Hospital emergencies: multiple substances implicated

Hospital emergency data can provide an insight into acute drug-related harms. Information is available from the European Drug Emergencies Network (Euro-DEN Plus), which monitors drug-related presentations in 15 (sentinel) hospitals in 9 European countries. The 5 054 presentations recorded by the project in 2015 had a median age of 31 years, and most were male (77 %).

On average about 1.5 drugs were reported per presentation (7 768 in total). Nearly two thirds of presentations (65 %) involved the use of established drugs, and the most common were heroin, cocaine, cannabis, GHB/GBL, amphetamine and MDMA; one quarter (24 %) involved the misuse of prescription or over the counter drugs (most commonly opioids and benzodiazepines); and 9 % involved new psychoactive substances (up from 6 % in 2014).

Top 20 drugs recorded in emergency presentations in sentinel hospitals in 2015

Half of the presentations for new psychoactive substances involved a synthetic cathinone and 14 % a synthetic cannabinoid. The drugs involved in emergency presentations differed between sites, reflecting local patterns of use. For example, emergencies related to heroin were the most common presentations in Dublin (Ireland) and Oslo (Norway), whereas presentations related to GHB/GBL, cocaine and MDMA were predominant in London (United Kingdom).

The majority (80 %) of those presenting with acute drug toxicity were discharged from hospital within 12 hours; a small minority (6 %) developed severe toxicity requiring admission to critical care and 4 % were admitted to a psychiatric ward. Around half (9) of the 17 deaths recorded involved opioids.

Only a few countries have monitoring systems in place that allow a national analysis of trends in acute drug intoxications. Among these, acute heroin emergencies have increased in the United Kingdom, but continued to decline in the Czech Republic and Denmark, where methadone emergencies are increasing. In Lithuania, opioid-related emergencies almost doubled between 2013 and 2015. In Spain, cocaine is involved in about half of the reported drug-related emergencies, and the trend is stabilising after a decline, while cannabis emergencies are continuing to increase. Slovenia also reports an upward trend in cannabis emergencies. In the Netherlands, half of the cases presenting at first aid stations at festivals (51 %) involved MDMA and the proportion is decreasing. Methamphetamine-related emergency cases, recorded by sentinel centres in the Czech Republic, increased by more than 50 % between 2014 and 2015.