Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 151 No. 5152 (2021)

Presentations with reported methamphetamine use to an urban emergency department in Switzerland

  • Valerie Romann
  • Monika Illgen
  • Adrian Derungs
  • Jolanta Klukowska-Rötzler
  • Meret E. Ricklin
  • Aristomenis Exadaktylos
  • Evangelia Liakoni
DOI
https://doi.org/10.4414/SMW.2021.w30099
Cite this as:
Swiss Med Wkly. 2021;151:w30099
Published
28.12.2021

Summary

AIMS OF THE STUDY: The stimulant methamphetamine (e.g., “crystal meth”) is a commonly abused drug in many parts of the world and can cause significant health problems. The present study aims to describe presentations with reported methamphetamine use at an urban emergency department (ED) in Switzerland, to investigate prevalence, patterns and susceptible groups.

METHODS: Retrospective study at the ED of the University Hospital of Bern, Switzerland. Cases from June 2012 to July 2019 were retrieved from the electronic patient database using full-text terms and were categorised into three groups based on patient history: “acute”, if patients presented within 72 hours of last reported use, “chronic” in cases of regular use but not within the previous 72 hours, and “past” in cases of discontinued consumption. Cases with a positive methamphetamine urine drug screening test with no further information available were described separately.

RESULTS: During the study period, 40 cases were categorised as “acute”. Among those, the mean age was 29.5 years (standard deviation [SD] 8.7), 75% (n = 30) were male, and agitation (n = 11, 28%), hypertension (n = 11, 28%), tachycardia (n = 11, 28%), sleep disturbances (n = 10, 25%) and aggression (n = 8, 20%) were the most common symptoms. Most patients (n = 22, 55%) were medically discharged, but 35% (n = 14) were admitted to a psychiatric clinic. Most (n = 33, 82.5%) were polydrug users, with alcohol, cocaine and cannabis being the most frequent co-used substances. The “chronic” group included 37 cases. Those patients were mostly male (n = 26, 70%), with a mean age of 31 years (SD 11.0), and 46% (n = 17) presented because of psychiatric symptoms, such as psychosis, depression or aggression. Of the 45 cases in the “past” group (mean age of 30 years, SD 8.6), 69% (n = 31) were male, and 49% (n = 22) and 24% (n = 11), respectively, had medical and psychiatric symptoms as the reason for admission. Of 61 cases with a positive urine drug screening test as the sole indicator of methamphetamine use, 19 patients reported MDMA use (cross-reactivity with methamphetamine in the urine immunoassay used). In the 42 remaining cases, it was unclear if the positive result was due to unreported methamphetamine use or cross-reactivity.

CONCLUSIONS: Most patients with reported methamphetamine use were young and male, with signs of sympathomimetic arousal and/or psychiatric symptoms. Although ED visits with reports of methamphetamine use appear to be uncommon, consumption-related health problems can require significant pre- and in-hospital resources.

References

  1. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. Methamphetamine in Europe: EMCDDA-Europol Threat assessment 2019. Luxembourg: Publications Office of the European Union. 2019. doi: https://www.emcdda.europa.eu/publications/joint-publications/methamphetamine-threat-assessment_en
  2. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2020: Executive Summary. Vienna: United Nations publications. 2020. doi: https://reliefweb.int/report/world/unodc-world-drug-report-2020
  3. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2020: Drug Supply. Vienna: United Nations publications. 2020. doi: https://reliefweb.int/report/world/unodc-world-drug-report-2020
  4. Logan BK. Methamphetamine - Effects on human performance and behavior. Forensic Sci Rev. 2002 Feb;14(1-2):133–51.
  5. Schep LJ, Slaughter RJ, Beasley DM. The clinical toxicology of metamfetamine. Clin Toxicol (Phila). 2010 Aug;48(7):675–94. https://doi.org/10.3109/15563650.2010.516752
  6. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Europol. Methamphetamine – A European Union perspective in the global context. Luxembourg: Publications Office of the European Union. 2009.
  7. Zobel F, Schneider C. (fedpol), Marthaler M. Neue Tendenzen im Drogenbereich (NTD) - Methamphetamin in der Schweiz. Lausanne: Sucht Schweiz. 2015.
  8. Panenka WJ, Procyshyn RM, Lecomte T, MacEwan GW, Flynn SW, Honer WG, et al. Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings. Drug Alcohol Depend. 2013 May;129(3):167–79. https://doi.org/10.1016/j.drugalcdep.2012.11.016
  9. Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009 Jul;104(7):1085–99. https://doi.org/10.1111/j.1360-0443.2009.02564.x
  10. Lecomte T, Mueser KT, MacEwan WG, Laferrière-Simard MC, Thornton AE, Buchanan T, et al. Profiles of individuals seeking psychiatric help for psychotic symptoms linked to methamphetamine abuse – baseline results from the MAPS (methamphetamine and psychosis study). Ment Health Subst Use. 2010;3(3):168–81. https://doi.org/10.1080/17523281.2010.504645
  11. Isoardi KZ, Ayles SF, Harris K, Finch CJ, Page CB. Methamphetamine presentations to an emergency department: management and complications. Emerg Med Australas. 2019 Aug;31(4):593–9. https://doi.org/10.1111/1742-6723.13219
  12. Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008 May;27(3):253–62. https://doi.org/10.1080/09595230801923702
  13. McGregor C, Srisurapanont M, Jittiwutikarn J, Laobhripatr S, Wongtan T, White JM. The nature, time course and severity of methamphetamine withdrawal. Addiction. 2005 Sep;100(9):1320–9. https://doi.org/10.1111/j.1360-0443.2005.01160.x
  14. Bunting PJ, Fulde GW, Forster SL. Comparison of crystalline methamphetamine (“ice”) users and other patients with toxicology-related problems presenting to a hospital emergency department. Med J Aust. 2007 Nov;187(10):564–6. https://doi.org/10.5694/j.1326-5377.2007.tb01417.x
  15. Jones R, Woods C, Usher K. Rates and features of methamphetamine-related presentations to emergency departments: an integrative literature review. J Clin Nurs. 2018 Jul;27(13-14):2569–82. https://doi.org/10.1111/jocn.14493
  16. Cloutier RL, Hendrickson RG, Fu RR, Blake B. Methamphetamine-related psychiatric visits to an urban academic emergency department: an observational study. J Emerg Med. 2013 Jul;45(1):136–42. https://doi.org/10.1016/j.jemermed.2012.11.094
  17. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2020: Drug Use an Health Consequences. Vienna: United Nations publications. 2020. doi: https://reliefweb.int/report/world/unodc-world-drug-report-2020
  18. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). European Drug Report 2020: Trends and Developments. Luxembourg: Publications Office of the European Union; 2020. 2020.
  19. Griffiths P, Mravcik V, Lopez D, Klempova D. Quite a lot of smoke but very limited fire—the use of methamphetamine in Europe. Drug Alcohol Rev. 2008 May;27(3):236–42. https://doi.org/10.1080/09595230801932588
  20. Ort C, van Nuijs AL, Berset JD, Bijlsma L, Castiglioni S, Covaci A, et al. Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis. Addiction. 2014;109(8):1338-52. doi: https://www.ncbi.nlm.nih.gov/pubmed/24861844. PubMed PMID: 24861844; PubMed Central PMCID: PMCPMC4204159.
  21. European Monitoring Center for Drugs and Drug Addiction (EMCDDA). Exploring methamphetamine trends in Europe. EMCDDA Papers Luxembourg: Publications Office of the European Union; 2014. 2014.
  22. Gamma A, Schleifer R, Weinmann W, Buadze A, Liebrenz M. Could Google trends be used to predict methamphetamine-related crime? An analysis of search volume data in Switzerland, Germany, and Austria. PLoS One. 2016;11(11):e0166566. doi: https://doi.org/10.1371/journal.pone.0166566. PubMed PMID: 27902717; PubMed Central PMCID: PMCPMC5130206.
  23. Been F, Bijlsma L, Benaglia L, Berset JD, Botero-Coy AM, Castiglioni S, et al. Assessing geographical differences in illicit drug consumption—A comparison of results from epidemiological and wastewater data in Germany and Switzerland. Drug Alcohol Depend. 2016 Apr;161:189–99. https://doi.org/10.1016/j.drugalcdep.2016.02.002
  24. Lynd LD, Richardson KJ, Purssell RA, Abu-Laban RB, Brubacher JR, Lepik KJ, et al. An evaluation of the osmole gap as a screening test for toxic alcohol poisoning. BMC Emerg Med. 2008;8:5. doi: https://doi.org/10.1186/1471-227X-8-5. PubMed PMID: 18442409; PubMed Central PMCID: PMCPMC2390580.
  25. Aderjan R, Daldrup T, Käferstein H, Krause D, Musshoff F, Paul LD. Richtlinien zur Bestimmung der Blutalkoholkonzentration (BAK) für forensische Zwecke der Deutschen Gesellschaft für Rechtsmedizin. Gesellschaft für Toxikologische und Forensische Chemie und Deutschen Gesellschaft für Verkehrsmedizin. 2011;48(3):137–43.
  26. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep;39(33):3021–104. https://doi.org/10.1093/eurheartj/ehy339
  27. Park SB, Khattar D. Tachypnea. StatPearls. Treasure Island (FL)2021.
  28. Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36(3):205–13. https://doi.org/10.3109/15563659809028940
  29. Alere TM. Triage® TOX Drug Screen Product Insert. Rapid qualitative simultaneous detection of drug and/or the major urinary metabolites of 10 different drug classes (11 unique assays). Available from: https://www.quidel.com/sites/default/files/2972E8590A6600494C.pdf. ed2016.
  30. Hendrickson RG, Cloutier R, McConnell KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med. 2008 Jan;15(1):23–31. https://doi.org/10.1111/j.1553-2712.2007.00006.x
  31. Liakoni E, Muller S, Stoller A, Ricklin M, Liechti ME, Exadaktylos AK. Presentations to an urban emergency department in Bern, Switzerland associated with acute recreational drug toxicity. Scand J Trauma Resusc Emerg Med. 2017;25(1):26. doi: https://doi.org/10.1186/s13049-017-0369-x. PubMed PMID: 28264690; PubMed Central PMCID: PMCPMC5340017.
  32. Swanson SM, Sise CB, Sise MJ, Sack DI, Holbrook TL, Paci GM. The scourge of methamphetamine: impact on a level I trauma center. J Trauma. 2007 Sep;63(3):531–7. https://doi.org/10.1097/TA.0b013e318074d3ac
  33. Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW. Methamphetamine abuse and emergency department utilization. West J Med. 1999;170(4):198-202. PubMed PMID: 10344172; PubMed Central PMCID: PMCPMC1305548.
  34. Mattson ME. Emergency department visits involving methamphetamine: 2007 to 2011. The CBHSQ report. 2013:1-7. PubMed PMID: 27606402; PubMed Central PMCID: PMCPMID27606402.
  35. Jones R, Woods C, Barker R, Usher K. Patterns and features of methamphetamine-related presentations to emergency departments in QLD from 2005 to 2017. Int J Ment Health Nurs. 2019 Aug;28(4):833–44. https://doi.org/10.1111/inm.12618
  36. Toles M, Jiang CS, Goebert D, Lettich L. Methamphetamine in emergency psychiatry. Addict Disord Their Treat. 2006;5(4):191–9. https://doi.org/10.1097/01.adt.0000210076.53993.05
  37. Pasic J, Russo JE, Ries RK, Roy-Byrne PP. Methamphetamine users in the psychiatric emergency services: a case-control study. Am J Drug Alcohol Abuse. 2007;33(5):675–86. https://doi.org/10.1080/00952990701522732
  38. Richards JR, Farias VF, Clingan CS. Association of leukocytosis with amphetamine and cocaine use. ScientificWorldJournal. 2014;2014:207651. doi: https://doi.org/10.1155/2014/207651. PubMed PMID: 24578625; PubMed Central PMCID: PMCPMC3919105.
  39. Swiss Guidelines Committee for Drugs of Abuse Testing (SCDAT). Richtlinien für Suchtstoffanalytik. 2021(Version EN). Epub 2021-03-25.
  40. Liakoni E, Yates C, Dines AM, Dargan PI, Heyerdahl F, Hovda KE, et al. Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series. Medicine (Baltimore). 2018;97(5):e9784. doi: https://doi.org/10.1097/MD.0000000000009784. PubMed PMID: 29384873; PubMed Central PMCID: PMCPMC5805445.
  41. Liakoni E, Dolder PC, Rentsch K, Liechti ME. Acute health problems due to recreational drug use in patients presenting to an urban emergency department in Switzerland. Swiss Med Wkly. 2015 Jul;145:w14166. https://doi.org/10.4414/smw.2015.14166
  42. Liakoni E, Dolder PC, Rentsch KM, Liechti ME. Presentations due to acute toxicity of psychoactive substances in an urban emergency department in Switzerland: a case series. BMC Pharmacol Toxicol. 2016;17(1):25. doi: https://doi.org/10.1186/s40360-016-0068-7. PubMed PMID: 27228985; PubMed Central PMCID: PMCPMC4882845.
  43. Bodmer M, Enzler F, Liakoni E, Bruggisser M, Liechti ME. Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series. BMC Res Notes. 2014;7:173. doi: https://doi.org/10.1186/1756-0500-7-173. PubMed PMID: 24666782; PubMed Central PMCID: PMCPMC3987164.
  44. European Monitoring Center for Drugs and Drug Addiction (EMCDDA). Wastewater analysis and drugs: a European multi-city study. Perspectives on Drugs 2020. 2020. doi: https://www.emcdda.europa.eu/publications/html/pods/waste-water-analysis_en
  45. Bruggisser M, Ceschi A, Bodmer M, Wilks MF, Kupferschmidt H, Liechti ME. Retrospective analysis of stimulant abuse cases reported to the Swiss Toxicological Information Centre during 1997-2009. Swiss Med Wkly. 2010 Oct;140:w13115. https://doi.org/10.4414/smw.2010.13115

Most read articles by the same author(s)