burn injury as a stimulus to help patients improve their life.”

The researchers noted that a prospective study is needed to better define the differences observed in their study and better predict the hospital course for users of illicit stimulants. “For example, it would be helpful to determine why users of illicit stimulants tend to stay in the hospital longer than those who don’t use these substances,” says Dr. Gillenwater. “We also need to establish if we can reduce LOS and improve outcomes if patients are appropriately connected to resources that help them quit their illicit stimulant use.”

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