From Lab to action: The role of a General Hospital Toxicology Lab in multidisciplinary responses to Flakka's regional emergence

Abstract

In November 2022 an intoxicated patient was admitted to the AZ Delta General Hospital emergency department declaring he smoked Flakka. Initially appearing as an isolated case, it quickly became clear that this was the beginning of a regional emergence. In the following weeks, several patients presented with symptoms ranging from excited delirium syndrome and psychosis to coma, all linked to the use of Flakka. This surge necessitated a coordinated response at multiple levels: hospital, regional, and national.

To address this, our toxicology lab rapidly developed an LC-MS/MS method to selectively detect the cathinones alpha-PVP, alpha-PHP and alpha-PHiP in urine and implemented in the routine tox screening. To date, this method has been used to identify over 100 alpha-PHiP positive patients and enabled correct monitoring of the situation.

In parallel, actions were initiated along multiple axes. In the hospital, close cooperation with e.g. the emergency department led to effective follow-up and the initiation of patient management plans.

On a regional level, regular consultations were established with local stakeholders: the city council, law enforcement and healthcare providers. The focus here was on ensuring the exchange of accurate and up-to-date information on the issue, as well as streamlining external communication.

The toxicology lab's findings were continuously reported to Belgian Early Warning System (BEWSD). This ensured that the data collected at the regional level induced national responses.

One and a half years after the first case, our laboratory results indicate that alpha-PHiP has disappeared from the regional drug market. Interdisciplinary collaboration and rapid, open communication have proven to be crucial in tackling and containing this surge. However, continued monitoring of the (regional) drug market for potential successors to alpha-PHiP remains essential. While the toxicology lab plays a key role in this effort, progress depends on the activation of a multidisciplinary network.