Reported recreational drug and new psychoactive substance use versus laboratory detection of substances by high-resolution mass spectrometry in patients presenting to an emergency department in London with acute drug toxicity.

IF 3 3区 医学 Q2 TOXICOLOGY
Caitlin E Wolfe, Ashley Rowe, Simon Hudson, John Rh Archer, Paul I Dargan, David M Wood
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引用次数: 0

Abstract

Introduction: Clinicians managing patients with acute recreational drug or new psychoactive substance toxicity typically depend on self-reported drug(s) used. This study compares patient self-report (and/or from other sources) to the substance(s) that were subsequently identified in serum.

Methods: A prospective sample of 1,000 adults presenting to a tertiary care, urban emergency department in London, United Kingdom, with acute recreational drug/new psychoactive substance toxicity was collected from 1 February 2019 to 2 February 2020. A total of 939 appropriate samples underwent qualitative analysis by high-resolution mass spectrometry with comparison to a database of drugs/metabolites. Data on the stated drug(s) used were extracted from the routine medical chart/records; results were batched by drug class, when appropriate, and analysis was performed using R software.

Results: Seven hundred and ninety-nine (85.1%) patients were male with a median (IQR) age of 34 years (27 to 42 years). Six hundred and thirty-five (67.6%) patients reported using two or more drugs. The median (IQR) positive predictive value of a self-report substance having been taken was 0.68 (IQR: 0.44-0.86); conversely, the median negative predictive value of a substance having not been taken was 0.90 (IQR: 0.53-0.95). There was variability in the accuracy of reporting. For example, self-reported opioid use had a 90.5% likelihood that opioids were detected on analysis, whereas hallucinogens were only detected in 18.8% of samples when use was reported. Individuals were also mostly accurate in not underreporting substances. For example, those not explicitly reporting gamma-hydroxybutyrate use were 97.5% truly negative.

Discussion: Overall, most users were relatively accurate in their self-report of what class of drugs they had used, although there was variability in this accuracy. However, other drugs were present even when not reported, for example, opioids with disproportionate detection of prescription and over-the-counter (non-prescription) opioids that were unreported.

Conclusions: Self-report (and/or collateral reports) had overall relatively high concordance with the likelihood that a substance was, or was not, recently used. Therefore, clinicians can make initial treatment decisions based on the self-reported drug(s) used in most cases.

在伦敦急诊科就诊的急性药物中毒患者中,报告的娱乐性药物和新型精神活性物质使用情况与实验室通过高分辨率质谱仪检测到的物质对比。
导言:临床医生在管理急性娱乐性药物或新型精神活性物质中毒患者时,通常依赖于患者自我报告的药物使用情况。本研究将患者的自我报告(和/或其他来源)与随后在血清中发现的药物进行了比较:从 2019 年 2 月 1 日至 2020 年 2 月 2 日,在英国伦敦的一家三级医疗城市急诊科收集了 1000 名急性娱乐性药物/新型精神活性物质中毒的成人前瞻性样本。共对 939 份样本进行了高分辨率质谱定性分析,并与药物/代谢物数据库进行了比对。从常规病历/记录中提取所用药物的数据;适当时按药物类别对结果进行分组,并使用 R 软件进行分析:799 名(85.1%)患者为男性,中位数(IQR)年龄为 34 岁(27 至 42 岁)。635名患者(67.6%)报告使用两种或两种以上药物。自我报告已服用药物的阳性预测值中位数(IQR)为 0.68(IQR:0.44-0.86);相反,未服用药物的阴性预测值中位数为 0.90(IQR:0.53-0.95)。报告的准确性存在差异。例如,自我报告使用阿片类药物的样本中,90.5% 的样本在分析中检测到阿片类药物,而报告使用致幻剂的样本中,只有 18.8% 的样本检测到致幻剂。个人在不漏报物质方面也大多比较准确。例如,未明确报告使用γ-羟丁酸的人中,97.5%的人真正呈阴性:讨论:总体而言,大多数吸毒者在自我报告曾吸食哪一类毒品时相对准确,但准确性存在差异。然而,即使未报告,也存在其他药物,例如,阿片类药物中处方药和非处方药(非处方药)未报告的比例过高:自我报告(和/或旁证报告)与近期使用或未使用某种药物的可能性总体上具有相对较高的一致性。因此,在大多数情况下,临床医生可以根据自我报告的药物使用情况做出初步治疗决定。
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来源期刊
Clinical Toxicology
Clinical Toxicology 医学-毒理学
CiteScore
5.70
自引率
12.10%
发文量
148
审稿时长
4-8 weeks
期刊介绍: clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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