Emergency department presentations related to abuse of prescription and over-the-counter drugs in Switzerland: time trends, sex and age distributions
AIMS OF THE STUDY
To analyse emergency department (ED) presentations related to acute medical problems after recreational use of prescription/over-the-counter (OTC) drugs in two major Swiss hospitals in order to identify the prevalence of specific drugs, vulnerable groups, time trends and local differences which could have major public health implications.
Retrospective analysis of cases presenting with signs/symptoms consistent with acute toxicity due to recreational use of prescription/OTC drugs from May 2012 to August 2017 at the ED of the University Hospital of Bern and from October 2013 to July 2017 at the ED of the University Hospital Basel. We investigated time trends, sex differences, patient characteristics and consumption patterns within three age groups (≥16 to <36 years; ≥36 to <56 years; ≥56 years).
During the study period, 344 cases were included out of 1715 ED attendances due to acute drug toxicity and a total of 412,557 ED presentations. The use of prescription drugs in conjunction with illegal drugs was reported in nearly half the cases. The most frequently reported prescription drugs were benzodiazepines (64%, n = 220) and methadone (13%, n = 45). Forty-eight percent (n = 166) of all presentations occurred within the youngest age group. The analysis of time trends showed a significant increase in presentations in the youngest and the oldest groups in Basel (both p <0.05), while the trend remained stable over time in Bern for all age groups. While the number of presentations remained constant over time for men and women in Bern, a significant increase was found for the female cohort in Basel (p <0.05). Patients in all age groups presented with toxicities of predominantly minor severity.
The prescription/OTC drugs most frequently leading to ED presentations after recreational use were sedative substances. A large proportion of the patients belonged to the youngest age group. A significant increase in presentations was seen in the youngest and oldest age groups and within women in Basel. This information can be used to inform health care providers so that they can adapt their prevention and treatment strategies in their communities.
- European Drug Report 2018. Trends and Developments 2018; Available from: http://www.emcdda.europa.eu/edr2018_en.
- European Monitoring Centre for Drugs and Drug Abuse. Data Tables. 2015. http://www.emcdda.europa.eu/stats13#display:/stats13/gpstab1c, in emcdda.
- World Drug Report Global overview of drug demand and supply. 2017; Available from: https://www.unodc.org/wdr2017/field/Booklet_2_HEALTH.pdf.
- Mena G, Giraudon I, Álvarez E, Corkery JM, Matias J, Grasaasen K, et al. Cocaine-related health emergencies in Europe: a review of sources of information, trends and implications for service development. Eur Addict Res. 2013;19(2):74–81. doi:.https://doi.org/10.1159/000341719
- Monitoring the future national results on drug use: key findings on adolescent drug use. 2013; Available from: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/142406/Overview%202017%20FINAL.pdf?sequence=1&isAllowed=y.
- Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM ; Centers for Disease Control and Prevention (CDC). Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013. MMWR Surveill Summ. 2015;64(SS09):1–14. doi:.https://doi.org/10.15585/mmwr.ss6409a1
- Heyerdahl F, Hovda KE, Giraudon I, Yates C, Dines AM, Sedefov R, et al. Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations. Clin Toxicol (Phila). 2014;52(10):1005–12. doi:.https://doi.org/10.3109/15563650.2014.976792
- Wood DM, Heyerdahl F, Yates CB, Dines AM, Giraudon I, Hovda KE, et al. The European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila). 2014;52(4):239–41. doi:.https://doi.org/10.3109/15563650.2014.898771
- Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, et al.; Euro-DEN Research Group. Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN). Clin Toxicol (Phila). 2015;53(9):893–900. doi:.https://doi.org/10.3109/15563650.2015.1088157
- Liakoni E, Müller 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
- 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;145:w14166. doi:.https://doi.org/10.4414/smw.2015.14166
- 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
- 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. doi:.https://doi.org/10.3109/15563659809028940
- 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). 2013; Available from: http://www.alere.com/en/home/product-details/triage-tox-drug-screen-au.html.
- Mueller DM, Rentsch KM. Online extraction toxicological MS(n) screening system for serum and heparinized plasma and comparison of screening results between plasma and urine in the context of clinical data. J Chromatogr B Analyt Technol Biomed Life Sci. 2012;883-884:189–97. doi:.https://doi.org/10.1016/j.jchromb.2011.08.022
- R Core Team (2013). R Foundation for Statistical Computing, Vienna, Austria; Available from: http://www.R-project.org/.
- Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. Eur Addict Res. 2012;18(5):228–45. doi:.https://doi.org/10.1159/000337028
- Kapil V, Green JL, Le Lait C, Wood DM, Dargan PI. Misuse of benzodiazepines and Z-drugs in the UK. Br J Psychiatry. 2014;205(5):407–8. doi:.https://doi.org/10.1192/bjp.bp.114.149252
- Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36(1):559–74. doi:.https://doi.org/10.1146/annurev-publhealth-031914-122957
- McCabe SE, Cranford JA, Boyd CJ, Teter CJ. Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addict Behav. 2007;32(3):562–75. doi:.https://doi.org/10.1016/j.addbeh.2006.05.022
- Lakhan SE, Kirchgessner A. Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav. 2012;2(5):661–77. doi:.https://doi.org/10.1002/brb3.78
- Hall KM, Irwin MM, Bowman KA, Frankenberger W, Jewett DC. Illicit use of prescribed stimulant medication among college students. J Am Coll Health. 2005;53(4):167–74. doi:.https://doi.org/10.3200/JACH.53.4.167-174
- Liakoni E, Schaub MP, Maier LJ, Glauser GV, Liechti ME. The Use of Prescription Drugs, Recreational Drugs, and “Soft Enhancers” for Cognitive Enhancement among Swiss Secondary School Students. PLoS One. 2015;10(10):e0141289. doi:.https://doi.org/10.1371/journal.pone.0141289
- Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: National Findings, in Rockville, MD: 2008. Office of Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-4343(Table B-8).
- Volkow ND. Teen prescription drug abuse a major health concern. Tenn Med. 2009;102(4):28–9.
- Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006;4(4):380–94. doi:.https://doi.org/10.1016/j.amjopharm.2006.10.002
- Back SE, Payne RA, Waldrop AE, Smith A, Reeves S, Brady KT. Prescription opioid aberrant behaviors: a pilot study of sex differences. Clin J Pain. 2009;25(6):477–84. doi:.https://doi.org/10.1097/AJP.0b013e31819c2c2f