Comparison of drug abuse fatalities and emergencies

[Emergencies in patients attender in a drug abuse treatment center]

BACKGROUND AND OBJECTIVE

To find out the type of emergency consultations made by users at a substance abuse treatment center (SATC).

PATIENTS AND METHOD

Prospective study of emergency consultations made during six months by patients controlled at a SATC.

RESULTS

333 patients were followed up; 27 (8%) of them consulted and 9 (33%) were found to have an HIV infection. Heroin addicts consulted more times and repeated visits more commonly than cocaine addicts (p < 0.04 and 0.03). Patients enrolled in the methadone maintenance programme consulted less commonly than patients included in other programmes (p < 0.01). 35% of visited patients did not need treatment and 75% were discharged.

CONCLUSIONS

We have detected two different types of consultations: those owing to a psychiatric/drug disorder in patients followed-up for less than 1 year, which are resolved after just one visit, without need of hospitalization; and those consultations caused by medical disorders, frequently related to HIV, which are generated by patients submitted to longer follow-up periods; these patients use to repeat the consultations and are commonly admitted.

Using ambulance attendances to recruit people who have experienced non-fatal heroin overdose

AIMS

To trial two novel methods of recruiting people who experience non-fatal heroin overdose through the ambulance service.

SETTING

Melbourne and Sydney, Australia.

METHODS

In Melbourne potential participants were given numbered contact cards by ambulance paramedics after revival, while in Sydney potential participants were approached after revival by a researcher who travelled with ambulance paramedics to the overdose scene.

RESULTS

In Melbourne 281 cards were distributed during the period 1 June 1998-31 December 1998 and a subsequent contact rate of 24% was achieved with 14% attending a subsequent interview. In Sydney there were 170 initial contacts of which 139 (82%) answered a series of questions asked at the scene (the remainder either ineligible or incapable of answering questions) with 48 (35%) also attending for follow-up interviews.

CONCLUSIONS

Recruitment through contact with ambulance services is a novel method of recruiting heroin users for research into non-fatal heroin overdose with advantages over other methods of sampling for research on non-fatal heroin overdose.

Seroprevalence of hepatitis C markers among intravenous drug users in western European countries: a systematic review

Currently, the most important risk factor for hepatitis C virus (HCV) infection in Europe is intravenous drug use. To establish a better insight into the epidemiology of hepatitis C among intravenous drug users (IVDUs) in western European countries a systematic review on the prevalence of hepatitis C markers and their determinants was performed. Reports were identified by searches on Medline and on the internet and by screening reference lists of selected papers. The prevalence rates of anti-HCV in western European IVDUs reported in the 66 studies selected for analysis, ranged between 37 and 98%. No relation was found between prevalence rates and mean age, mean duration of intravenous drug use, geographical area, setting of the study, method of recruitment or the year(s) of collection of samples. Eleven studies concerning the prevalence of HCV-RNA in hepatitis C-infected IVDUs were selected for analysis. Prevalence rates ranged from 26 to 86%. Based on five studies, a statistically significant positive linear relation was found between the mean age of study population and the prevalence of HCV-RNA. Our analysis revealed considerable variation in prevalence rates of hepatitis C markers among IVDUs in western Europe. We found no conclusive explanation for this variability. Further research investigating the dynamics of the hepatitis C epidemic in IVDUs is necessary.

Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service

Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs.

Drugs in blood samples from unconscious drug addicts after the intake of an overdose

This investigation includes whole blood samples from 53 drug addicts found unconscious in the Copenhagen area with evidence of a heroin overdose. Heroin/morphine was detected in 85% of the patients and other opioids in 11%. One or more benzodiazepines, most often diazepam, were detected in 75% of the patients. A blood alcohol concentration higher than 1.00 mg/g was detected in 57% of the patients. Methadone was detected in seven patients, ketobemidone in four, amphetamine in five and cocaine in one. This investigation showed widespread multi-drug abuse and heroin/morphine alone was detected in only one patient. As indicators of heroin intake, 6-mono-acetylmorphine (MAM) and morphine were detected in this investigation.