Toxicological Analysis Unveiling the Low Rate of Self-Reporting of Addictive/Recreative Substances in Acute Severe Drug Overdose Cases [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-28003 | DOI: 10.5152/TJAR.2019.28003  

Toxicological Analysis Unveiling the Low Rate of Self-Reporting of Addictive/Recreative Substances in Acute Severe Drug Overdose Cases

Khadija Al Alaywa1, Jouffroy Romain2, Christine Le Beller3, Jean-herlé Rapalen2, Lionel Lamhaut4, Agnes Lillo Le Louet3, Frederic Baud5
1UMR - 8257, Cognitive Action Group; University Paris Descartes, Paris, France
2Department of Anaesthesiology, Intensive Care Unit, SAMU de Paris, Necker Hospital Paris, APHP, Paris, France
3Regional Center of Pharmacovigilance of Paris-HEGP, European Hospital of Georges Pompidou, Paris, France
4INSERM U970, Paris, France
5University Paris Diderot, Paris, France

Objective: Toxicological analysis (TA) is advised when assessing the prognosis and the treatment of drug overdose patients. Apart from this use, the value of TA has remained unclear. This study aimed at defining the value of TA regarding the toxicological diagnosis in severe overdose cases that involved addictive or recreational drugs (ARDs) that were used either alone or in combination with medicinal drugs.
Methods: The patients who were enrolled in the study had been admitted to our intensive care unit for the treatment of poisoning. TA was performed using advanced technologies such as mass spectrometry of blood/urine on admission. An occurrence indicated the supposed ingestion of a defined substance. Patients were included in a group depending on the combination of the occurrences of supposed ingested drugs (SID) and the results of the 1) TA: SID+, TA+; 2) SID+, not searched by TA; 3) SID-, TA+.
Results: There were 224 occurrences of 90 substances in 70 patients. ARDs were present in 30 patients (43%). ARD accounted for 24 occurrences in the SID+, TA+ group, 10 occurrences in the SID+, not searched group and 196 occurrences in the SID-, TA+ group. In the SID+, TA+ group, 9 occurrences (69%) of ethanol were confirmed by TA. Ingestion of ethanol was invalidated in 4 occurrences (31%). In the patients who denied ethanol ingestion, TA confirmed the non-ingestion of ethanol using 30 blood measures (81%). Ethanol was involved in 57% of the patients, being the lone substance in only 1 case.
Conclusion: In drug overdose instances that result in organ failure(s) and involve ARDs, self-reporting is of limited value in assessing the patients’ exposure to ARD. Multiple consumptions expose patients to unexpected drug interactions.

Keywords: Addiction, overdoses, poisonings, recreational use, toxicological analysis

Corresponding Author: Frederic Baud, France

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