Comparison of crystalline methamphetamine (“ice”) users and other patients with toxicology‐related problems presenting to a hospital emergency department

Abstract

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”.

Pattern and characteristics of ecstasy and related drug (ERD) presentations at two hospital emergency departments, Melbourne, Australia, 2008–2010

“…In terms of the context of presentation, they were less likely to attend the ED after attendance at licensed premises, a music festival or event. This fits with other Australian studies of amphetamine-related ED presentations, which suggest that a significant proportion of these patients inject drugs, and experience high rates of psychiatric comorbidity 24 25. Given that hospital admission was three times as common in amphetamine as GHB users, and that a significant proportion of these patients were admitted for psychiatric care, hospitals may need to consider developing separate management strategies for presentations involving amphetamines that take into consideration these complex needs.…”

“…While there have been a number of case series describing ERD-related ED presentations internationally10 15 22 23 and in Australia,12 24 25 these have generally focused on one ERD type only, and have not been conducted at the same time or place, thus making it difficult to understand contexts of harms experienced in a particular setting. To date, there has been only one comprehensive review of ERD-related presentations at Australian EDs.…”

Rates and features of methamphetamine‐related presentations to emergency departments: An integrative literature review

“…The results for percentage of methamphetamine‐related presentations for the remaining studies were 1% (Bunting et al., ), 1.4% (Richards et al., ), 1.8% (Cloutier et al., ) and 1.9% (Hendrickson et al., ). Interestingly, the studies conducted in the United States had similar results (Cloutier et al., ; Hendrickson et al., , ), except for Richards et al.…”

“…The number of participants varied from 60 methamphetamine‐related ED presentations to 461 ( N = 2,200) with an average of 234. The studies looked at four different types of participants: street‐involved youth (Marshall et al., ), overdoses presenting to ED (Wood et al., ), psychiatric methamphetamine‐related presentations (Cloutier et al., ; Pasic et al., ; Toles et al., ) and methamphetamine‐related presentations (Bunting et al., ; Hendrickson et al., , ; Richards et al., ).…”

Comparison of crystalline methamphetamine (“ice”) users and other patients with toxicology‐related problems presenting to a hospital emergency department

“…To the Editor : We read the article by Bunting and colleagues 1 with interest, as it attempted to address the important question of whether agitation and aggression are more commonly seen with methamphetamine toxicity. However, we have several concerns about the results presented in this study and the conclusions drawn by the authors.…”