A prospective observational study of emergency department presentations following novel psychoactive substance use

2018 ◽  
Vol 63 (2) ◽  
pp. 39-44 ◽  
Author(s):  
David E Henshall ◽  
Callum WD Innes ◽  
Scott R Morrison ◽  
Blair Wilson ◽  
Ryan A Brown ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Illicit Drugs ◽  
Behavioural Change ◽  
Population Characteristics ◽  
Novel Psychoactive Substances ◽  
Psychoactive Substances ◽  
Unique Challenge ◽  
Patient Demographics ◽  
History Of

Background and aims Novel psychoactive substances are compounds intended to mimic the effects of illicit drugs. They provide a unique challenge to healthcare, as complications of their use and their impact on services are relatively unknown. This study aims to determine nature of presentations, patient demographics and impact on healthcare. Methods Novel psychoactive substances users who presented to a large urban emergency department over 4 weeks were prospectively identified and followed for 1 year. Patients over 13 years old were eligible for inclusion. Information regarding patient demographics and presentations was collected. Results During the study period, 53 patients (39 male), mean age 32.6 ± 8.9 (±standard deviation), presented 148 times with complaints relating to novel psychoactive substances use. Study population characteristics included history of illicit drug use (83.0%), intravenous drug use (64.2%), psychiatric diagnosis or symptoms (56.6%), methadone prescription (52.8%) and having no fixed abode (37.7%). Injection was the most common method of use (72.3%), Burst the most commonly named agent (19.6%) and behavioural change the most common presenting complaint (31.1%). Patients collectively spent 10,620 h in hospital over 1 year. Conclusion This study highlights differences between the young population targeted by government campaigns regarding novel psychoactive substances use and the presenting population to hospital, and the associated burden on the National Health Service.

scholarly journals Substance Use in the Club Scene of Rome: A Pilot Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Alessandro Emiliano Vento ◽  
Giovanni Martinotti ◽  
Eduardo Cinosi ◽  
Matteo Lupi ◽  
Tiziano Acciavatti ◽  
...  
Keyword(s):  
Substance Use ◽  
Illicit Drugs ◽  
Significant Proportion ◽  
Novel Psychoactive Substances ◽  
Psychoactive Substances ◽  
Smart Drugs ◽  
History Of ◽  
Public Health Challenge ◽  
Self Administered Questionnaire ◽  
Very High

Objective. Over the last few years, a wide number of unregulated substances have been marketed on the Web and in smart and head shops; they are usually advertised as legal alternatives to commonly known drugs and are defined as “smart drugs,” “legal highs,” and “novel psychoactive substances” (NPS). Aim of our work is to describe use habits and distribution of NPS in a population of young adults in Rome club scene.Methods. A self-administered questionnaire was proposed to subjects over 18 years of age at the entrance of 5 nightclubs in Rome. Socioeconomic characteristics and substance use were investigated.Results. Preliminary results give evidence that 78% of respondents have a lifetime history of NPS use. In addition, 56% of the sample has consumed illicit drugs in the past and 39% has used psychoactive substances in the 12 hours preceding the questionnaire administration.Conclusions. A significant proportion of subjects report use of novel psychoactive substances; traditional illicit drugs consumption, particularly cocaine, appears to be very high as well in the club scene. These data highlight a serious public health challenge, since pharmacological, toxicological, and psychopathological effects linked to interactions among all these substances may be unpredictable and sometimes fatal in vulnerable individuals.

scholarly journals Forensic Analysis of Illicit Drugs and Novel Psychoactive Substances in Wastewater: A review of Toxicological, Chemical and Microbiological Aspects

2021 ◽  
Author(s):  
Eduardo Campos ◽  
Elaine De Martinis ◽  
Bruno De Martinis
Keyword(s):  
Drug Use ◽  
Illicit Drugs ◽  
Drugs Of Abuse ◽  
Treatment Plant ◽  
Forensic Analysis ◽  
Novel Psychoactive Substances ◽  
Psychoactive Substances ◽  
Main Concept ◽  
Analytical Strategy ◽  
Microbiological Aspects

Wastewater-based epidemiology has emerged as a new analytical strategy for monitoring licit and illicit drug use in a population by measuring the levels of biomarkers in wastewater. The main concept of this approach is that chemical substances ingested by the population will be excreted in urine and feces, which will be discarded into the sewage network and may accumulate at the wastewater treatment plant. Several licit and illicit substances such as ethanol, nicotine, cocaine, amphetamine, methamphetamine and morphine have been investigated and reported in wastewater in worldwide. In recent years, this approach has also been explored for environmental monitoring of novel psychoactive substances (NPS) as well, since analyses of wastewater represent a fast and cost-effective way to evaluate collectively drug intake in a given population served by a sewage network. In this paper, a comprehensive and interdisciplinary review of the forensic, toxicological, chemical and microbiological aspects of the analysis of “traditional” drugs of abuse and NPS in wastewater and examples of applications reported in recently published papers is provided. Wastewater analysis is a very promising strategy in monitoring drug use in the context of Forensic Chemistry and Toxicology, and has been implemented by many researchers in the analysis of drugs of abuse, as supported by many recent literature reports.

Novel psychoactive substances in a psychiatric young adults sample: A multicenter, observational study

2017 ◽  
Vol 41 (S1) ◽  
pp. S311-S311
Author(s):  
M. Lupi ◽  
T. Acciavatti ◽  
S. Marini ◽  
E. Cinosi ◽  
R. Santacroce ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Binge Drinking ◽  
Illicit Drugs ◽  
Synthetic Cannabinoids ◽  
Clinical Effects ◽  
Novel Psychoactive Substances ◽  
Psychoactive Substances ◽  
Multicenter Observational Study ◽  
Compulsive Disorder ◽  
Psychiatric Population

IntroductionComorbidities between psychiatric diseases and consumption of traditional substances of abuse are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population.ObjectivesThe purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample.MethodsBetween September 2013 and November 2015, a questionnaire has been administered, in ten Italian psychiatric care facilities, to a sample of 671 psychiatric patients (48.5% men; 51.5% women), aged between 18 and 26 years (mean age: 22.24).Results8.2% of the sample declared use of NPS at least once in a lifetime and 2.2% have assumed NPS in the last three months. The NPS more used were synthetic cannabinoids (4.5%), followed by methamphetamine (3.6%). The three psychiatric diagnosis with more frequent NPS consumption were bipolar disorder (23.1%), personality disorders (11.8%) and schizophrenia and related disorders (11.6%). Bipolar disorder was associated with NPS consumption (P < .001). Among the illicit drugs investigated, 31.4% of the sample was cannabis smoker and 10.7% cocaine user. Moreover, 70.6% of the sample declared alcohol use and 47.7% had binge drinking conducts. In univariate regression analysis, bipolar disorder was positive associated with binge drinking while obsessive compulsive disorder resulted negative associated.ConclusionsThe use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Bipolar disorder shows an association with NPS use. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals “Hot” and “Cold” Cognition in Users of Club Drugs/Novel Psychoactive Substances

2021 ◽  
Vol 12 ◽  
Author(s):  
George Savulich ◽  
Owen Bowden-Jones ◽  
Robert Stephenson ◽  
Annette B. Brühl ◽  
Karen D. Ersche ◽  
...  
Keyword(s):  
Cognitive Processes ◽  
Sensation Seeking ◽  
Illicit Drugs ◽  
Neuropsychological Functioning ◽  
Neuropsychological Test ◽  
Childhood Adversity ◽  
Self Control ◽  
Novel Psychoactive Substances ◽  
Club Drugs ◽  
Psychoactive Substances

Novel psychoactive substances (NPS) are popular “club/party” drugs that first attracted attention in the UK in 2009 and remained legal until the 2016 Psychoactive Substances Act criminalized their distribution. Unlike “traditional” illicit drugs, very little is known about the influence of their analogs on neuropsychological functioning. We characterized the cognitive and emotional profile of NPS/polydrug users using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and EMOTICOM test battery in adult male (aged 20–49 years) recreational users without psychiatric comorbidities (n = 27; “psychonauts”), service users attending a UK specialist “Club Drug” Clinic for problematic use (n = 20) and healthy control volunteers without significant drug-taking histories (n = 35). Tasks were selected to distinguish “hot” cognitive processes that are highly influenced by emotion from “cold” cognitive processes that are largely independent of emotional influence. Both user groups reported significantly higher sensation-seeking traits compared with non-users. Recreational NPS users demonstrated more risk-taking behavior compared with controls and treatment-seeking NPS users showed poorer learning, episodic memory and response inhibition compared with the other two groups. These effects persisted, when controlling for age, intelligence, alcohol and cannabis use severity, nicotine dependence, trait anxiety, depression, childhood adversity, impulsivity, and sensation seeking. Overall, recreational NPS users showed elevated “hot” (emotion-laden) cognition in the absence of “cold” (non-emotional) cognitive deficits, whereas “cold” cognitive dysfunction was pronounced in individuals seeking treatment for problematic NPS use. High trait impulsivity and poor self-control may confer additional risk to NPS/polydrug use severity and separate those seeking treatment from those using NPS recreationally.

scholarly journals Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Kelsey Ragan ◽  
Anjali Pandya ◽  
Tristan Holotnak ◽  
Katrina Koger ◽  
Neil Collins ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
High Risk ◽  
Drug Use ◽  
Hcv Rna ◽  
High Risk Patients ◽  
Risk Patients ◽  
History Of ◽  
Hcv Screening

Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods. A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9–7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.

Psycho-Oncology: Cancer patients with past suicide attempts, or a family history of suicide.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23173-e23173
Author(s):  
Daniela Gercovich ◽  
Ernesto Gil Deza ◽  
Flavio Tognelli ◽  
Carlos Fernando Garcia Gerardi ◽  
Claudia Lorena Acuna ◽  
...  
Keyword(s):  
Family History ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Illicit Drugs ◽  
Suicide Attempts ◽  
The United States ◽  
Population Characteristics ◽  
History Of ◽  
Psychological Risk

e23173 Background: “The suicide rate in cancer patients is twice that observed in the general population in the United States” (JNCI vol 100, 24, page 1750, 2008). This paper focuses ona population with great psychological risk: cancer patients (Pt) with previous suicide attempts (SA) or a family history of suicide (FS); both grouped under SAFS for the purpose of this study. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions. The database was locked and anonymized. Those with a history of SAFS before cancer diagnosis were selected. Results: Out of 15,617 Pt, 184 Pt (1.2%) were SAFS(141 Pt were SA, 39 Pt were FS and 4 Pt were both). The relative risk ofSA was ten times larger for those with FS. Psychiatric Medication: Antipsychotics: 15Pt (8%), Antidepressants: 23 Pt (12%) and Benzodiazepines 45 Pt(24%), No treatment 101 Pt (55%). Population Characteristics: Sex: F:144 Pt . M: 40 Pt. Age: 56y (r = 26-88). Tumor Dx: Breast (65 Pt ) - Gastrointestinal (24 Pt) - Urological (21 Pt ) - Lung (21 Pt ) -Gynecological (19 Pt) - Hematological (11 Pt) -Head &Neck (8 Pt) - Endocrine (7 Pt) - Other (8 Pt). Stages: Early (0-I-II-III): 130 Pt, Advanced: 54 Pt. Ob-Gyn history:25 Pt (17%) nulliparous, 18 Pt (12%) with one child, 77 Pt (53%) with 2 or 3 children and 24 Pt (17%) with more than 3 children; 62 Pt (43%) had previous abortions. Average severe comorbidities (respiratory and psychiatric) was 3 per Pt (r = 0-18). Toxic habits: Smoking: 120 Pt (65%), Alcohol: 37 Pt (20%) and Illicit Drugs: 4 Pt (2%). Follow-up: 19 months (r = 0-70). No Pt had any SA, or commited suicide, during the follow-up.Living patients:177 (96%). Conclusions: 1) In our vast cohort, 184 Pt (1.2%) were identified as highly vulnerable psychiatric Pt due to SAFS. 2) Given the high psychological risk and stressful cancer diagnosis, 83 Pt (45%) were prescribed psychiatric drugs. 3) Follow-up of SAFS Pt by a multidisciplinary team is requiredfor adequate Pt and family support.

scholarly journals Substance Use Disorder in the Emergency Department:  Approaches to Estimating Prevalence

2019 ◽  
Author(s):  
Brittany Punches ◽  
Kimberly W. Hart ◽  
Christopher J Lindsell ◽  
Raul Mandler ◽  
Katia Delrahim-Howlett ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Drug Use ◽  
Substance Use Disorder ◽  
Chart Review ◽  
Population Based ◽  
Population Characteristics ◽  
Self Report ◽  
Cross Sectional ◽  
Pragmatic Clinical Trials

Abstract Background: Understanding the prevalence of substance use disorder (SUD) in emergency department (ED) settings could facilitate prevention and treatment responses to the epidemic. However, little information is available on the true prevalence of SUD in the ED population. We characterized 1) methods for determining the prevalence of substance use and SUDs within an ED, and 2) the degree to which prevalence differs between geographically proximate EDs. Methods: This cross-sectional, multi-hospital study analyzed data from prior studies and electronic health records (EHR). Our data sources included 1) interviews of a population-based sample of ED patients, 2) chart review for a cohort of ED patients, and 3) ICD-9 codes from an urban, academic trauma center. In addition, ICD-9 codes were obtained for three geographically proximate hospitals of differing type. The sampling methods and ED settings were compared descriptively in terms of their population characteristics and estimated prevalence of SUDs. Results: Prevalence of SUDs at the urban academic center was extremely high, particularly when measured by prospective survey, but also with chart review. Use over the prior year (binge drinking, illicit drug use, or treatment for alcohol or drug use) as determined by self-report and chart review respectively was: 41.9% and 15.2% for alcohol, 36.2% and 21.6% for drugs, and 59.2% and 30.4% for either. Estimates using ICD-9 codes indicated a far lower prevalence of substance use and suggest differences between EDs. Conclusions: SUDs are highly prevalent in ED populations, though significant variability between EDs is likely. SUDs are infrequently coded, suggesting that clinicians may be unaware of SUDs, or that discharge coding is insufficient to understand and respond to SUDs. Feasible and efficacious methods of identification and documentation of SUDs is an urgent priority to aid efforts to facilitate health services planning and quality improvement, and enable pragmatic clinical trials.

scholarly journals Snapshot of narcotic drugs and psychoactive substances in Kuwait: a qualitative analysis of illicit drugs and their associated mortality in Kuwait from 2015 to 2018

2020 ◽  
Author(s):  
Abdullah Al-Matrouk ◽  
Mohammed Al-Hasan ◽  
Neamat Al-Abkal ◽  
Hanan Mohammed ◽  
Meshaal Haider ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Mortality Rate ◽  
Drug Use ◽  
Illicit Drugs ◽  
Drug Misuse ◽  
Health Concern ◽  
Psychoactive Substances ◽  
Gulf Region ◽  
Chromatography Mass Spectrometry ◽  
Narcotic Drugs

Abstract Background The misuse of illicit substances is associated with increased morbidity and mortality; thus, substance abuse is a global health concern. However, a lack of laboratory-based research has limited the scientific assessment of drug misuse in the Arabian Gulf region. Thus, the primary aim of this study was to assess the problem of illicit drugs in Kuwait using laboratory-based analyses. Methods We investigated the type and quantity of detained narcotic drugs and psychotropic substances from 2015 to 2018, number of abusers, and mortality among abusers. In total, 6220 cases from the Narcotic and Psychotropic Laboratory and 17,755 cases from the Forensic Toxicology Laboratory were reviewed and analyzed. Substances were identified and documented using gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry. Results Cannabis, including marijuana, was the most seized substance, followed by heroin, opium, and cocaine. Amphetamines, including methamphetamine, in the form of powder or pills, were seized in larger quantities than other psychoactive substances. Benzodiazepines, tramadol, Khat, synthetic cannabinoids, and psilocin were also seized. The most consumed substances were, in order, amphetamines (including methamphetamine), benzodiazepines, cannabis, and heroin. Drug misuse was considerably higher among men than among women. We report the death rate associated with the abuse of various illegal drugs according to sex. The mortality rate associated with single-drug use was the highest among abusers of heroin, benzodiazepines, and methamphetamine. The mortality rate asscoaited with multiple-drug use was the highest among abusers of heroin–benzodiazepines, cannabis–benzodiazepines, and cannabis–amphetamines. Conclusions Our study shows the changing trends in quantity and variety of substances illegally abused and marketed in Kuwait. Additionally, we report a direct gender-based association between mortality and consumption of certain substances. These findings suggest that there is a growing need to conduct larger scale studies to implement new strategies, policies, and interventions in populations affected by illicit drugs.

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