As well, the long-term health consequences to the individual may be worse if they systematically use drugs in a lumpy manner Warner-Smith et al. 2001. Evidence
from nonfatal heroin overdose cases suggests that such users may suffer permanent pulmonary impairment, and an increased probability of developing pneumonia. For
heroin and cocaine, there is evidence that users suffer permanent cognitive impair- ments and muscular complications proportional to their overdose experiences.
Finally, lumpy drug use deteriorates your state of awareness and thus increases the chance of sharing needles Mandell et al. 1994—a key risk factor in contracting HIV.
IV. Data
The data were compiled from the records of St. Paul’s Hospital, Vancouver’s only downtown hospital, which almost exclusively handles the city’s
injection drug user population. The final data were based on two sources: the chart file and the administrative file, which are merged using an individual’s identification num-
ber. When a patient is admitted to the hospital for the first time they are given an iden- tification number. This identification number is unique to every individual and can be
used to track an individual over time if they have subsequent admissions.
The administrative file contains the individual’s personal information such as name, address if they have a fixed address, indicates homeless otherwise, date of birth, gen-
der as well as the identification number. The administrative file also contains impor- tant medical information not necessarily specific to a particular admissiondischarge
such as whether the patient is an injection drug user and HIV status. Each time a patient is admitted they are given a chart, which in addition to the identification num-
ber, contains the information relevant to that particular admission such as the patient’s diagnosis, length of stay, and discharge status planned discharge versus AMA. Our
data include all admissions from injection drug users, and thus can be considered a census of IDU admissions to St. Paul’s Hospital. Medical records staff employees
specialized in the coding of medical statistics flag patients as being IDUs upon chart review if they have injected drugs within the last six months that is, the IDU flag is
a self-reported measure combined with an assessment and diagnosis by an addiction medical specialist.
The data cover fiscal year 1996 March 1 1995 to February 29 1996 to fiscal year 2000, and includes a total of 4,760 records from 2,432 individuals. Summary statis-
tics on all relevant information available in the data are presented in Table 1. There are 1491 individuals for whom we have no longitudinal information only one admis-
sion. For the 941 individuals that had multiple admissions over the sample period, the average number of observations per person is 3.5 with the minimum being two
observations and the maximum being 23.
A striking feature of the data is the AMA rate—the proportion of cases involving a patient leaving against medical advice—which, at 26 percent, is extremely high. That
is, one in every four admissions involves an IDU failing to complete treatment and leaving the hospital against medical advice. This AMA rate is far greater than the
AMA rate for St. Paul’s Hospital as a whole, which is 1.3 percent—similar to U.S. evidence on AMA rates for instance, 1.2 percent in Smith and Telles 1991; 2.2 per-
cent in Jeremiah, O’Sullivan, and Stein 1995. Riddell and Riddell
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The Journal of Human Resources 144
Table 1 Summary Statistics
Variable Mean Standard Deviation
Left hospital against medical advice 0.264
0.423 Female
0.378 0.485
Age in years 35.11
8.63 Homeless
0.131 0.338
Downtown Eastside postal code 0.436
0.496 Other downtown Vancouver postal code
0.308 0.462
All other postal codes 0.124
0.330 HIV positive
0.509 0.500
Hospital unit: 10C HIV ward 0.153
0.360 Hospital unit: CTU ward
0.370 0.483
Hospital unit: emergency room 0.152
0.359 Hospital unit: other
0.325 0.468
Principal diagnosis: cellulitis 0.110
0.313 Principal diagnosis: osteomyelitis
0.015 0.122
Principal diagnosis: advanced AIDS-related condition 0.122
0.327 Principal diagnosis: psychological disorder
0.120 0.325
Principal diagnosis: endocarditis 0.047
0.211 Principal diagnosis: drug overdose
0.051 0.216
Principal diagnosis: septicemia 0.023
0.150 Principal diagnosis: trauma
0.056 0.230
Principal diagnosis: pneumonia 0.119
0.323 Principal diagnosis: pyrogenic arthritis
0.019 0.135
Principal diagnosis: Other condition 0.322
0.467 Length of stay in hospital in days
9.07 15.09
Readmitted to hospital within 2 weeks 0.111
0.310 Sample size number of admissionsdischarges
4,760 Number of individuals
2,432
The main drawback of the data is that we do not observe whether an individual is a social assistance recipient. However, an additional advantage of testing for check
effects among IDUs in Vancouver is that we know from other sources that social assistance receipt is likely to be extremely high in our data. For example, in June
1999, of the 405 IDUs in the provincially funded Vancouver Injection Drug-User Program, 89 percent were welfare recipients Palepu et al. 2001. Unfortunately, it is
not possible to match our data with social assistance records from the Ministry of Human Resources due to confidentiality concerns.
We also conducted our own test of social assistance receipt. We randomly chose a week in June 2002 and asked a welfare caseload worker from the Ministry to assist us
in a survey of all IDUs that were admitted to the hospital on that day. We first col- lected information including detailed interviews on the IDUs admitted, and then
called the worker at the Ministry the following week to confirm the relevant social assistance information. Of the 25 IDUs admitted, 22 were receiving Assistance two
of three not receiving assistance indicated homelessness including four on basic, four on Disability I, and 14 on Disability II.
We also have information on housing status, which will be used in the analysis to provide a test of social assistance receipt. To collect social assistance on a consistent
basis, one must have a fixed address. Based on our discussions with Ministry staff, some recipients have been cut off from support because they were unable unwilling
to find shelter. Our own experience with this population is that the homeless IDUs do not keep the Ministry updated on information required for continuing benefits,
such as efforts to find a job or alternative income sources. Moreover, British Columbia law eliminates the “comfort money” component of the support allowance
payment for recipients defined as transients, which includes those without depend- ent children who have no fixed address thereby leaving such recipients with only the
food component.
11
V. Welfare Wednesday and the Distribution of Overdose Admissions
