Drug Misuse in Adolescents Presenting to the Emergency Department

Finkelstein, Yaron; Goel, Gautam; Hutson, Janine R.; Armstrong, Jeffrey D.; Baum, Carl R.; Wax, Paul M.; Brent, Jeffrey

doi:10.1097/pec.0000000000000571

Cited by 22 publications

(31 citation statements)

References 30 publications

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Section: Introductionmentioning

confidence: 99%

“…Because of this, cases of acute poisoning, accidental overdose, and unforeseen adverse reactions associated with NPS use have become an increasing problem at emergency departments (EDs) and intensive care units (ICUs). 6,[9][10][11] To study the occurrence and health hazards of newly emerging drugs of abuse in Sweden, the STRIDA project was started in 2010. 6,12 The project combines data on clinical features with the laboratory results from an extended toxicological investigation of blood and urine samples collected from EDs and ICUs cases of acute intoxication suspected to involve NPS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Investigation of drug products received for analysis in the Swedish STRIDA project on new psychoactive substances

Bäckberg

Jönsson

Beck

et al. 2017

Drug Testing and Analysis

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The web-based open sale of unregulated new psychoactive substances (NPS) has shown a steady increase in recent years. Analysis of drug products sold as NPS is useful to confirm the true chemical contents, for comparison with the substances detected in corresponding body fluids, but also to study drug trends. This work describes the examination of 251 drug products that were randomly submitted for analysis in 173 cases of suspected NPS-related intoxications in the Swedish STRIDA project in 2010-2015. Of the products, 39% were powders/crystals, 32% tablets/capsules, 16% herbal materials, 8% liquids, 1% blotters, and 4% others. The analysis involved tandem mass spectrometry and nuclear magnetic resonance spectroscopy. In 88 products (35%), classic psychoactive substances, prescription pharmaceuticals, dietary supplements, or doping agents were found; however, in none of these cases had an NPS-related intoxication been indicated from product markings or patient self-reports. Another 12 products tested negative for psychoactive substances. The remaining 151 products contained 86 different NPS (30% contained ≥2 substances). In 104 drug products, a specific NPS ingredient was indicated based on labelling (69%) or patient self-report; in 92 cases this was also analytically confirmed to be correct. Overall, the NPS products submitted for analysis in the STRIDA project showed a high degree of consistency between suspected and actual content (88%). The results of related urine and/or blood analysis further demonstrated that the patients commonly (89%) tested positive for the indicated NPS, but also revealed that polysubstance intoxication was common (83%), indicating use of additional drug products.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigation of drug products received for analysis in the Swedish STRIDA project on new psychoactive substances

Bäckberg

Jönsson

Beck

et al. 2017

Drug Testing and Analysis

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“…In 2015, six manuscripts using ToxIC data were published in the peer-reviewed literature (Finkelstein et al [2]; Froberg et al [3]; Rhyee et al [4]; Smith and Farmer [5]; Watkins et al [6]; Zelner et al [7]), and 25 published abstracts based on ToxIC data were presented at three national and international meetings.…”

Section: Introductionmentioning

confidence: 99%

The Toxicology Investigators Consortium Case Registry—the 2015 Experience

Rhyee¹,

Campleman²,

Ruha³

et al. 2016

J. Med. Toxicol.

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The American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC) Case Registry in 2010. The Registry contains all medical toxicology consultations performed at participating sites. The Registry has continued to grow since its inception, and as of December 31, 2015, contains 43,099 cases. This is the sixth annual report of the ToxIC Registry, summarizing the additional 8115 cases entered in 2015. Cases were identified by a query of the Registry for all cases entered between January 1 and December 31, 2015. Specific data reviewed for analysis included demographics (age, race, gender), source of consultation, reason for consultation, agents and agent classes involved in exposures, signs, symptoms, clinical findings, fatalities, and treatment. By the end of 2015, there were 50 active sites, consisting of 101 separate health-care facilities; 51.2 % of cases involved females. Adults between the ages of 19 and 65 made up the majority (64.2 %) of Registry cases. Caucasian race was the most commonly reported (55.6 %); 9.6 % of cases were identified as Hispanic ethnicity. Inpatient and emergency department referrals were by far the most common referral sources (92.9 %). Intentional pharmaceutical exposures remained the most frequent reason for consultation, making up 52.3 % of cases. Of these intentional pharmaceutical exposures, 69 % represented an attempt at self-harm, and 85.6 % of these were a suicide attempt. Nonopioid analgesics, sedative-hypnotics, and antidepressant agents were the most commonly reported agent classes in 2015. Almost one-third of Registry cases involved a diagnosed toxidrome (32.8 %), with a sedative-hypnotic toxidrome being the most frequently described. Significant vital sign abnormalities were recorded in 25.3 % of cases. There were 98 fatalities reported in the Registry (1.2 %). Adverse drug reactions were reported in 4.3 % of cases. Toxicological treatment was given in 65.3 % of cases, with 33.0 % receiving specific antidotal therapy. Exposure characteristics and trends overall were similar to prior years. While treatment interventions were required in the majority of cases, fatalities were rare.

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“…A high index of suspicion for substance abuse is warranted in relevant clinical contexts for agents that are not present on routine toxicology screening, such as SCs. Detection of SCs requires specialized mass spectrophotometry capabilities (25). The confirmation test in our study was a high-specific specialized mass spectrophotometric test.…”

Section: Discussionmentioning

confidence: 99%

Identification of Substance Abuse Among Children in a Pediatric Emergency Department

Çiftdemir¹,

Eren²,

Karal³

2020

jpr

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Illicit substance use is a worldwide important public health problem with increasing substance abuse rates and decreasing starting age. In this study, our aim was to determine the complaints of the patients in pediatric emergency department (PED) admission in order to increase awareness about substance abuse. Materials and Methods: The data of this cross-sectional study was gathered from those patients admitted to a PED with complaints of substance abuse and patients without a history of substance abuse, but with a positive urine drug test. A screening urine test was used for the qualitative determination of drug substances. If positive, a quantitative liquid chromatography integrated mass/mass spectrometry test was ordered for confirmation. Results: A total of 17 patients presented to the emergency department. The most frequent symptoms were unstable cognitive conditions and tachycardia. Laboratory analyses showed high creatine kinase-MB. Synthetic cannabinoids were the most frequently detected substance in urine screening and confirmation tests. Twenty-nine percent of patients were hospitalized and no mortality was observed. Conclusion: The use of illegal substances has increased in teenagers. Emergency department doctors must be informed and trained regarding substance abuse since patients frequently presented to the emergency department with cognitive malfunctions. Also, it should be remembered that patients may present with symptoms concerning various organ systems.

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Drug Misuse in Adolescents Presenting to the Emergency Department

Cited by 22 publications

References 30 publications

Investigation of drug products received for analysis in the Swedish STRIDA project on new psychoactive substances

Investigation of drug products received for analysis in the Swedish STRIDA project on new psychoactive substances

The Toxicology Investigators Consortium Case Registry—the 2015 Experience

Identification of Substance Abuse Among Children in a Pediatric Emergency Department

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