Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia.
East Metropolitan Health Service, Perth, Australia.
Clin Toxicol (Phila). 2023 Jul;61(7):500-508. doi: 10.1080/15563650.2023.2229951. Epub 2023 Jul 14.
The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia.
Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation.
The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25-40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine ( = 201, 77.9%) and gamma-hydroxybutyrate ( = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected ( = 29, 60.4%). Frequent pharmaceuticals detected included diazepam ( = 100, 26.1%) and clonazepam ( = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, < 0.001).
Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments.
澳大利亚急性非法药物使用的负担在很大程度上尚不清楚。在急诊部门使用分析确认建立一个前瞻性的药物监测系统可能有助于早期发现新出现的药物。我们描述了在 2020 年 4 月至 2021 年 12 月期间，澳大利亚西部五个急诊部门参与新兴毒品网络的患者的人口统计学数据和急性毒性模式，这些患者的临床特征严重且/或不寻常，与娱乐性药物毒性一致。
在澳大利亚新兴毒品网络的五个西澳大利亚急诊部门参与期间，确定了严重且/或不寻常的毒理学表现一致的患者，这些患者的临床特征严重且/或不寻常，与娱乐性药物毒性一致。在急诊部门就诊时，收集了有和没有血液样本中分析确认的非法药物/新型精神活性物质的患者的人口统计学和毒理学模式。
该队列包括 434 例严重且/或不寻常的毒理学表现；中位年龄为 33 岁（第一和第三四分位数为 25-40 岁），268 名男性（61.8%）。在 405 例（93.3%）检测中发现任何物质（非法、新型精神活性物质、药物）。在 257 例（59.2%）检测中发现了非法药物/新型精神活性物质，其中 73 例（28.3%）有不止一种确认的非法药物/新型精神活性物质。经常检测到的非法药物包括甲基苯丙胺（ = 201，77.9%）和γ-羟基丁酸（ = 30，11.6%）。在 43 例（16.7%）检测中检测到 48 种新型精神活性物质。新型苯并二氮䓬类最常被检测到（ = 29，60.4%）。经常检测到的药物包括地西泮（ = 100，26.1%）和氯硝西泮（ = 40，10.4%）。155 例（35.7%）出院回家，56 例（12.9%）入住重症监护病房。与未检出非法药物/新型精神活性物质的检测相比，检出非法药物/新型精神活性物质的检测患者的重症监护病房中位住院时间较短（分别为 32.6 小时和 50.8 小时， < 0.001）。
在澳大利亚新兴毒品网络中，对严重且/或不寻常毒理学表现的患者进行临床和分析数据的整合，提供了关于导致西澳大利亚急诊部门急性伤害的非法药物/新型精神活性物质使用的见解。
