In this study, we explored how patients who have used narcotics or illicit substances present to the ED. Increased rates of ED visits and admissions related to substance addiction have been documented in previous studies. Since many patients enter the ED with undetected drug and alcohol use, we considered characterizing the different presentations of these patients in an attempt to identify groups with a higher risk of active substance use in the EDs and formulate screening criteria.

According to our findings, young men between the ages of 21 and 30 accounted for most of the patients with a history of substance use or abuse who were admitted to the ED. Of these patients, 60.3% used cannabis, while 34.9% used amphetamines. This supports the conclusion by Bamofleh et al ¹⁶ from 2017 that the most addicted age group in Western Saudi Arabia was 15–25 years old. Alcohol was used less frequently than amphetamines and cannabis. In contrast, ethanol (alcohol) was the most commonly used substance in a survey carried out in the Eastern region of Saudi Arabia in 2020, followed by cannabis (38.6%) and amphetamines (17%). ¹⁷ Further, smaller than the reported rate of 31.5%, 27.8% of our patients showed a bi- or triple-drug use pattern, despite the strict regulations on alcohol and illegal drug usage in Saudi Arabia. ¹⁰ However, only a small number of studies have been published that examined the patterns of drug and illegal substance use in Saudi Arabia and were able to identify the most frequently used types, quantities, administration techniques, and motivations. ⁹ According to reports, older Saudi men are more likely to use cannabis, whereas younger men are more likely to use amphetamines. ¹⁸

We found that 74 (12.7%) patients were involved in car accidents, most of whom were men between the ages of 21 and 30 (64.9%). The high prevalence of drug use, combined with risky driving behavior, quantity consumed, and overall drug use, is a strong independent predictor of the number of accidents and injuries. ¹⁹ Our findings are comparable to those of Manimaran et al ²⁰ who reported that the age range of 21-30 years accounted for 45.7% of MVCs, including alcohol and other drugs. Unsurprisingly, this age group includes people who are just beginning to appreciate their freedom as young adults. Meanwhile, older people who use drugs or abuse substances are more likely to be violent, unemployed, and to physically abuse their spouses. ²¹

The finding that men in the ED are 5.5 times more likely than women to present with a medical conditions and suffer serious injuries due to active substance use is noteworthy. In women and girls, the spectrum of substance use is distinct. ²² Women may report less substance and drug misuse than men, but girls and women report greater rates of all mental health issues and a heavier burden of psychosocial risk factors than men. They are also more likely to need extensive therapeutic treatments. Compared to males, women report more impediments related to family obligations, interpersonal issues, and mental health as well as higher degrees of perceived stigma. ²²

The ongoing issue of substance abuse is still a problem. According to reports, 62% of patients who use or abuse illicit drugs do not have access to services, especially women, who are stigmatized for abusing drugs. ²³ Acute and persistent pain that cannot be controlled, stigmatization and prejudice by medical employees regarding their condition, and hospital restrictions, such as being forbidden to leave the hospital floor, are all reasons why these patients leave the hospital too soon. Moreover, individuals with criminal backgrounds may associate hospitalization with being locked up. ²⁴

Based on our findings and the risks of medical, traumatic, and psychological sequelae that are likely to occur to patients who abuse drugs and illicit substances, in addition to the need for appropriate interventions and stricter application of the Saudi national program for drug prevention together with widespread community action, as proposed by Mahmoud et al ²⁵ in 2020, there is also a need for EDs and doctors to provide an environment that is conducive to the safe screening of users of drugs and illicit substances. To ensure effective management, patients who are taking these drugs must be recognized and given priority upon being admitted. Furthermore, patient education should be prioritized for individuals who have a history of substance abuse, overdose, and addiction. ^26,27