Analysis of recreational drug samples obtained from patients presenting to a busy inner-city emergency department: a pilot study adding to knowledge on local recreational drug use.

INTRODUCTION: Routine toxicological screening is not undertaken in individuals presenting to emergency departments (ED) with acute recreational drug toxicity, because it does not usually alter an individual patient's management. Localised information on the types of recreational drugs being used is often not available. The pilot study described here looks at the analysis of presumed recreational drugs in the possession of individuals presenting to the ED with acute recreational drug toxicity. METHODS: Suspected recreational drug samples were handled as controlled drugs and transported to a Home Office approved laboratory. Samples were initially categorised on the basis of their physical appearance; liquid samples were analysed by infrared spectrophotometry and non-liquid samples were analysed by gas chromatography-mass spectrometry. RESULTS: A total of 33 (12 liquid and 21 non-liquid) samples was analysed in this pilot study. Liquid samples were shown to contain either γ-butyrolactone or isopropyl nitrite. 19% of non-liquid samples (12% of total samples) did not contain any drugs and 23% contained legal pharmaceutical agents. Of the remaining samples, they contained both 'classic' and 'novel' recreational drugs. Only 33.3% of crystalline substances contained methamphetamine. DISCUSSION: This pilot study has shown that analysing samples obtained in the ED can contribute to clinicians' knowledge of local drug epidemiology. Extension of this approach in areas with a high prevalence of recreational drug use, with appropriate funding, may be useful in monitoring drug trends and detecting novel emerging drugs.

Pharmacy services to UK emergency departments: a descriptive study.

OBJECTIVE: To describe current hospital pharmacy services and facilities provided to United Kingdom Emergency Departments (EDs), identify potential roles for pharmacy technicians and possible benefits pharmacists may bring to the ED. SETTING: Emergency care specialist interest group workshop at an UK Clinical Pharmacy Association (UKCPA) conference in 2004. Workshop attendance was open to pharmacists and technicians. METHOD: A descriptive study using a voluntary self-completed questionnaire covering ED services, pharmacy services and facilities to the ED and potential roles and benefits. RESULTS: Of 40 questionnaires distributed, 31/40 (78%) were returned representing 25 NHS hospitals. Most (72%) EDs received some level of pharmacy service. Emergency Department skill-mix, ED service models and pharmacy services varied. Pharmacists' current roles were similar across EDs, with input into guideline development and review 12/25 (48%), patient group directions 11/25 (44%), provision of training 11/25 (44%), provision of advice (general and clinical)/liaison 10/25 (40%) and drug history taking 11/25 (40%). Potential roles identified for pharmacy technicians included assessment of patients' own drugs, support for drug history taking, stock management and drug storage. Further benefits pharmacists could bring to EDs included rationalisation of medicines on admission, identification of ADRs causing admission, support with complex medicine issues, new prescribing skills, supporting the maximum waiting time target and facilitating discharge. CONCLUSION: Pharmacy services have developed to support service provision in EDs with similar roles to in-patient pharmacists. Pharmacy services in some EDs are now extensive with funded, full-time pharmacy posts but pharmacy service review is required to optimise ED patient care where there is limited or no current pharmacy input. New pharmacy services must fit with local ED service models and skill mix. Evaluation of these new services is vital to maximise benefit to patients and the NHS.