Abstract
BackgroundAlthough the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are only available from the University Hospital of Basel. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period.MethodsRetrospective analysis of cases presenting from May 2012 to April 2016 at the emergency department of the University Hospital of Bern, Switzerland, with symptoms/signs consistent with acute toxicity of recreational drug use. The cases were retrieved using a comprehensive full-text search algorithm of the electronic health records. Isolated ethanol intoxications were excluded.ResultsDuring the study period, 503 of the 157,328 emergency department attendances were directly related to acute toxicity of substances used recreationally. The mean patient age was 33 years (range 16–74), 68% were male. Alcohol co-ingestion was reported in 54% of the cases, and use of more than one recreational drug in 37% of the cases. Most presentations were related to cocaine (29%), cannabis (26%), heroin (20%) and benzodiazepines/sedatives (18%). Urine drug screening immunoassay was available in 277 cases (55%). The most frequently detected substances were cannabis (29%), cocaine (22%), benzodiazepines (21%) and opioids excluding methadone (20%). There were only two intoxications with novel psychoactive substances (NPSs): One with methylone and one with 2,5-dimethoxy-4(n)-propylphenethylamine (2C-P). The majority of patients (58%) displayed impaired consciousness (Glasgow Coma Scale (GCS) <15) upon presentation and/or pre-hospital; 21% were unconscious (GCS <8). Other frequent symptoms were agitation (36%), tachycardia (29%), and anxiety (24%). Severe complications included two fatalities, three acute myocardial infarctions, two intracranial haemorrhages, as well as psychosis and seizures in 71 and 26 cases, respectively.ConclusionsMost medical problems related to recreational drug use were associated with cocaine and cannabis use and were mainly characterised by central nervous system depression, sympathomimetic toxicity and/or psychiatric disorders. Presentations related to acute toxicities of NPSs appear to be uncommon, while prescription drugs were after classical recreational drugs the substances most commonly reported.
Highlights
The recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations
Novel psychoactive substances (NPSs, known as “designer drugs” and “legal highs”) are usually analogues or derivatives of controlled substances produced in order to circumvent regulations and their use has rapidly increased in recent years [2]
In 2015, 98 NPSs were reported to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) for the first time, bringing the number of NPSs detected for the first time in the last 5 years to 380 (101 in 2014, 81 in 2013) [1]
Summary
The recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period. Substance use data are usually collected on the basis of indicators such as custom seizures, drug-related deaths, and user surveys. Such data often lack information on the acute toxicities of these substances. The NPSs are typically not detectable with the usual drug of abuse immunoassays. They can cause acute toxicities and medical complications, including deaths, but escape detection
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