Atlantic Canada Poison Centre, Halifax, Canada.
Department of Emergency Medicine, Dalhousie University, Halifax, Canada.
Clin Toxicol (Phila). 2024 Nov;62(11):693-697. doi: 10.1080/15563650.2024.2402070. Epub 2024 Nov 1.
Clinicians managing patients with acute recreational drug or new psychoactive substance toxicity typically depend on self-reported drug(s) used. This study compares patient self-report (and/or from other sources) to the substance(s) that were subsequently identified in serum.
A prospective sample of 1,000 adults presenting to a tertiary care, urban emergency department in London, United Kingdom, with acute recreational drug/new psychoactive substance toxicity was collected from 1 February 2019 to 2 February 2020. A total of 939 appropriate samples underwent qualitative analysis by high-resolution mass spectrometry with comparison to a database of drugs/metabolites. Data on the stated drug(s) used were extracted from the routine medical chart/records; results were batched by drug class, when appropriate, and analysis was performed using R software.
Seven hundred and ninety-nine (85.1%) patients were male with a median (IQR) age of 34 years (27 to 42 years). Six hundred and thirty-five (67.6%) patients reported using two or more drugs. The median (IQR) positive predictive value of a self-report substance having been taken was 0.68 (IQR: 0.44-0.86); conversely, the median negative predictive value of a substance having not been taken was 0.90 (IQR: 0.53-0.95). There was variability in the accuracy of reporting. For example, self-reported opioid use had a 90.5% likelihood that opioids were detected on analysis, whereas hallucinogens were only detected in 18.8% of samples when use was reported. Individuals were also mostly accurate in not underreporting substances. For example, those not explicitly reporting gamma-hydroxybutyrate use were 97.5% truly negative.
Overall, most users were relatively accurate in their self-report of what class of drugs they had used, although there was variability in this accuracy. However, other drugs were present even when not reported, for example, opioids with disproportionate detection of prescription and over-the-counter (non-prescription) opioids that were unreported.
Self-report (and/or collateral reports) had overall relatively high concordance with the likelihood that a substance was, or was not, recently used. Therefore, clinicians can make initial treatment decisions based on the self-reported drug(s) used in most cases.
管理急性娱乐性药物或新型精神活性物质中毒患者的临床医生通常依赖于患者自报的用药情况。本研究比较了患者的自我报告（或其他来源）与随后在血清中鉴定出的物质。
2019 年 2 月 1 日至 2020 年 2 月 2 日期间，前瞻性收集了英国伦敦一家三级保健城市急诊室 1000 名急性娱乐性药物/新型精神活性物质中毒成年患者的样本。对 939 个合适的样本进行了高分辨率质谱的定性分析，并与药物/代谢物数据库进行了比较。从常规医疗记录/病历中提取了关于所报药物的使用数据；当合适时，将结果按药物类别进行分组，并使用 R 软件进行分析。
799 名（85.1%）患者为男性，中位（IQR）年龄为 34 岁（27 至 42 岁）。635 名（67.6%）患者报告使用了两种或两种以上药物。自我报告的用药物质中有 0.68（IQR：0.44-0.86）的阳性预测值中位数；相反，未使用物质的阴性预测值中位数为 0.90（IQR：0.53-0.95）。报告的准确性存在差异。例如，自我报告的阿片类药物使用有 90.5%的可能性在分析中检测到阿片类药物，而报告使用时仅检测到 18.8%的样本中存在致幻剂。个体在不隐瞒物质使用方面也大多是准确的。例如，那些没有明确报告使用γ-羟基丁酸的个体，其检测结果为阴性的概率为 97.5%。
总体而言，大多数使用者对自己使用的药物类别报告相对准确，尽管这种准确性存在差异。然而，即使没有报告，其他药物也存在，例如，阿片类药物的检测比例不成比例，包括未报告的处方和非处方（非处方）阿片类药物。
自我报告（和/或旁证报告）与物质近期使用的可能性具有较高的一致性。因此，在大多数情况下，临床医生可以根据患者自我报告的用药情况做出初始治疗决策。
