Objective: To compare demographic and clinical characteristics of methamphetamine users and patients with other toxicology‐related problems requiring medical intervention in a hospital emergency department (ED). Design and setting: Prospective observational study of toxicology‐related presentations to the ED of St Vincent's Hospital (SVH), Sydney, an inner‐city tertiary hospital, between 1 October and 31 December 2006. Main outcome measures: Differences between methamphetamine‐related and other toxicology‐related presentations to the ED in relation to behaviour, mode of arrival, accompaniment, need for scheduling, location of drug use, intravenous drug use history, psychiatric history and demographic characteristics. Results: During the study period there were 10 305 patient presentations to SVH ED; 449 (4%) were toxicology‐related presentations, of which 100 (1% of total) were methamphetamine‐related. Methamphetamine users were significantly more agitated, violent and aggressive than patients with other toxicology‐related presentations and significantly less alert, communicative and cooperative (P < 0.001); 24% of methamphetamine users (24/100) arrived with police accompaniment versus 9% of other toxicology patients (33/349) (P < 0.001). Methamphetamine users were more likely to have a history of intravenous drug use and mental health problems (P < 0.001); 39% of methamphetamine presentations (39/100) required scheduling under the Mental Health Act 1990 (NSW) compared with 19% of other toxicology‐related presentations (67/349) (P < 0.001); 43% of methamphetamine‐related presentations (43/100) involved drug use on the street compared with 24% of other toxicology‐related presentations (83/349) (P < 0.001). Two‐thirds of all methamphetamine users were male, and the most common age group for both male and female users was 26–30 years. The mean age and sex distribution of patients with other toxicology‐related presentations were not significantly different. Among methamphetamine users, 27% of women (9/33) were in the 21–25‐year age group compared with 10% (7/67) of men (P < 0.001). Conclusion: There were significant differences between methamphetamine‐related and other toxicology‐related presentations to SVH ED. Methamphetamine users were more aggressive, violent and dangerous, and thus more likely to pose a risk to health personnel and others. Methamphetamine appeared to be used consistently, rather than as an episodic “party drug”.

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