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 (n = 201, 77.9%) and gamma-hydroxybutyrate (n = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (n = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (n = 100, 26.1%) and clonazepam (n = 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, P < 0.001). Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations via 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使用所造成的公共卫生负担，目前仍未被充分知晓。在急诊科建立基于实验室分析确认的前瞻性药物监测系统，或可助力早期识别新兴药物。本研究针对西澳大利亚州急诊科患者，描述按非法药物及新型精神活性物质（novel psychoactive substances, NPS）的实验室分析确认结果分层的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，参与澳大利亚新兴药物网络（Emerging Drugs Network of Australia, EDNA）的5家西澳大利亚州急诊科，纳入了表现出与娱乐性药物中毒相符的严重及/或异常临床特征的患者。在患者急诊科就诊期间，收集其血液样本中经分析确认存在/不存在非法药物/新型精神活性物质的人口统计学数据与毒理学特征。
本队列共纳入434例严重及/或异常中毒就诊病例，患者年龄中位数为33岁（四分位间距25~40岁），其中男性268例，占比61.8%。93.3%（405例）的就诊病例中检出了任意类别物质（非法药物、新型精神活性物质、处方药物）。59.2%（257例）的就诊病例中检出非法药物/新型精神活性物质，其中28.3%（73例）同时检出至少1种确认的非法药物/新型精神活性物质。
本次研究检出的常见非法药物包括甲氧安非他明（metamfetamine，n=201，占比77.9%）与γ-羟基丁酸（gamma-hydroxybutyrate, GHB，n=30，占比11.6%）。在16.7%（43例）的就诊病例中检出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物质（n=29，占比60.4%）。检出频率较高的处方药物包括地西泮（n=100，占比26.1%）与氯硝西泮（n=40，占比10.4%）。
35.7%（155例）的就诊病例被准予出院回家，12.9%（56例）被收入重症监护病房。检出非法药物/新型精神活性物质的病例，其重症监护停留时长的中位数（32.6小时）低于未检出该类物质的病例（50.8小时，P<0.001）。
通过澳大利亚新兴药物网络整合严重及/或异常中毒就诊患者的临床与实验室分析数据，可帮助明确西澳大利亚州急诊科内导致急性伤害的非法药物/新型精神活性物质使用情况。