Example of alert and reporting system of scopolamine poisoning among Parisian cocaine users at regional, national and European levels

Abstract

IntroductionIn the literature, few intoxications are related to scopolamine due to its presence in cocaine, heroin or even in counterfeit rohypnol tablets. Nonetheless, during summer 2016, several cases of non-fatal intoxication appeared in the region of Paris.ObjectivesDemonstrate how clinical detection of rare toxic events are fostered by exchanges in close collaboration with different territorial level.AimsImprove the detection of short toxic epidemic.MethodsSuspected cases of scopolamine poisoning notified to Parisian Addictovigilance centre were reported. Information shared through different levels of the alert process contributed to strengthen their assessment.ResultsSeventeen cases of probable scopolamine poisoning among cocaine users were registered between the 6 and 24 of July. In the first 4 cases, toxicological analysis, of blood samples were scopolamine positive, with high concentration between 7 ng/mL and 25 ng/mL (usual therapeutic range: 0.1 to 1.1 ng/mL). A collected sample of this cocaine powder had a purity of 23.2%, with 15.2% of scopolamine. Half time of scopolamine is longer than half time of cocaine (3–8 hours versus 1–2 hours): this could explain why the observed effects lasted over 24 hours (8/17). Main clinical features were mydriasis (15/17), high blood pressure (12/17), tachycardia (13/17), behavioural disorder with agitation (13/17), hallucinations (5/17), and coma (8/17). Practitioner's responsiveness and the extensive information sharing [MM1] between regional and European level were congruent.ConclusionsAdulterated street drugs can lead to short toxic epidemic which could be unnoticed. Emerging event should require careful assessment with linkage between risk assessors and risk managers.Disclosure of interestThe authors have not supplied their declaration of competing interest.