ABSTRACT
Introduction: Incidence of hospitalisations related to psychoactive substance intoxication (H-SPA) might have been differently impacted by the Covid-19 pandemic according to age-groups. This study aimed to describe (i) the incidence of H-SPA during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. Material and methods: This historical cohort study was conducted in adults admitted to the University Hospital of Bordeaux with main or secondary diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-SPA were described according to patients age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). Results: Among the 5824 stays included over the study period, SPA most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-SPA's incidence was more important in young adults (-40%;nbaseline = 450) in comparison to those aged 30+ (-18%;nbaseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%;n2017 = 145 vs-35%;n2017 = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalization indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides increased during lockdown compared to the baseline period (almost 50% vs 29%) and the proportion of accidents in context of intoxication (3.5 vs 0.7%) after lockdown. Discussion/Conclusion: The period following lockdown should be considered at risk for hospitalizations due to accident in context of SPA use. Strong decrease in the incidence of H-SPA in young adult during the lockdown highlights the health burden of recreational use of alcohol and ecstasy in this population and the need for prevention.
ABSTRACT
Objective: To describe a case of extensive nitrous oxide (NO) misuse in a commercial airline pilot to specifically avoid detection on employer urine drug screens (UDS). Case report: A 48-year-old male commercial airline pilot was evaluated in a Medical Toxicology clinic for history of NO misuse. He started using NO and cannabis as a teenager. When he became an airline pilot, he stopped his cannabis use to ensure he passed frequent employer drug screens. He researched that NO was not detected on UDS and continued its use. During the COVID-19 pandemic, the patient's use grew to 1,200 eight gram NO canisters daily in an attempt to alleviate his stress. He described inhaling the gas until he passed-out. Upon waking, he, would use more until he again passed-out, repetitively cycling throughout the night. His developed paresthesias, progressive weakness in legs, and difficulty walking to the point where he had to crawl to the front door to receive his shipments of NO canisters. His cognition declined and he was brought to the hospital for help after being found in his home garage. Magnetic resonance imaging (MRI) imaging of the brain showed atrophy from chronic toxic metabolic encephalopathy. MRI of the spine did not show abnormalities. Upon referral to the Medical Toxicology clinic, he had not used NO for 3 months and had been taking vitamin B172. Symptoms had improved, but he still had extremity paresthesias, memory difficulties, and required a cane to walk. The patient's NO misuse had been reported to the Federal Aviation Administration (FAA) during his hospitalization and he was no longer allowed to pilot commercial airlines. Conclusion: Random drug testing of airline pilots is required by the FAA and the UDS test for D-9-tetrahydrocannabinol-9-carboxylic acid, benzoylecgonine, codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone, 6-acetylmorphine, phencyclidine, amphetamine, methamphetamine, methylenedioxymethamphetamine and methylenedioxyamphetamine [1]. Negative drug screens may give an employer a false sense of security that a pilot is not using/misusing substances but the UDS does not pick up numerous abused substances, including inhalants. This case illustrates the dangers in relying solely on the UDS to ensure pilots are clear from illicit substances. This patient was misusing nitrous oxide for decades which lead to permanent cognitive decline that negatively impacted his ability to safely fly.
ABSTRACT
Objective: In response to the evolving threat of illicit drug use, combined with anticipated SARS-CoV-2 (COVID-19) pandemicrelated market volatility, we created a multi-institution network supplying high-quality data on illicit drug presentations to Victorian emergency departments (EDs). Primary objective: timely data provision to a state Early Warning System (EWS) utilising multiple intelligence sources (including syringe residue and wastewater analysis) to inform public health interventions. Methods: The Emerging Drugs Network of Australia VIC (EDNAV) project is a multi-site prospective observational study collating de-identified clinical and analytical information within an electronic clinical registry (Research Electronic Data Capture secure web-based software platform). Case inclusion criteria: individuals ≥16 years of age presenting with suspected illicit drug toxicity requiring venepuncture as part of standard care. Hospital ethics committee approved waiver of patient consent for inclusion of deidentified data. Nine metropolitan and one regional ED contributed blood samples for weekly toxicological analysis at the Victorian Institute of Forensic Medicine. Liquid chromatographytandem mass spectrometry (LC-MS/MS) screened for 327 pharmaceuticals and illicit substances, as well as 268 novel psychoactive substances. EDNAV data was reviewed weekly as a component of the state EWS. High-risk signals were disseminated to government and external stakeholders. Results: During September 2020 - March 2021, 320 cases were analysed (70% male, mean age 30 years, 72% ambulance arrival). Sedation (Glasgow Coma Score (GCS)<9, 35%) and agitation (33%) were the commonest reasons for presentation;33% of patients required parenteral sedation, and 18% were administered naloxone. In addition, 8% were intubated and 11% required critical care admission;85% had a Poisoning Severity Score of ≥2. There were two deaths. There were 815 separate detections (345 illicit substances, 470 pharmaceuticals). At least one illicit drug was detected in 87% of cases (> 1 illicit drug in 43%). Common illicit drugs included methylamphetamine (52% of cases), gamma-hydroxybutyrate (GHB), 3,4-methylenedioxymethamphetamine (MDMA), cocaine and opioids. Eight novel benzodiazepines, 7 cathinones, 5 hallucinogens, 3 synthetic cannabinoid receptor agonists (SCRAs) and one novel opioid (Beta-U10) were detected. In 90% of cases, reported exposure differed from analytical findings. During COVID-19 related lockdowns, there was evidence of substance substitution including benzodiazepines in products sold as heroin. Three public health warnings were released in association with EDNAV findings (Nethylpentylone in cocaine, 25B-NBOH sold as lysergic acid diethylamide (LSD), paramethoxymethamphetamine (PMMA) sold as MDMA). Conclusion: For the first time in Victoria, a network of healthcare institutions working together enabled timely detection of illicit drug related harm, facilitating early public health warnings and notification of peer-based harm reduction services.
ABSTRACT
The proceedings contain 209 papers. The topics discussed include: an illicit drug early warning system utilizing comprehensive toxicological analysis of emergency department presentations in Victoria, Australia;4-fluoroamphetamine (4-FA) intoxication results in exaggerated blood pressure effects compared to 3,4-methylenedioxymethamphetamine (MDMA) and amphetamine: a retrospective analysis;single nucleotide polymorphisms of mu opioid receptor gene OPRM1 in emergency department patients with acute opioid overdose;ketamine in acute recreational poisonings in the Balearic Islands;the neuro-respiratory effects of pregabalin and the potential deleterious effects of its combination with diazepam or morphine ? a rat investigation;cobaltism from metal-on-metal (MoM) hip implants: how to manage and treat with acetylcysteine;analytically-confirmed polydrug use is more common in drug misuse patients attending emergency departments in Scotland compared with those in England and Wales;and it is not always COVID-19: a case of respiratory failure from lung damage associated with electronic cigarettes (EVALI).