Swiss Med Wkly. 2015 Jul 28;145:w14166. doi: 10.4414/smw.2015.14166. eCollection 2015.

Acute health problems due to recreational drug use in patients presenting to an urban emergency department in Switzerland.

Liakoni E1, Dolder PC2, Rentsch K3, Liechti ME1.

• 1Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Switzerland.
• 2Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Switzerland / Laboratory Medicine, University Hospital Basel and University of Basel, Switzerland.
• 3Laboratory Medicine, University Hospital Basel and University of Basel, Switzerland.

QUESTIONS UNDER STUDY: To describe acute toxicity of recreational drugs including novel psychoactive substances.

METHODS: We included all cases presenting at the emergency department (ED) of the University Hospital of Basel, Switzerland, between October 2013 and September 2014 with acute toxicity due to self-reported recreational drug use or with symptoms/signs consistent with acute toxicity. Isolated ethanol intoxications were excluded. Intoxications were confirmed with immunoassays and liquid chromatography coupled with mass spectrometry (LC-MS/MS), which also detected novel psychoactive substances.

RESULTS:  Among the 47,767 attendances at the ED, 216 were directly related to acute toxicity of recreational drugs. The mean patient age was 31 years and 69% were male. Analytical drug confirmation was available in 180 cases. Most presentations were related to

• cocaine (36%),
• cannabis (31%),
• opioids (13%),
• 3,4-methylenedioxy-methamphetamine (MDMA, 9%),
• other amphetamines (7%),
• benzodiazepines (7%),
• and lysergic acid diethylamide (LSD, 5%).

The substances most commonly detected analytically were

• cannabis (37%),
• cocaine (33%),
• opioids (29%),
• benzodiazepines (21%), and
• amphetamines including MDMA (13%).

Notably, there were only two cases of novel psychoactive substances (2,5-dimethoxy-4-bromophenethylamine [2C-B] and pentylone). The most frequent symptoms were tachycardia (31%), anxiety (27%), nausea or vomiting (23%), and agitation (22%).

Severe complications included myocardial infarction (2), psychosis (10), seizures (10), and 1 fatality.

Most patients were discharged home (68%), 8% were admitted to intensive care and 9% were referred to psychiatric care.

CONCLUSION: Medical problems related to illicit drugs mostly concerned cocaine and cannabis and mainly involved sympathomimetic toxicity and/or psychiatric disorders. ED presentations associated with novel psychoactive substances appeared to be relatively rare.

PMID:  26218967