Toxicological analysis unveils the low self-reporting rate of addictive/recreative substances in acute severe overdose [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-28003

Toxicological analysis unveils the low self-reporting rate of addictive/recreative substances in acute severe overdose

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. France
2Department of anesthesiology, intensive Care Unit, SAMU de Paris, Necker Hospital Paris, APHP, France
3Regional center of pharmacovigilance of Paris-HEGP, European Hospital of Georges Pompidou. France
4INSERM U970, Paris, France
5University Paris Diderot

Objective: In drug overdose, toxicological analysis (TA) is advised when helping in assessing the prognosis and the treatment. Otherwise, the value of TA remains unclear. This study aimed at defining the value of TA regarding the toxicological diagnosis in severe overdoses involving addictive or recreational drugs (ARD) used either alone or in combination with medicinal drugs.
Methods: Included patients were poisonings admitted in one Intensive Care Unit. TA was performed using technologies up to mass spectrometry on blood/urine on admission. An occurrence means 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 TA: SID+, TA+; 2) SID+, not searched by TA; 3) SID-, TA+.
Results: There were 224 occurrences of 90 substances in 70 patients. ARD were present in 30 (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 in 30 blood measures (81%). Ethanol was involved in 57% of the patients, being the lone substance in only one case.

Conclusion: In overdoses resulting in organ failure(s) and involving ARD, self-reporting is of limited value to assess exposure to ARD. Multiple consumptions expose patients to unsuspected drug-drug interactions.

Keywords: Poisonings, Overdoses, Recreational use, Addiction, Toxicological Analysis

Corresponding Author: Frederic Baud, France

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