Aim To identify the prevalence of drug misuse (illicit, over-the-counter and prescribed) by patients at Bristol Royal Infirmary, an inner-city teaching hospital, and the problems encountered by ward staff in the management of these patients.

Method A prevalence survey was conducted in the A&E department of the hospital using an adapted version of the two-item conjoint screening test (TICS), a validated screening tool devised by Brown et al (1997). A qualitative survey of ward managers was used to identify the problems presented by drug misusers on the ward, and to gather suggestions for the role of a specialist substance misuse liaison worker.

Results An 11 per cent prevalence of drug misuse was found among 64 patients attending the A&E department. In the survey of 18 ward managers, ten (55.5 per cent) wards admitted a minimum of one drug misuser each week and 15 wards (83 per cent) described negative behaviours among this patient group which had an effect on the management of the ward.

Conclusion Consideration should be given to routine screening for the presence of drug misuse among patients. Introduction of a specialist drug misuse liaison worker and guidelines for the management of this patient group would help to reduce the significant problems experienced by staff.