Liakoni Evangelia, Dolder Patrick C, Rentsch Katharina M, Liechti Matthias E
Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Hebelstrasse 2, CH-4031, Basel, Switzerland.
Laboratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
BMC Pharmacol Toxicol. 2016 May 26;17(1):25. doi: 10.1186/s40360-016-0068-7.
Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations, in particular regarding novel psychoactive substances (NPS) that have emerged on the illicit market in the last years.
We included all cases presenting at the emergency department (ED) of the University Hospital of Basel, Switzerland, between October 2014 and September 2015 with acute toxicity due to self-reported recreational drug use or with symptoms/signs consistent with acute toxicity. Intoxications were confirmed using immunoassays and LC-MS/MS, detecting also novel psychoactive substances.
Among the 50'624 attendances at the ED, 210 were directly related to acute toxicity of recreational drugs. The mean patient age was 33 years and 73 % were male. Analytical drug confirmation was available in 136 cases. Most presentations were reportedly related to cocaine (33 %), cannabis (32 %), and heroin (14 %). The most commonly analytically detected substances were cannabis (33 %), cocaine (27 %), and opioids excluding methadone (19 %). There were only two NPS cases; a severe intoxication with paramethoxymethamphetamine (PMMA) in combination with other substances and an intoxication of minor severity with 2,5-dimethoxy-4-propylphenethylamine (2C-P). The most frequent symptoms were tachycardia (28 %), anxiety (23 %), nausea or vomiting (18 %), and agitation (17 %). Severe complications included two fatalities, two acute myocardial infarctions, seizures (13 cases), and psychosis (six cases). Most patients (76 %) were discharged home, 10 % were admitted to intensive care, and 2 % were referred to psychiatric care.
Most medical problems related to illicit drugs concerned cocaine and cannabis and mainly included sympathomimetic toxicity and/or psychiatric disorders confirming data from the prior year. Importantly, despite the dramatic increase in various NPS being detected in the last years, these substances were infrequently associated with ED presentations compared with classic recreational drugs.
尽管精神活性物质的娱乐性使用很常见，但关于急性药物毒性或医院就诊情况的系统数据收集有限，特别是关于过去几年在非法市场上出现的新型精神活性物质（NPS）。
我们纳入了2014年10月至2015年9月期间在瑞士巴塞尔大学医院急诊科就诊的所有病例，这些病例因自我报告的娱乐性药物使用导致急性毒性，或有与急性毒性一致的症状/体征。使用免疫测定法和液相色谱-质谱/质谱法确认中毒情况，同时也检测新型精神活性物质。
在急诊科的50624次就诊中，210次与娱乐性药物的急性毒性直接相关。患者的平均年龄为33岁，73%为男性。136例病例有药物分析确认结果。据报告，大多数就诊情况与可卡因（33%）、大麻（32%）和海洛因（14%）有关。分析检测到的最常见物质是大麻（33%）、可卡因（27%）和不包括美沙酮的阿片类药物（19%）。只有两例新型精神活性物质病例；一例是与其他物质联合使用对甲氧基甲基苯丙胺（PMMA）导致的严重中毒，另一例是2,5-二甲氧基-4-丙基苯乙胺（2C-P）导致的轻度中毒。最常见的症状是心动过速（28%）、焦虑（23%）、恶心或呕吐（18%）和激动（17%）。严重并发症包括两例死亡、两例急性心肌梗死、癫痫发作（13例）和精神病（6例）。大多数患者（76%）出院回家，10%入住重症监护病房，2%被转诊至精神科治疗。
与非法药物相关的大多数医疗问题涉及可卡因和大麻，主要包括拟交感神经毒性和/或精神障碍，这与上一年的数据一致。重要的是，尽管近年来检测到的各种新型精神活性物质急剧增加，但与经典娱乐性药物相比，这些物质很少与急诊科就诊相关。
