Evaluating the impact of an emergency department protocol that guides management of methamphetamine-induced agitation and psychosis

Julie Nguyen; Stephen Lee; Dennis Ankrah; Erin Knox

doi:10.9740/mhc.2022.01.009

Evaluating the impact of an emergency department protocol that guides management of methamphetamine-induced agitation and psychosis

Ment Health Clin. 2022 Jan 21;12(1):9-14. doi: 10.9740/mhc.2022.01.009. eCollection 2022 Jan.

Authors

Julie Nguyen^{1

1

2}, Stephen Lee¹, Dennis Ankrah¹, Erin Knox²

Affiliations

¹ Pharmacist, UC Irvine Health Medical Center, Orange, California.
² Pharmacist Education Specialist, Department of Pharmacy, UC Irvine Health Medical Center, Orange, California.

Abstract

Background: Methamphetamine is an addictive stimulant that may induce symptoms of agitation and psychosis. The estimated rate of methamphetamine use is 6.6 per 1000 people. Currently, no treatment guidelines exist to support the optimal management of patients presenting with methamphetamine-induced agitation. Emergency department (ED) providers may prescribe various benzodiazepines (BZDs) and antipsychotics (APs) as first-line agents to stabilize these agitated patients. This study aims to determine the effectiveness of a protocol to guide management of this condition.

Methods: This was a retrospective, pre- and poststudy conducted from July 2020 to March 2021 at a large academic medical center. A multidisciplinary protocol was designed to help manage methamphetamine-induced agitation in the ED. The primary outcome of the study was a reduction in the number of BZDs and APs used for the treatment of methamphetamine-induced agitation. This was measured by the incidence of overprescribing, defined as 3 or more APs or BZDs administered within 30 minutes. Secondary outcomes included the use of physical restraints, ED length of stay, and adverse events.

Results: We did not observe a significantly lower incidence of overprescribing, adverse events, or ED length of stay when comparing pre- and postprotocol groups. A subgroup analysis demonstrated that when protocol was followed, there was a statistically significant reduction in overprescribing (P = .001).

Discussion: We did not find any differences among our primary and secondary outcomes, which may be attributed to protocol nonadherence. Full compliance to the protocol may reduce the rate of overprescribing APs or BZDs in patients with methamphetamine-induced agitation.

Keywords: acute agitation; agitation; antipsychotics; benzodiazepines; emergency room; methamphetamine; methamphetamine induced agitation; methamphetamine psychosis; stabilization; substance use.