Analytically confirmed illicit and novel psychoactive drug use in Western Australian emergency departments: initial results from the Emerging Drugs Network of Australia (EDNA)

The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia. Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation. The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25–40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine (<i>n</i> = 201, 77.9%) and gamma-hydroxybutyrate (<i>n</i> = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (<i>n</i> = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (<i>n</i> = 100, 26.1%) and clonazepam (<i>n</i> = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, <i>P</i> &lt; 0.001). Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations <i>via</i> the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments.

澳大利亚急性非法药物滥用所带来的疾病负担整体尚不明确。在急诊科建立基于实验室确证的前瞻性药物监测系统，或有助于早期识别新型药物。本研究针对西澳大利亚州急诊科患者，按非法药物与新型精神活性物质（novel psychoactive substances）的实验室确证结果分层，描述其人口统计学特征与急性中毒模式。
2020年4月至2021年12月期间，在参与澳大利亚新型药物监测网络（Emerging Drugs Network of Australia）的5家西澳大利亚州急诊科中，筛选出因符合娱乐性药物中毒的重度及/或非典型临床特征就诊的患者。
研究收集了急诊科就诊期间，经血液样本确证存在/未确证存在非法药物/新型精神活性物质的患者的人口统计学特征与毒理学模式。
本研究队列共纳入434例重度及/或非典型中毒就诊病例，患者年龄中位数为33岁（四分位间距25~40岁），其中男性268例（61.8%）。
405例（93.3%）就诊病例中检出任何类型物质（非法药物、新型精神活性物质、处方药物）。
257例（59.2%）就诊病例中检出非法药物/新型精神活性物质，其中73例（28.3%）同时检出≥2种确证的非法药物/新型精神活性物质。
检出率较高的非法药物为甲氧安非他命（metamfetamine，n=201，77.9%）与γ-羟基丁酸（gamma-hydroxybutyrate，n=30，11.6%）。
43例（16.7%）就诊病例中检出48种新型精神活性物质，其中检出频率最高的为新型苯二氮䓬类药物（n=29，60.4%）。
检出率较高的处方药物为地西泮（diazepam，n=100，26.1%）与氯硝西泮（clonazepam，n=40，10.4%）。
155例（35.7%）就诊病例于急诊科出院回家，56例（12.9%）收入重症监护室。
检出非法药物/新型精神活性物质的病例，其重症监护住院时长中位数（32.6小时）低于未检出此类物质的病例（50.8小时，P<0.001）。
通过澳大利亚新型药物监测网络整合重度及/或非典型中毒患者的临床与实验室分析数据，有助于明确西澳大利亚州急诊科中导致急性损害的非法药物/新型精神活性物质使用情况。