Clinical Toxicology Research Group, The University of Newcastle, Newcastle, New South Wales, Australia.
Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
Emerg Med Australas. 2023 Dec;35(6):946-952. doi: 10.1111/1742-6723.14272. Epub 2023 Jul 6.
Opioid-related harm has risen in recent decades, but limited research describes the clinical burden of opioid poisoning to Australian EDs. We aimed to investigate hospital presentations with opioid poisoning over three decades.
This is an observational series of prospectively collected data investigating presentations of opioid poisoning to an ED in Newcastle (1990-2021). Type of opioid, naloxone administration, intubation, intensive care unit (ICU) admission, length of stay and death were extracted from the unit's database.
There were 4492 presentations in 3574 patients (median age 36, 57.7% female), increasing from an average of 93 presentations annually in the first decade to 199 in the third decade. Deliberate self-poisonings accounted for 3694 presentations (82.2%). Heroin dominated the 1990s, peaking in 1999 before decreasing. Prescription opioids then rose, with codeine (usually in paracetamol combination) predominating until 2018, after which oxycodone presentations exceeded them. Methadone consistently increased from six presentations annually in the first decade to 16 in the last decade. Naloxone was administered in 990 (22.0%) presentations and 266 (5.9%) were intubated, most frequently following methadone and heroin exposures. ICU admissions increased from 5% in 1990 to 16% in 2021. Codeine exposures resulted in less severe effects, whereas methadone had more severe effects overall. The median length of stay was 17 h (interquartile range 9-27 h). There were 28 deaths (0.6%).
Opioid presentations increased in number and severity over three decades as the type of opioid changed. Oxycodone is currently the main opioid of concern. Methadone poisoning was the most severe.
近几十年来，阿片类药物相关危害有所增加，但对澳大利亚急诊室阿片类药物中毒的临床负担的研究有限。我们旨在调查三十年来阿片类药物中毒的住院情况。
这是一项对纽卡斯尔急诊室（1990-2021 年）阿片类药物中毒患者进行前瞻性数据收集的观察性系列研究。从该单位的数据库中提取阿片类药物类型、纳洛酮给药、插管、重症监护病房（ICU）入院、住院时间和死亡情况。
在 3574 名患者中，有 4492 名患者出现阿片类药物中毒，中位数年龄为 36 岁，57.7%为女性，在第一个十年中每年平均有 93 例就诊，到第三个十年则增加到 199 例。故意自我中毒占 3694 例（82.2%）。海洛因在 1990 年代占据主导地位，1999 年达到高峰后下降。随后，处方类阿片类药物上升，其中可待因（通常与对乙酰氨基酚合用）占主导地位，直到 2018 年，之后羟考酮的就诊量超过了可待因。美沙酮从第一个十年每年 6 例增加到最后十年的 16 例。990 例（22.0%）就诊患者给予了纳洛酮，266 例（5.9%）患者插管，最常见于美沙酮和海洛因暴露后。1990 年 ICU 入院率为 5%，2021 年增加到 16%。可待因暴露的后果相对较轻，而美沙酮总体上的后果更严重。中位数住院时间为 17 小时（四分位距 9-27 小时）。有 28 例死亡（0.6%）。
三十年来，随着阿片类药物类型的变化，阿片类药物就诊的数量和严重程度都有所增加。羟考酮目前是主要关注的阿片类药物。美沙酮中毒最严重。
