Liakoni Evangelia, Yates Christopher, Dines Alison M, Dargan Paul I, Heyerdahl Fridtjof, Hovda Knut Erik, Wood David M, Eyer Florian, Liechti Matthias E
Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern Clinical Toxicology Unit, Emergency Department, Hospital Universitari Son Espases, Research Institute of Health Sciences (IdISBa), Palma de Mallorca, Spain Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Medicine (Baltimore). 2018 Feb;97(5):e9784. doi: 10.1097/MD.0000000000009784.
The aim of the study was to compare self-reported and analytically confirmed substance use in cases of acute recreational drug toxicity.We performed a retrospective analysis of emergency department presentations of acute recreational drug toxicity over 2 years (October 2013 to September 2015) within the European Drug Emergencies Network Plus project.Among the 10,956 cases of acute recreational drug toxicity during the study period, 831 could be included. Between the self-reported substance use and the toxicological results, the highest agreement was found for heroin (86.1%) and cocaine (74.1%), whereas inhalants, poppers, and magic mushrooms were self-reported but not analytically detected. Cathinones and other new psychoactive substances (NPS) could be detected using additional analytical methods. Among cases with both immunoassay (IA) and confirmation with mass spectrometry (MS), the results were consistent for methadone (100%) and cocaine (95.5%) and less consistent for amphetamines (81.8%). In cases with a positive IA for amphetamines (n = 54), MS confirmed the presence of 3,4-methylenedioxymethamphetamine (MDMA), amphetamine, methamphetamine, and NPS in 37, 20, 10, and 6 cases, respectively, also revealing use of more than 1 substance in some cases. MS yielded positive results in 21 cases with a negative IA for amphetamines, including amphetamine, MDMA, methamphetamine, and NPS, in 14, 7, 2, and 2 cases, respectively.In conclusion, the highest agreement was found between self-reports and analytical findings for heroin and cocaine. The diagnosis of NPS use was mainly based on self-report. The IAs accurately identified methadone and cocaine, and MS had advantages for the detection of NPS and amphetamine derivatives.
本研究的目的是比较急性娱乐性药物中毒病例中自我报告的和经分析确认的物质使用情况。我们对欧洲药物紧急情况网络升级版项目中2年（2013年10月至2015年9月）内急诊科急性娱乐性药物中毒病例进行了回顾性分析。在研究期间的10956例急性娱乐性药物中毒病例中，831例可纳入研究。在自我报告的物质使用情况和毒理学结果之间，海洛因（86.1%）和可卡因（74.1%）的一致性最高，而吸入剂、Poppers和神奇蘑菇是自我报告但未通过分析检测到的。卡西酮和其他新型精神活性物质（NPS）可使用额外的分析方法检测到。在同时进行免疫分析（IA）和质谱（MS）确证的病例中，美沙酮（100%）和可卡因（95.5%）的结果一致，而苯丙胺类药物的一致性较低（81.8%）。在苯丙胺类药物IA呈阳性的病例（n = 54）中，MS分别在37例、20例、10例和6例中确认存在3,4-亚甲基二氧基甲基苯丙胺（MDMA）、苯丙胺、甲基苯丙胺和NPS，在某些病例中还显示使用了不止一种物质。MS在21例苯丙胺类药物IA呈阴性的病例中得出阳性结果，其中分别在14例、7例、2例和2例中检测到苯丙胺、MDMA、甲基苯丙胺和NPS。总之，海洛因和可卡因的自我报告与分析结果之间一致性最高。NPS使用的诊断主要基于自我报告。IA能准确识别美沙酮和可卡因，而MS在检测NPS和苯丙胺衍生物方面具有优势。
