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Emergencies related to recreational drug abuse in Spain compared to emergencies attended in 3 European areas

MirĂł O, Yates C, Dines AM, Wood DM, Dargan PI, GalĂĄn I, Jerez A, Puiguriguer J, Waring WS, Moughty A, O'Connor N, Heyerdahl F, Hovda KE, Vallersnes OM, Paasma R, Pold K, JĂŒrgens G, MĂ©garbane B, Anand HS, Liakoni E, Liechti M, Eyer F, Zacharov S, Caganova B, Giraudon I, Galicia M

Área de Urgencias, Hospital ClĂ­nic, Barcelona; Grupo de InvestigaciĂłn “Urgencias: Procesos y PatologĂ­as”, IDIBAPS, Barcelona, Spain. Facultad de Medicina, Universitat de Barcelona, Spain. Servicio de Urgencias, Hospital Son Espases, Palma de Mallorca, Spain. Clinical Toxicology, Guy's and St Thomas’ NHS Foundation Trust and King’s Health Partners, Londres, United Kingdom. Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, Londres, United Kingdom. Acute Medical Unit York Teaching Hospitals NHS Foundation Trust York, United Kingdom. Emergency Department Mater Misericordiae University Hospital, Dublin,Ireland. Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, RepĂșblica de Irlanda. The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Noruega. Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Noruega. Foundation PĂ€rnu Hospital, PĂ€rnu, Estonia. North-Estonia Medical Centre, Tallin, Estonia. Zealand University Hospital Roskilde Clinical Pharmacology Unit Roskilde, Dinamarca. Department of Medical and Toxicological Critical Care, LariboisiĂšre Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, Francia. Department of Clinical Toxicology Medical University of Gdansk, Gdansk, Poland; Pomeranian Centre of Toxicology, Gdansk, Polonia. Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Berna, Suiza. Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basilea, Suiza. Bispebjerg Hospital, Copenague, Dinamarca. Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Alemania. Department of Occupational Medicine, Toxicological Information Centre, Charles Universtity and General Hospital University, Praga, RepĂșblica Checa. National Toxicological Information Center, University Hospital, Bratislava, Eslovaquia. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisboa, Portugal.

Objectives. To analyze epidemiologic, clinical, and care characteristics in cases in which patients came to 2 Spanish emergency departments (EDs) with symptoms caused by recreational drug abuse. To compare the characteristics with those reported for other areas of Europe.
Methods. Secondary analysis of the registry of the European Drug Emergencies Network (Euro-DEN Plus), which collects cases in 14 European countries and 20 EDs. The registry included all patients attending EDs with symptoms of recreational drug abuse (excepting cases involving alcohol alone) over a period of 39 consecutive months (October 2013 to December 2016). We compared the cases from the 2 Spanish EDs (in Barcelona and Palma de Mallorca) to those from the 5 EDs in Ireland and the UK, 6 in northern Europe, and 7 in central Europe.
Results. A total of 17 104 patients’ cases were included: Spain, 1186; UK and Ireland, 6653; northern Europe, 6097; and central Europe, 3168. Spain saw more emergencies related to cocaine (48.4%) and fewer related to opioids (12.4%) than the other areas. The Spanish patients were younger (32.2 years) on average than those in northern Europe and older than those in the UK and Ireland and central Europe. Fewer patients were women in Spain (21.9%) than in northern or central Europe. Fewer arrived in ambulances in Spain (70.0%) than in the UK and Ireland or northern Europe. The Spanish EDs recorded the temperature and respiratory frequency of fewer patients (29.8% and 30.3%, respectively).Clinical signs differed between geographical areas attributable to differences in drug-use patterns. In Spain, naloxone was used by fewer patients (9.6%) than in the UK and Ireland and northern Europe, and flumazenil was used by more patients (5.6%) than in other areas. Spain saw lower percentages of admissions (4.6%) and patients
who left without an ED discharge (6.2%) in comparison with other areas. Mortality rates in the Spanish EDs (0.4%) and after discharge from them (0.7%) were higher than in northern Europe.
Conclusions. The characteristics of emergencies related to recreational drug abuse registered by the Spanish EDs were differed from those registered in other parts of Europe due to different patterns of drug use. We also detected differences between the Spanish and other European EDs with respect to examinations or tests performed, treatment
given, and discharge disposition.

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