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Differences in clinical signs and severity of intoxication due to street drugs in adolescents and young adults treated in emergency departments

Burillo-Putze G, Ibrahim-Achi D, Mart√≠nez-S√°nchez L, Galicia M, Superv√≠a A, Puiguriguer Ferrando J, Matos Castro S, Leci√Īena MA, Venegas de L'Hotellerie MJ, Rodr√≠guez Miranda B, Bajo Bajo A , Mart√≠n-P√©rez B, Due√Īas-Laita A, Ferrer Dufol A, Callado-Moro F, Nogu√©-Xarau S, Mir√≥ O

Universidad Europea de Canarias, Facultad de Ciencias de la Salud, Tenerife, Spain. Red de Investigaci√≥n en Atenci√≥n Primaria de Adicciones (RIAPAD). Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain. √Ārea de Urgencias Pedi√°tricas, Hospital Sant Joan de D√©u, Barcelona, Spain. √Ārea de Urgencias, Hospital Cl√≠nic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. Servicio de Urgencias y Unidad de Toxicolog√≠a Cl√≠nica, Hospital Son Espases, Palma de Mallorca, Spain. Servicio de Urgencias, Hospital Can Misses, Ibiza, Spain. Servicio de Urgencias, Hospital Rey Juan Carlos, M√≥stoles, Spain. Servicio de Urgencias, Hospital Cl√≠nico de Salamanca, Salamanca, Spain. Servicio de Urgencias y Unidad de Toxicolog√≠a Cl√≠nica, Hospital Universitario R√≠o Hortega, Valladolid, Spain. Unidad de Toxicolog√≠a Cl√≠nica, Hospital Cl√≠nico Universitario Lozano Blesa, Zaragoza, Spain. Servicio de Urgencias y Unidad de Toxicolog√≠a Cl√≠nica, Hospital Universitario de Burgos, Spain.

Objective. To determine whether symptoms and levels of severity of intoxication from street drugs differ between adolescents and young adults who come to hospital emergency departments for treatment.
Methods. We studied a consecutive cohort of adolescents (aged 12-17 years) and young adults (aged 18-30 years) who were treated in 11 hospital emergency departments belonging to the Drug Abuse Network of Spanish Hospital Emergency Departments (REDURHE). Sociodemographic and clinical characteristics and level of severity were recorded for comparison between between adolescents and young adults, adjusted for sex, alcohol co-ingestion, and type of drug used. An intoxication was recorded as severe if at least 1 of the following indicators was present: cardiac arrest, tracheal intubation, intensive care unit admission, and in-hospital death.
Results. We included a total of 2181 patients: 249 adolescents (11.4%) and 1932 young adults (88.6%). Alcohol coingestion and use of multiple drugs were less common in adolescents, who had significantly more events related to cannabis (in 81.1% vs 49.0% of young adults) and benzodiazepines (13.3% vs 5.5%). The adolescents had significantly fewer intoxications from the use of cocaine (10.8% vs 45.1%), amphetamines (17.3% vs 32.3%), ketamine (0.4% vs 6.0%) and gamma-hydroxybutyrate (0.4% vs 4.0%). A higher proportion of adolescents than young adults presented with diminished consciousness (23.0% vs 16.9%), but fewer manifested anxiety (15.9% vs 26.3%), palpitations (11.0% vs 19.5%), or chest pain (2.8% vs 9.2%). The pattern of associations was similar in the
subgroup of intoxications due to cannabis. The adjusted model confirmed that the adolescents were more likely to have diminished consciousness, with an odds ratio (OR) of 1.851 (95% CI, 1.204-2.844) and less likely to have anxiety (OR, 0.529 (95% CI, 0.347-0.807). Intoxication was severe in 46 patients overall (2.1%); in adolescents and young adults the proportions were 0.8% and 2.3%, respectively (P = 0.129). In adolescents, the OR was 0.568 (95% CI, 0.131-2.468) for severity; for component indicators, the ORs were 0.494 (95% CI, 0.063-3.892) for intubation and 0.780 (95% CI, 0.175-3.475) for intensive care unit admission. No deaths occurred.
Conclusion. Adolescents requiring emergency care for street drug intoxication had co-ingested alcohol or taken multiple drugs less often than young adults. Cannabis was the drug most often used by adolescents, who presented more often with diminished consciousness but less often with anxiety. We detected no differences related to event

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