Novel psychoactive substances-related presentations to the emergency departments of the European drug emergencies network plus (Euro-DEN plus) over the six-year period 2014–2019

Novel psychoactive substances (NPS) have been increasingly reported in the last 15–20 years. We aimed to describe presentations to the emergency department (ED) with acute recreational drug toxicity involving NPS. Data were extracted from the European Drug Emergencies Network (Euro-DEN) Plus database for all presentations to ED (36 EDs in 24 European countries) with acute toxicity between January 2014 and December 2019. Patient demographics, agents involved, and clinical outcomes were described and the subgroup of presentations involving NPS was compared with the rest of the cohort. Out of 43,633 Euro-DEN Plus presentations, 3304 (7.6%) involved at least one NPS. Agents were identified mainly based on self-report or clinical presentation, with analytical confirmation being performed only in 17.9% of NPS presentations. The proportion of NPS presentations varied by centre (0–48.8%). For centres where data were available for all 6 years, NPS-related presentations peaked in 2015 (11.9%). In 2014, 78.4% of NPS agents reported were cathinones, while only 3.4% were synthetic cannabinoids (SCs); conversely, in 2019 only 11.6% of NPS agents reported were cathinones, while 72.2% were SCs. NPS-related presentations involved younger patients (median 30 (23–37) <i>vs.</i> 32 (25–40) years, <i>p</i> &lt; 0.001) and more males (84.8 <i>vs</i>. 75.8%, <i>p</i> &lt; 0.001) compared with the rest of the cohort. Patients presenting to ED after using NPS were more likely to self-discharge (22.8 <i>vs.</i> 15.1%), less likely to be admitted to critical care (3.6 <i>vs</i>. 6.1%) but had a longer length of stay in hospital (median 5.1 (2.7–18.7) <i>vs.</i> 4.7 (2.5–9.2) h, <i>p</i> &lt; 0.001). Death occurred in 0.5% of all presentations involving NPS and in 0.4% of non-NPS presentations. This large multicentre series of NPS presentations to European EDs showed marked geographical variation and changes over time in the proportion of presentations to ED involving NPS, as well as the proportion of NPS subgroups.

新型精神活性物质（Novel Psychoactive Substances, NPS）在过去15至20年间的报告案例日益增多。本研究旨在描述涉及新型精神活性物质的急性娱乐性药物中毒患者前往急诊科室（Emergency Department, ED）就诊的情况。研究数据提取自欧洲药物急诊网络（European Drug Emergencies Network, Euro-DEN）Plus数据库，涵盖2014年1月至2019年12月期间，欧洲24个国家的36家急诊科室收治的所有急性中毒急诊就诊案例。本研究对患者人口统计学特征、涉毒品种类及临床转归进行了描述，并将涉及新型精神活性物质的就诊亚组与其余队列进行对比。在Euro-DEN Plus数据库收录的43633例急诊就诊案例中，3304例（7.6%）涉及至少一种新型精神活性物质。涉毒品种类主要通过患者自述或临床表现进行认定，仅17.9%的新型精神活性物质相关就诊案例完成了实验室分析确认。新型精神活性物质相关就诊案例的占比因就诊中心不同存在显著差异（0%~48.8%）。对于有完整6年数据的就诊中心，新型精神活性物质相关就诊案例占比在2015年达到峰值（11.9%）。2014年，报告的新型精神活性物质中78.4%为卡西酮类（cathinones），仅3.4%为合成大麻素类（Synthetic Cannabinoids, SCs）；与之相反，2019年报告的新型精神活性物质中仅11.6%为卡西酮类，而72.2%为合成大麻素类。与其余队列相比，涉及新型精神活性物质的就诊患者年龄更小（中位年龄30岁，四分位距23~37岁 vs. 32岁，25~40岁，p<0.001），男性占比更高（84.8% vs. 75.8%，p<0.001）。使用新型精神活性物质后前往急诊科室就诊的患者更易自行离院（22.8% vs. 15.1%），入住重症监护室的概率更低（3.6% vs. 6.1%），但住院留观时长更长（中位时长5.1小时，四分位距2.7~18.7小时 vs. 4.7小时，2.5~9.2小时，p<0.001）。涉及新型精神活性物质的就诊案例中死亡率为0.5%，非新型精神活性物质相关案例的死亡率为0.4%。这项针对欧洲急诊科室新型精神活性物质相关就诊案例的大型多中心研究显示，涉及新型精神活性物质的急诊就诊占比以及新型精神活性物质亚类的占比均存在显著的地域差异，并随时间发生明显变化。