Vol. 140 No. 4344 (2010)
Retrospective analysis of stimulant abuse cases reported to the Swiss Toxicological Information Centre during 1997–2009
- M Bruggisser
- M Bodmer
- MF Wilks
- H Kupferschmidt
- M Liechti
STUDY AIM: To describe characteristics of stimulant abuse and toxicity.
METHOD: We conducted a retrospective analysis of cases of exposure to cocaine, amphetamines (amphetamine, methamphetamine, and 3,4-methylenedioxymethamphetamine [MDMA]) and methylphenidate reported to the Swiss Toxicological Information Centre between 1997 and 2009.
RESULTS: There were 667 reports for cocaine, 147 for amphetamine, 41 for methamphetamine, 433 for MDMA, and 122 for methylphenidate. Detailed outcome data were available in 546 (39%) of all reported cases. Exposure to amphetamine or MDMA commonly resulted in mild to moderate toxicity, but severe toxicity was seen in approximately 15% of reported cocaine and MDMA exposures with a known medical outcome. Frequently observed clinical signs and symptoms included tachycardia, arterial hypertension, nausea, agitation, and panic. Amphetamine and MDMA exposures were seen in a younger population and were mainly reported at weekends, while cocaine users were older and exposures occurred proportionally more frequently on weekdays. Parenteral drug use and co-use of heroin was more frequent in cocaine users than in those using other stimulants.There has been an increase in reports of non-medical use of methylphenidate in recent years, indicating a need for further studies of abuse of prescription stimulants.
- McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction. 2005;100:96–106.
- Kroutil LA, Van Brunt DL, Herman-Stahl MA, Heller DC, Bray RM, Penne MA. Nonmedical use of prescription stimulants in the United States. Drug Alcohol Depend. 2006;84:135–43.
- McKetin R, Kozel N, Douglas J, Ali R, Vicknasingam B, Lund J, et al. The rise of methamphetamine in Southeast and East Asia. Drug Alcohol Rev. 2008;27:220–8.
- Setlik J, Bond GR, Ho M. Adolescent Prescription ADHD Medication Abuse Is Rising Along With Prescriptions for These Medications. Pediatrics. 2009;124:875–80.
- Maxwell JC, Rutkowski BA. The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992–2007. Drug Alcohol Rev. 2008;27:229–35.
- Degenhardt L, Roxburgh A, Black E, Bruno R, Campbell G, Kinner S, et al. The epidemiology of methamphetamine use and harm in Australia. Drug Alcohol Rev. 2008;27:243–52.
- Prinzleve M, Haasen C, Zurhold H, Matali JL, Bruguera E, Gerevich J, et al. Cocaine use in Europe – a multi-centre study: patterns of use in different groups. Eur Addict Res. 2004;10:147–55.
- Andersson B, Hibell B, Beck F, Choquet M, Kokkevi A, Fotiou A, et al. Alcohol and Drug Use Among European 17–18 Year Old Students: Data from the ESPAD Project. Stockholm, Sweden: Swedish Council for Information on Alcohol and Other Drugs (CAN), The Pompidou Group at the Council of Europe and the authors, 2007.
- SFA. Schweizerische Fachstelle für Alkohol- und andere Drogenprobleme. Berechnungen auf Basis der Schweizerischen Gesundheitsbefragung 2007. Available from http://www.sfa-ispa.ch/ 2009.
- McCabe SE, Boyd CJ, Teter CJ. Subtypes of nonmedical prescription drug misuse. Drug Alcohol Depend. 2009;102:63–70.
- Michaud PA, Berchtold A, Jeannin A, Chossis I, Suris JC. Secular trends in legal and illegal substance use among 16 to 20 year old adolescents in Switzerland. Swiss Med Wkly. 2006;136:318–26.
- Liechti ME, Kunz I, Kupferschmidt H. Acute medical problems due to Ecstasy use. Case-series of emergency department visits. Swiss Med Wkly. 2005;135:652–7.
- Gray SD, Fatovich DM, McCoubrie DL, Daly FF. Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation. Med J Aust. 2007;186:336–9.
- Brody SL, Slovis CM, Wrenn KD. Cocaine-related medical problems: consecutive series of 233 patients. Am J Med. 1990;88:325–31.
- Williams H, Dratcu L, Taylor R, Roberts M, Oyefeso A. “Saturday night fever”: ecstasy related problems in a London accident and emergency department. J Accid Emerg Med. 1998;15:322–6.
- Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW. Methamphetamine abuse and emergency department utilization. West J Med. 1999;170:198–202.
- Cregg MT, Tracey JA. Ecstasy abuse in Ireland. Ir Med J. 1993;86:118–20.
- Guirguis M, Gossweiler B, Kupferschmidt H, Lorent JP, Rauber C, Meier PJ. TOXI – A multifunctional system for poisons information and clinical toxicological data evaluation. J Toxicol Clin Toxicol. 1999;37:405.
- Liechti ME, Kupferschmidt H. Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL): analysis of overdose cases reported to the Swiss Toxicological Information Centre. Swiss Med Wkly. 2004;134:534–7.
- Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998;36:205–13.
- Hintze J. NCSS and PASS statistical & power analysis software. Kaysville, Utah, USA, 2004.
- Liechti ME, Kunz I, Greminger P, Speich R, Kupferschmidt H. Clinical features of gamma-hydroxybutyrate and gamma-butyrolactone toxicity and concomitant drug and alcohol use. Drug Alcohol Depend. 2006;81:323–6.
- Livio F, Rauber-Lüthy C, Biollaz J, Holzer L, Winterfeld U, Buclin T. Methylphénidate et abus. Pediatrica. 2009;20:41–4.
- Schaub M, Quinteros-Hungerbühler I. Lokale Trendstudie. Zurich: Institut für Sucht- und Gesundheitsforschung Zürich (ISGF), 2010.
- Kostka R, Monego R, Rüegg S, Suter D, Zeltner C. Monitoringbericht Drogen und Sucht 2010. Zurich, Switzerland: Stadt Zürich, 2010.
- Klein-Schwartz W, McGrath J. Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry. 2003;42:288–94.
- Bright MG. Abuse of medications employed for the treatment of ADHD: results from a lage-scale community survey. Medscape J Med. 2008;10:111.
- Wilens TE, Gignac M, Swezey A, Monuteaux MC, Biederman J. Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. J Am Acad Child Adolesc Psychiatry. 2006;45:408–14.
- Forsling M, Fallon JK, Kicman AT, Hutt AJ, Cowan DA, Henry JA. Arginine vasopressin release in response to the administration of 3,4-methylenedioxymethamphetamine (“ecstasy”): is metabolism a contributory factor? J Pharm Pharmacol. 2001;53:1357–63.
- Liechti ME. “Ecstasy” (MDMA): pharmacology, toxicology, and treatment of acute intoxication. Dtsch Med Wochenschr. 2003;128:1361–6.
- Rosenson J, Smollin C, Sporer KA, Blanc P, Olson KR. Patterns of ecstasy-associated hyponatremia in California. Ann Emerg Med. 2007;49:164–71, 71 e1.
- Dughiero G, Schifano F, Forza G. Personality dimensions and psychopathological profiles of Ecstasy users. Hum Psychopharmacol. 2001;16:635–9.
- Hoffman RS. Understanding the limitations of retrospective analyses of poison center data. Clin Toxicol. (Phila) 2007;45:943–5.