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

Henshall, David; Innes, Callum Wd; Morrison, Scott; Wilson, Blair; Brown, Ryan Andrew; McAllister, Shannon M; Culshaw, Seamus L; Reda, Elaina

doi:10.1177/0036933018760761

Cited by 5 publications

(8 citation statements)

References 10 publications

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“…Since there may well be further information available on both the deep web and the dark net, future studies of our group will be focussing on expanding drug searches on these less accessible areas of the web. NPS.Finder‐based studies will need to focus as well on further languages, which should include: Chinese, Japanese and Arabic, since previous studies have highlighted their importance in NPS‐based studies . Furthermore, from a formal point of view the current literature review would not be considered as systematic.…”

Section: Discussionmentioning

confidence: 99%

“…NPS.Finder-based studies will need to focus as well on further languages, which should include: Chinese, Japanese and Arabic, since previous studies have highlighted their importance in NPS-based studies. 98 Furthermore, from a formal point of view the current literature review would not be considered as systematic. Instead, it was conceived as a literature overview, focussing on the cathinone clinical issues of interest.…”

Section: Limitationsmentioning

confidence: 99%

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The clinical challenges of synthetic cathinones

Schifano

Napoletano

Arillotta

et al. 2020

Brit J Clinical Pharma

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Aims Within the new psychoactive substances (NPS) scenario, several hundred different molecules, mostly including synthetic cannabinoids and cathinones, have been identified so far. The aims of the paper were to: (i) identify the number of synthetic cathinones mentioned in a range of psychonaut, NPS‐related, online sources; and (ii) describe the associated acute/long term clinical scenario and the related treatment/management plan. Methods After about 18 months of operation and exclusion of false positives/duplicates, some 4204 unique NPS molecules were included in the NPSfinder® crawling/navigating software database. Most popular NPS included: 1265 psychedelic phenethylamines (30.1%; confidence interval [CI] 95%: 28.7–31.5%); 1253 synthetic cannabinoids (29.8%; CI 95%: 28.4–31.2%); 429 synthetic opioids (10.2%; CI 95%: 9.3–10.2%); and 171 synthetic cathinones (4.1%; CI 95% 3.5–4.7%). Conversely, the United Nations Office on Drugs and Crime and the European Monitoring Centre for Drugs and Drug Addiction databases respectively included 169 and 140 cathinones. Overall, the 3 databases reported some 222 synthetic cathinones, and 41 were uniquely identified by the NPSfinder®. Results In terms of clinical scenarios, synthetic cathinone ingestion is initially associated with stimulant effects; however, psychopathological disturbances, violence, suicidal behaviour, hyperthermia, coma and death have also been described. Conclusion The proportion of cathinones commented on by psychonaut fora appeared to be relatively small, and similar to those reported by both the United Nations Office on Drugs and Crime and European Monitoring Centre for Drugs and Drug Addiction. This may be associated with a recent significant decline in both cathinone‐related consumption and acute medical presentation. Due to their complex behavioural and medical toxicity issues, healthcare professionals should be, however, be educated to recognise the signs and symptoms of NPS, including synthetic cathinone, ingestion.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The clinical challenges of synthetic cathinones

Schifano

Napoletano

Arillotta

et al. 2020

Brit J Clinical Pharma

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“…Henshall et al [22] in 2015 reported that the average age of hospitalized patients using NPS was 33 years; the youngest was 17 and the oldest 57. Most of the patients were male.…”

Section: Discussionmentioning

confidence: 99%

Designers Drugs—A New Challenge to Emergency Departments—An Observational Study in Poland

et al. 2020

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Background and objective: In the last decade, the phenomenon of using new psychoactive substances (NPS), called designer drugs, has been on rise. Though their production and marketing in Poland is prohibited, reports of the Supreme Audit Office noted that young people are increasingly reaching for new intoxication agents in the form of designer drugs. There is a significant increase in the number of patients with NPS abuse admitted to the emergency departments. As NPS cannot be detected by standard tests for the presence of psychoactive substances, it is difficult to choose the appropriate therapeutic intervention. Therefore, the aim of the present study was to evaluate the patient characteristics in the population of adults and children suspected of using NPS and formulate the protocol for diagnosis and treatment. Materials: The paper is based on a retrospective analysis of medical records of hospitalized patients in the Clinical Emergency Department of The Regional Specialist Hospital in Olsztyn (SKOR WSS, emergency department (ED)) and the Pediatric Emergency Department of the Provincial Specialist Children′s Hospital in Olsztyn (SORD WSSD, pediatric emergency department (PED)) between years 2013 to 2018. The patient records related to their general symptoms at admission, mental state and laboratory diagnostic tests were evaluated. Results: The majority of patients hospitalized due to the suspected use of NPS were adolescents in 2013–2016 and a reversal of this trend was observed in 2017–2018 when number of adults admitted to the emergency department (ED) due to NPS use was higher. The NPS abuse was significantly higher among male patients, alcoholics, people using other psychoactive substances, patients suffering from mental disorders and teenagers in difficult socio-economic family situations. Whereas, the most common symptoms among pediatric patients were co-ordination disorder and aggression, in adults mainly tachycardia and aggression was observed. The laboratory tests in significant number of adult patients showed leukocytosis and ketonuria. Conclusions: In the present study, no unambiguous toxidrome or biochemical pattern characteristic for using NPS was observed. However, evaluation of blood morphology, coagulation parameters, liver and kidney function can be helpful in the diagnostic and therapeutic process. Symptomatic treatment of patients, fluid therapy and sedation was sufficient in most cases to resolve the patient symptoms in 48 h.

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“…Some of the more immediate consequences of NPS use are evident in the prisons system and in admissions to hospital accident and emergency departments for acute intoxication (Liakoni, Dolder, Rentsch, & Liechti, ; Ralphs, Williams, Ashew, & Norton, ). These harmful consequences are particularly associated with people who are homeless (Henshall et al, ). The impact of NPS use on mortality and morbidity, both medium and long‐term has yet to be evaluated.…”

Section: Introductionmentioning

confidence: 99%

End of life care for people with alcohol and drug problems: Findings from a Rapid Evidence Assessment

Witham

Galvani

Peacock

2019

Health Soc Care Community

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People who use alcohol and other drugs(hereafter “substances”) and who are over the age of 40 are now more likely to die of a non‐drug related cause than people who use substances under the age of 40. This population will therefore potentially need greater access to palliative and end of life care services. Initially, the purpose of this rapid evidence assessment (REA), conducted August 2016–August 2017, was to explore the peer‐reviewed evidence base in relation to end of life care for people with problematic substance use. The following databases were searched using date parameters of 1 January 2004–1 August 2016: Amed, Psycharticles, Ovid, Ageinfo, Medline, Ebscohost, ASSIA, Social Care Online, Web of Knowledge, Web of Science, SSCI, Samsha, NIAAA. Data were extracted using a predefined protocol incorporating inclusion and exclusion criteria. Given the dearth of evidence emerging on interventions and practice responses to problematic substance use, the inclusion criteria were broadened to include any peer‐reviewed literature focussing on substance use specifically and end of life care. There were 60 papers that met the inclusion criteria. These were quality assessed. Using a textual thematic approach to categorise findings, papers fell into three broad groups (a) pain management, (b) homeless and marginalised groups, and (c) alcohol‐related papers. In general, this small and diverse literature lacked depth and quality. The papers suggest there are challenges for health and social care professionals in meeting the end of life needs of people who use substances. Addressing issues like safe prescribing for pain management becomes more challenging in the presence of substance use and requires flexible service provision from both alcohol/drug services and end of life care providers. Work is needed to develop models of good practice in working with co‐existing substance use and end of life conditions as well as prevalence studies to provide a wider context for policy development.

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

Cited by 5 publications

References 10 publications

The clinical challenges of synthetic cathinones

The clinical challenges of synthetic cathinones

Designers Drugs—A New Challenge to Emergency Departments—An Observational Study in Poland

End of life care for people with alcohol and drug problems: Findings from a Rapid Evidence Assessment

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