Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series.

Authors:
Evangelia Liakoni
Evangelia Liakoni
University Hospital Basel
Switzerland
Christopher Yates
Christopher Yates
Royal Melbourne Hospital
Australia
Alison M Dines
Alison M Dines
Clinical Toxicology
Paul I Dargan
Paul I Dargan
Clinical Toxicology
United Kingdom
Fridtjof Heyerdahl
Fridtjof Heyerdahl
Ullevaal University Hospital
Norway
Knut Erik Hovda
Knut Erik Hovda
Ullevaal University Hospital
Norway
David M Wood
David M Wood
University of London
United Kingdom
Florian Eyer
Florian Eyer
Technische Universität München

Medicine (Baltimore) 2018 02;97(5):e9784

Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland.

The aim of the study was to compare self-reported and analytically confirmed substance use in cases of acute recreational drug toxicity.We performed a retrospective analysis of emergency department presentations of acute recreational drug toxicity over 2 years (October 2013 to September 2015) within the European Drug Emergencies Network Plus project.Among the 10,956 cases of acute recreational drug toxicity during the study period, 831 could be included. Between the self-reported substance use and the toxicological results, the highest agreement was found for heroin (86.1%) and cocaine (74.1%), whereas inhalants, poppers, and magic mushrooms were self-reported but not analytically detected. Cathinones and other new psychoactive substances (NPS) could be detected using additional analytical methods. Among cases with both immunoassay (IA) and confirmation with mass spectrometry (MS), the results were consistent for methadone (100%) and cocaine (95.5%) and less consistent for amphetamines (81.8%). In cases with a positive IA for amphetamines (n = 54), MS confirmed the presence of 3,4-methylenedioxymethamphetamine (MDMA), amphetamine, methamphetamine, and NPS in 37, 20, 10, and 6 cases, respectively, also revealing use of more than 1 substance in some cases. MS yielded positive results in 21 cases with a negative IA for amphetamines, including amphetamine, MDMA, methamphetamine, and NPS, in 14, 7, 2, and 2 cases, respectively.In conclusion, the highest agreement was found between self-reports and analytical findings for heroin and cocaine. The diagnosis of NPS use was mainly based on self-report. The IAs accurately identified methadone and cocaine, and MS had advantages for the detection of NPS and amphetamine derivatives.

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Source
http://dx.doi.org/10.1097/MD.0000000000009784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805445PMC
February 2018
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