Characteristics of analytically confirmed illicit substance-using patients in the Emergency Department

Te-I Weng; Lian-Yu Chen; Ju-Yu Chen; Pai-Shan Chen; Hsaio-Lin Hwa; Cheng-Chung Fang

doi:10.1016/j.jfma.2020.01.005

Characteristics of analytically confirmed illicit substance-using patients in the Emergency Department

J Formos Med Assoc. 2020 Dec;119(12):1827-1834. doi: 10.1016/j.jfma.2020.01.005. Epub 2020 Feb 6.

Authors

Te-I Weng¹, Lian-Yu Chen², Ju-Yu Chen³, Pai-Shan Chen⁴, Hsaio-Lin Hwa⁴, Cheng-Chung Fang⁵

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Forensic and Clinical Toxicology Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
³ Forensic and Clinical Toxicology Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Forensic and Clinical Toxicology Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Forensic and Clinical Toxicology Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: conrad@ntu.edu.tw.

PMID: 32037264
DOI: 10.1016/j.jfma.2020.01.005

Abstract

Background/purpose: Although illicit substance use-induced toxicity or complication is a frequent cause of visit to the emergency department (ED), there are limited data on cases confirmed by liquid chromatography tandem-mass spectrometry (LC-MS/MS) analysis. This study aimed to describe clinical presentations of patients who visited the ED because of acute illicit substance-related complications.

Methods: We performed a retrospective study between May 2017 and August 2018 on patients presenting to the ED with positive urine illicit substance analysis by LC-MS/MS.

Results: Of 203 patients with at least one illicit substance detected in their urine, 162 (79.8%) showed traditional illicit substances, and 56 (32.0%) showed new psychoactive substances (NPS). Methamphetamine was the most common illicit substance (67.9%). The most common NPS was ketamine (21.7%), followed by synthetic cathinones (14.8%). We divided patients into traditional, NPS and combined (both traditional illicit substance and NPS) groups. Polysubstance use was more common in the NPS group than in the traditional group (P < 0.001). Most patients were men (78.3%), and the average age was lower in the NPS group compared to the traditional group (P < 0.001). Although the chemical structures of cathinones are similar to that of amphetamine, 92.0% of the cathinone use cases without combination with methamphetamine use showed negative immunoassay results.

Conclusion: Our study provided the acute illicit substance complications at ED by LC-MS/MS analysis in Taiwan. Our study showed that more than one-third cases studied were NPS users. Young adults and polysubstance users were more common among NPS users.

Keywords: Cathinone; Emergency department; Illicit abused substance; New psychoactive substance.

MeSH terms

Chromatography, Liquid
Emergency Service, Hospital
Female
Humans
Illicit Drugs*
Male
Retrospective Studies
Substance Abuse Detection
Substance-Related Disorders* / complications
Substance-Related Disorders* / epidemiology
Taiwan / epidemiology
Tandem Mass Spectrometry

Substances

Illicit Drugs