BackgroundMethamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL).MethodsWe retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series.ResultsA total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014–2018 case series, 94.9% were male with a median (range) age of 35.1 (16–67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care.ConclusionED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.

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BackgroundPrevious audits of antidote stocking in UK hospitals have demonstrated variable but improving compliance with joint Royal College of Emergency Medicine and National Poisons Information Service guidance on antidote availability in emergency departments. The guidance was updated in 2017.AimTo provide a current picture of compliance with the 2017 antidote guidance and compare this to previous audits.MethodsQuestionnaires were distributed to all hospitals in the UK with an emergency department via medicines information and regional pharmacy procurement networks. Data were collected on availability and stock levels of category A (immediately available) and category B (available within 1 hour) antidotes. Additionally, data were collected on holdings of category C (held supra-regionally) antidotes and arrangements for sourcing these if not stocked locally.Results233 hospitals were surveyed and 178 replies (76.4%) were received. There were 73 hospitals (41.7%) fully compliant with guidance for category A, 34 hospitals (19.1%) for category B and 18 hospitals (10.1%) for both categories A and B antidotes. Few hospitals stocked category C antidotes (1.1%–34.8%). Evidence of formalised regional holding arrangements for category C antidotes, as advised in the guidance, was noted in some areas but many regions remain without such agreements.ConclusionsMost hospitals remain not fully compliant with stocking recommendations for categories A and B antidotes, with limited recent improvement. Category C antidotes are stocked by few hospitals although awareness of where these can be sourced appears to be increasing. Emergency departments should review their antidote stocking arrangements to ensure compliance with guidance. Formal arrangements for stocking of the more rarely used category C antidotes at a regional level are also required, where not already in existence, in order to assure their availability in an equitable way across the country.

IntroductionC-reactive protein (CRP) is an established acute-phase marker for infection and inflammation, which can help guide clinical decision-making in primary and secondary care. Many European guidelines recommend point-of-care (POC) CRP testing to improve antimicrobial stewardship in primary care. This performance evaluation study assessed the equivalence of the quantitative POC LumiraDx CRP Test compared to a laboratory-based reference method.MethodsMethod comparison, matrix equivalency, and precision were evaluated. Plasma samples from secondary care patients presenting with symptoms of infection or inflammation were analyzed centrally using the LumiraDx CRP Test and the reference test (Siemens CRP Extended Range for Dimension® Clinical Chemistry System). The method comparison was conducted used Passing-Bablok regression analysis with prespecified criteria of r≥95 and a slope of 0.95–1.05. The REACT study (NCT05180110) evaluated the equivalence and precision of the testing modalities (fingerstick, venous blood, and plasma samples from the same secondary care patient) using Passing-Bablok regression analysis of the results of the POC LumiraDx CRP Test.ResultsIn analysis of 320 plasma samples from 110 patients, the POC LumiraDx CRP Test demonstrated close agreement with the reference method, meeting the prespecified performance criteria (r=0.99, slope of 1.05, N=110). Paired replicate precision of the testing modalities was high, with mean %CV of 6.4 (plasma), 6.6 (capillary direct), and 8.1 (venous blood). Passing-Bablok regression showed matrix equivalency for all replicate pairs of the testing modalities, with r values across all sample types of 0.97–0.98.ConclusionThe quantitative POC LumiraDx CRP Test showed very close agreement with the established laboratory-based test when using capillary blood, venous blood, or plasma. The use of capillary blood testing in particular is beneficial in both primary and secondary care, with this portable test system providing rapid quantitative results within 4 minutes, potentiating the ability to help guide clinical decision-making.Data from two study collections, the NOVEL study and the REACT study with a trial registration: ClinicalTrials.gov identifier, NCT05180110, were used in this performance evaluation.Key summary pointsC-reactive protein (CRP) measurements are clinical markers for infection and inflammation, commonly used in primary and secondary carePoint-of-care (POC) CRP testing can assist primary care clinicians in making an immediate decision as to whether to prescribe antibiotics while the patient is still at the clinicPOC CRP testing that provides quantitative results near to the patient can be useful in emergency care assessment of patients and in hospital monitoring of antibiotic therapyThe POC LumiraDx CRP Test has demonstrated quantitative results comparable to those obtained using a recognized laboratory system using plasmaThe POC LumiraDx CRP Test has also demonstrated matrix equivalence of capillary blood (both direct application and transfer tube), venous blood, and plasma