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Abstract
Cocaine is, after cannabis, the second most used illicit drug in Europe, although prevalence and patterns of use differ considerably between countries. The European Drug Report 2024 reported a life-time prevalence of cocaine use in European adults aged 15–64 years ranging from 1.1 % in Portugal to 12 % in Spain, with a last-year prevalence of use of 0.2 % and 2.4 %, respectively [1]. Overall, adverse events associated with recreational use of cocaine mainly include sympathomimetic, neuropsychological and cardiovascular manifestations, with some of these being associated with severe toxicity and potentially death [2,3].
In general, the collection of data related to illegal substance use is mostly based on indicators such as drug seizures at customs and borders, treatment demand, drug-related deaths, wastewater analysis, and surveys [1,4]. However, as many individuals with acute drug toxicity present to an Emergency Department (ED), data on these presentations represent an important source of information on the public health implications of drug use; these data can be helpful to detect trends in acute drug related toxicity and factors influencing drug use and associated adverse consequences, including the patient's age and sex [[5], [6], [7], [8], [9]]. In this regard, clinical manifestations of acute drug toxicity can differ according to patient age, as numerous factors such as metabolism and target receptors of drugs can express differently according to age [10,11]. Furthermore, sex is a main modulator of drugs effects [12,13]. Therefore, different acute effects based on patient age and sex could be present in patients with acute cocaine toxicity, but this hypothesis has poorly been explored to date.
The European Drug Emergencies Network (Euro-DEN) is a European surveillance system created in 2013, subsequently expanded as the Euro-DEN Plus network since 2015 to date, which collects data on presentations to sentinel EDs with acute toxicity related to the use of recreational drugs and new psychoactive substances [[14], [15], [16]]. In this study, the Euro-DEN Plus dataset was used to determine whether there is a differential pattern in clinical manifestations and severity based on age and sex in patients presenting to the ED with acute cocaine toxicity.