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Smith JL, Greene S, McCutcheon D, Weber C, Kotkis E, Soderstrom J, Douglas B, Lenton S, Grigg J, Dessauer P, Ezard N, Fatovich DM. A multicentre case series of analytically confirmed gamma-hydroxybutyrate intoxications in Western Australian emergency departments: Pre-hospital circumstances, co-detections and clinical outcomes. Drug Alcohol Rev 2024. [PMID: 38426636 DOI: 10.1111/dar.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/26/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Gamma-hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre-hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA). METHODS This case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre-hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB-confirmed cases. RESULTS GHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One-third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co-detected in 37 (82.2%) GHB-confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, 'unresponsive' and 'unconscious' in various pre-hospital settings (n = 28, 62.2%). 'Agitated' and/or 'erratic' mental state and behavioural observations were recorded in 20 (44.4%) cases. DISCUSSION AND CONCLUSIONS Analytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co-ingestion warrants further exploration.
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Affiliation(s)
- Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Shaun Greene
- Emergency Department, Austin Hospital, Melbourne, Australia
- Victorian Poisons Information Centre, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - David McCutcheon
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- Royal Perth Hospital Research Foundation, Perth, Australia
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Ellie Kotkis
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
| | | | - Simon Lenton
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | - Jodie Grigg
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | | | - Nadine Ezard
- The National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
- The National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, Sydney, Australia
| | - Daniel M Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
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2
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McCutcheon D, Soderstrom J, Raghavan M, Oosthuizen F, Douglas B, Burrows S, Smith JL, Fatovich D. Illicit drugs in the emergency department: Can we determine on clinical grounds if patients are intoxicated? Results from the Western Australian Illicit Substance Evaluation (WISE) study. Drug Alcohol Rev 2023; 42:1807-1815. [PMID: 37587737 DOI: 10.1111/dar.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Presentations related to illicit drugs are a feature of emergency department practice. Clinicians may form a belief that a patient is intoxicated with illicit drugs based on patient self-report, clinical features on presentation and the local prevalence of illicit drug use. But evidence of the accuracy of this assessment is lacking. The Western Australian Illicit Substance Evaluation (WISE) study enrolled patients believed by their treating clinician to be intoxicated with illicit drugs, and this analysis aims to evaluate the validity of this belief. METHODS A blood sample was taken on patient arrival and details of patient history, examination and interventions were collected by clinical and research staff. Toxicological examination of biological samples used liquid chromatography-mass spectrometry techniques including Quadrupole Time of Flight screening and Triple Quadrupole targeted analyses. RESULTS Of 632 study presentations, 518 had illicit drugs detected representing a positive predictive value of 0.82 (95% confidence interval 78.7, 84.9). Those with illicit drugs detected were significantly less likely to arrive by police transport (p = 0.010) or to have used alcohol (p < 0.001). They were significantly more likely to report illicit drug use (p < 0.001) and a much smaller proportion were admitted to a psychiatric ward (3.5% vs. 19.3%, p < 0.0001). Heart rate and systolic blood pressure were significantly higher in the illicit drug group (p = 0.004 and p = 0.003). DISCUSSION AND CONCLUSIONS In this study, the positive predictive value of clinicians determining if their patient had taken illicit drugs was 0.82. Contemporaneous biochemical analysis in the clinical setting would increase this accuracy and inform patient care.
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Affiliation(s)
- David McCutcheon
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- Royal Perth Hospital Research Foundation, Perth, Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- Clinical Toxicology, Royal Perth Hospital, Perth, Australia
| | - Mohan Raghavan
- Emergency Department, Royal Perth Hospital, Perth, Australia
- Clinical Toxicology, Royal Perth Hospital, Perth, Australia
| | | | | | - Sally Burrows
- School of Medicine, University of Western Australia, Perth, Australia
- Royal Perth Hospital Research Foundation, Perth, Australia
| | - Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Daniel Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
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3
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Weber C, Smith JL, Soderstrom J, Burrows S, McCutcheon D, Oosthuizen F, Fatovich DM. Analytically confirmed illicit and novel psychoactive drug use in Western Australian emergency departments: initial results from the Emerging Drugs Network of Australia (EDNA). Clin Toxicol (Phila) 2023:1-9. [PMID: 37449677 DOI: 10.1080/15563650.2023.2229951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia. METHODS Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation. RESULTS The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25-40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine (n = 201, 77.9%) and gamma-hydroxybutyrate (n = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (n = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (n = 100, 26.1%) and clonazepam (n = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, P < 0.001). CONCLUSIONS Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations via the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments.
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Affiliation(s)
- Courtney Weber
- Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Jennifer L Smith
- Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
| | - Jessamine Soderstrom
- Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Sally Burrows
- School of Medicine, The University of Western Australia, Perth, Australia
- Royal Perth Hospital Research Foundation, Perth, Australia
| | - David McCutcheon
- Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | | | - Daniel M Fatovich
- Harry Perkins Institute of Medical Research, Centre for Clinical Research in Emergency Medicine, Perth, Australia
- East Metropolitan Health Service, Perth, Australia
- Emergency Department, Royal Perth Hospital, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
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Colalillo JM, Govindasamy LS, Ley Greaves R. Moving beyond the dose makes the poison. Emerg Med Australas 2023; 35:333-335. [PMID: 36843217 DOI: 10.1111/1742-6723.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/28/2023]
Affiliation(s)
- James M Colalillo
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Robbie Ley Greaves
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia
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5
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Kozman A. The path to becoming a clinical toxicologist. Emerg Med Australas 2023; 35:339-340. [PMID: 36822612 DOI: 10.1111/1742-6723.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Andrew Kozman
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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6
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Coombs T, Ginige T, Van Calster P, Abdelkader A, Corazza O, Assi S. New Psychoactive Substances in the Homeless Population: A Cross-Sectional Study in the United Kingdom. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-022-00988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
The last few years have seen the emergence of new psychoactive substance among the homeless population, specifically synthetic cannabinoid receptor agonists. The purpose of this study is to investigate the knowledge and experiences of new psychoactive substances amongst users from the homeless population. An explanatory research design was applied using a semi-structured questionnaire with the focus on gaining insights on the prevalence, motivations and effects. Participants were recruited through convenience sampling from support organisations and charities UK-wide. Descriptive statistics and logistic regression were applied to analyse the data obtained from participant surveys. A total of 105 participants met the inclusion criteria and were in the age range of 18 to 64 years old. Almost 70% consumed new psychoactive substance products, which “Spice” was the most prevalent substance. Homeless users had consumed new psychoactive substance to escape reality and to self-treat themselves and stopped consumption due to the adverse effects. Adverse events were reported from the majority of the participants and led to more than 20% of the participants requiring medical treatment following hospitalisation. Findings from this study can contribute to the development of guidelines and policies that specifically address the needs of the homeless population who use new psychoactive substances.
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7
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Brien R, Volpe I, Grigg J, Lyons T, Hughes C, McKinnon G, Tzanetis S, Crawford S, Eade A, Lee N, Barratt MJ. Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia. Harm Reduct J 2023; 20:30. [PMID: 36894933 PMCID: PMC9995746 DOI: 10.1186/s12954-023-00761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. METHODS An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. RESULTS Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves 'conduits' for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be 'shareable' across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. DISCUSSION Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.
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Affiliation(s)
- Rita Brien
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Social and Global Studies Centre, RMIT University, Melbourne, Australia.,Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Tom Lyons
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Caitlin Hughes
- Law and Commerce, Flinders University, Adelaide, Australia.,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Ginny McKinnon
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Stephanie Tzanetis
- Harm Reduction Victoria (DanceWize), Melbourne, Australia.,CanTEST - Directions Health Services, Canberra, Australia
| | - Sione Crawford
- Harm Reduction Victoria (DanceWize), Melbourne, Australia
| | - Alan Eade
- Safer Care Victoria, Melbourne, Australia.,Department of Paramedicine, Monash University, Melbourne, Australia
| | - Nicole Lee
- 360Edge, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia. .,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia. .,Digital Ethnography Research Centre, RMIT University, Melbourne, Australia.
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8
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Syrjanen R, Schumann J, Fitzgerald J, Gerostamoulos D, Abouchedid R, Rotella JA, Knott J, Maplesden J, Hollerer H, Hannon L, Bourke E, Hodgson SE, Greene SL. The Emerging Drugs Network of Australia - Victoria Clinical Registry: A state-wide illicit substance surveillance and alert network. Emerg Med Australas 2023; 35:82-88. [PMID: 36053993 DOI: 10.1111/1742-6723.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With an increasingly dynamic global illicit drug market, including the emergence of novel psychoactive substances, many jurisdictions have moved to establish toxicosurveillance systems to enable timely detection of harmful substances in the community. This paper describes the methodology for the Emerging Drugs Network of Australia - Victoria (EDNAV) project, a clinical registry focused on the collection of high-quality clinical and analytical data from ED presentations involving illicit drug intoxications. Drug intelligence collected from the project is utilised by local health authorities with the aim to identify patterns of drug use and emerging drugs of concern. METHODS The project involves 10 public hospital EDs in Victoria, Australia. Patients 16 years and over, presenting to a network ED with a suspected illicit drug-related toxicity and a requirement for venepuncture are eligible for inclusion in the study under a waiver of consent. Clinical and demographic parameters are documented by site-based clinicians and comprehensive toxicological analysis is conducted on patient blood samples via specialised forensic services. All data are then deidentified and compiled in a project specific database. RESULTS Cases are discussed in weekly multidisciplinary team meetings, with a view to identify potentially harmful substances circulating in the community. High-risk signals are escalated to key stakeholders to produce timely and proportionate public health alerts with a focus on harm minimisation. CONCLUSIONS The EDNAV project represents the first centralised system providing near real-time monitoring of community drug use in Victoria and is fundamental in facilitating evidence-based public health intervention.
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Affiliation(s)
- Rebekka Syrjanen
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Schumann
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - John Fitzgerald
- Department of Criminology, School of Social and Political Sciences, Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachelle Abouchedid
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia.,Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, The Northern Hospital, Northern Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hans Hollerer
- Emergency Department, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Liam Hannon
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia
| | - Elyssia Bourke
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Ballarat Base Hospital, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
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9
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Kozman A, Soderstrom J, Oosthuizen F, Fatovich D. An MDMA cluster and the utility of illicit drug blood sampling. Clin Toxicol (Phila) 2022; 60:1187-1188. [PMID: 36069775 DOI: 10.1080/15563650.2022.2100787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew Kozman
- Clinical Toxicology, Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jessamine Soderstrom
- Clinical Toxicology, Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.,Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Francis Oosthuizen
- ChemCentre, Perth-West Australian Police Toxicology, Perth, Western Australia, Australia
| | - Daniel Fatovich
- Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
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10
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Smith JL, McCutcheon D, Weber C, Soderstrom J, Burcham J, Fatovich DM. ‘Trial by fire’: An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department. Drug Alcohol Rev 2022; 41:1554-1564. [DOI: 10.1111/dar.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer L. Smith
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
| | - David McCutcheon
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
- Royal Perth Hospital Research Foundation Royal Perth Hospital Perth Australia
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
| | - Jonathon Burcham
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
| | - Daniel M. Fatovich
- Centre for Clinical Research in Emergency Medicine Harry Perkins Institute of Medical Research Perth Australia
- East Metropolitan Health Service Department of Health Perth Australia
- Emergency Department Royal Perth Hospital Perth Australia
- Emergency Medicine The University of Western Australia Perth Australia
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11
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Smith JL, Soderstrom J, Dawson A, Alfred S, Greene S, Isoardi K, McCutcheon D, Oosthuizen F, Ezard N, Burcham J, Fatovich DM. The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department. Emerg Med Australas 2021; 34:58-64. [PMID: 34382338 DOI: 10.1111/1742-6723.13839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The unprecedented rise in synthetic drugs, many containing unknown toxic agents, has made timely analytical diagnosis more difficult, and has reduced the confidence of clinicians providing ED management to this population of patients. This has also impacted the quality of evidence informing harm reduction responses. The Emerging Drugs Network of Australia (EDNA) brings together emergency physicians, toxicologists and forensic laboratories to establish a standardised ED toxicosurveillance system in Australia. METHODS Blood analysis of intoxicated patients will be conducted by forensic laboratories to enable precise identification of the substances causing acute toxicity. This will be linked with clinical data collected at the time of ED presentation to enable analysis of the clinical effects and outcomes associated with different illicit and emerging drugs. Toxicological and clinical data collected across sentinel sites will align with a nationally endorsed minimum dataset. RESULTS EDNA's collaborative network will establish a national system of surveillance and reporting of illicit and emerging drugs causing acute toxicity. Standardisation of data collection recorded in a national clinical registry will provide more robust data on epidemiology and associated harms. This will facilitate the translation of clinical and toxicological evidence into timely, appropriate harm reduction and policy. CONCLUSION Our work represents a collaborative response to calls for more sophisticated data on emerging drug trends in Australia. EDNA will improve coordination between clinicians and analytical services by way of its standardised approach to surveillance and reporting.
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Affiliation(s)
- Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Jessamine Soderstrom
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia.,Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.,Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Dawson
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sam Alfred
- Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shaun Greene
- Emergency Department, Austin Hospital, Melbourne, Victoria, Australia.,Victorian Poisons Information Centre, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Isoardi
- Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David McCutcheon
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia.,Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.,Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Clinical Research in Emerging Drugs, c/o National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathon Burcham
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia.,Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Daniel M Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia.,Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia.,Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Partridge E, Alfred S, Camilleri A, Green H, Haustead D, Kostakis C, Mallon J, Mason K, Rivers‐Kennedy A, Stockham P. Establishing the protocols for the South Australian Emergency Department Admission Blood Psychoactive Testing (EDABPT) programme for drug surveillance. Emerg Med Australas 2021; 33:883-887. [DOI: 10.1111/1742-6723.13752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/03/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Emma Partridge
- Forensic Science SA Adelaide South Australia Australia
- College of Science and Engineering Flinders University Adelaide South Australia Australia
| | - Sam Alfred
- Emergency Department Royal Adelaide Hospital Adelaide South Australia Australia
| | | | - Hannah Green
- Emergency Department Lyell McEwin Hospital Adelaide South Australia Australia
| | - Daniel Haustead
- Emergency Department Royal Adelaide Hospital Adelaide South Australia Australia
- Emergency Department The Queen Elizabeth Hospital Adelaide South Australia Australia
| | | | - Jake Mallon
- Emergency Department Flinders Medical Centre Adelaide South Australia Australia
| | - Kerryn Mason
- Forensic Science SA Adelaide South Australia Australia
| | - April Rivers‐Kennedy
- Forensic Science SA Adelaide South Australia Australia
- Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - Peter Stockham
- Forensic Science SA Adelaide South Australia Australia
- College of Science and Engineering Flinders University Adelaide South Australia Australia
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Mégarbane B, Oberlin M, Alvarez JC, Balen F, Beaune S, Bédry R, Chauvin A, Claudet I, Danel V, Debaty G, Delahaye A, Deye N, Gaulier JM, Grossenbacher F, Hantson P, Jacobs F, Jaffal K, Labadie M, Labat L, Langrand J, Lapostolle F, Le Conte P, Maignan M, Nisse P, Sauder P, Tournoud C, Vodovar D, Voicu S, Claret PG, Cerf C. Management of pharmaceutical and recreational drug poisoning. Ann Intensive Care 2020; 10:157. [PMID: 33226502 PMCID: PMC7683636 DOI: 10.1186/s13613-020-00762-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. METHODS A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. RESULTS The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. CONCLUSIONS The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
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Affiliation(s)
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Mathieu Oberlin
- Emergency Department, HuManiS Laboratory (EA7308), University Hospital, Strasbourg, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Inserm U-1173, FHU Sepsis, Raymond Poincaré Hospital, AP-HP, Paris-Saclay University, Garches, France
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, INSERM UMRS-1144, Paris-Saclay University, Boulogne-Billancourt, France
| | - Régis Bédry
- Hospital Secure Unit, Pellegrin University Hospital, Bordeaux, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Isabelle Claudet
- Pediatric Emergency Department Children’s Hospital CHU Toulouse, Toulouse, France
| | - Vincent Danel
- Department of Emergency Medicine, University Hospital of Grenoble, Grenoble, France
| | - Guillaume Debaty
- 5525, University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR, Grenoble, France
| | | | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM U942, University of Paris, Paris, France
| | - Jean-Michel Gaulier
- Laboratory of Toxicology, EA 4483 - IMPECS - IMPact de L’Environnement Chimique Sur La Santé Humaine, University of Lille, Lille, France
| | | | - Philippe Hantson
- Intensive Care Department, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Frédéric Jacobs
- Polyvalent Intensive Care Unit, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Magali Labadie
- Poison Control Centre of Bordeaux, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Labat
- Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, INSERM UMRS-1144, University of Paris, Paris, France
| | - Jérôme Langrand
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Frédéric Lapostolle
- SAMU 93-UF Recherche-Enseignement-Qualité, Inserm, U942, Avicenne Hospital, AP-HP, Paris-13 University, Bobigny, France
| | - Philippe Le Conte
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, INSERM U1042, Grenoble Alpes University, Grenoble, France
| | - Patrick Nisse
- Poison Control Centre, University Hospital of Lille, Lille, France
| | - Philippe Sauder
- Intensive Care Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Dominique Vodovar
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Charles Cerf
- Intensive Care Unit, Foch Hospital, Suresnes, France
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New psychoactive substances in Australia: patterns and characteristics of use, adverse effects, and interventions to reduce harm. Curr Opin Psychiatry 2020; 33:343-351. [PMID: 32250983 DOI: 10.1097/yco.0000000000000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To summarize the most recent peer-review literature on new psychoactive substances (NPS) within Australia. RECENT FINDINGS NPS use among the general Australian population is low, yet more pervasive among specific subpopulations. There is considerable heterogeneity among people who use NPS, however, overall, they are not unique from those who use more established illicit drugs. NPS have been shown to be highly adulterated, used as contaminants, variable in dose, and changeable as to the specific substances available over time. Further, analyses of coroners' cases highlight the importance of consumer understanding of NPS effects, particularly where they differ substantially to their more traditional illicit drug counterparts (e.g., synthetic vs. plant cannabinoids). One study posited that legislative approaches to NPS have been (partially) effective in reducing harms, and there are new systems being established to identify NPS-related health harms. SUMMARY There have been few studies recently published on NPS in Australia (n = 17), however, findings mostly align with the international literature with respect to the rapidly changing nature of the NPS market, the use of NPS as adulterants, and associated harms. These themes highlight the need for proactive, novel approaches to rapidly identify, and respond to emerging drugs of concern.
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Peacock A, Bruno R, Gisev N, Degenhardt L, Hall W, Sedefov R, White J, Thomas KV, Farrell M, Griffiths P. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet 2019; 394:1668-1684. [PMID: 31668410 DOI: 10.1016/s0140-6736(19)32231-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 12/30/2022]
Abstract
The rapid emergence since the mid-2000s of a large and diverse range of substances originally designed as legal alternatives to more established illicit drugs (pragmatically clustered and termed new psychoactive substances; [NPS]) has challenged traditional approaches to drug monitoring, surveillance, control, and public health responses. In this section of the Series, we describe the emergence of NPS and consider opportunities for strengthening the detection, identification, and responses to future substances of concern. First, we explore the definitional complexity of the term NPS. Second, we describe the origins and drivers surrounding NPS, including motivations for use. Third, we summarise evidence on NPS availability, use, and associated harms. Finally, we use NPS as a case example to explore challenges and opportunities for future drug monitoring, surveillance, control, and public health responses. We posit that the current means of responding to emerging substances might no longer be fit for purpose in a world in which different substances can be rapidly introduced, and where people who use drugs can change preferences on the basis of market availability.
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Affiliation(s)
- Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, TAS, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roumen Sedefov
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Paul Griffiths
- European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal
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