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Short report
Increasing emergency department attendances in central London with methamphetamine toxicity and associated harms
  1. James T Harnett1,
  2. Paul I Dargan2,3,
  3. Alison M Dines2,
  4. John R H Archer2,3,
  5. Shaun L Greene4,
  6. Laura J Hunter5,
  7. David M Wood2,3
  1. 1 Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2 Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 'Faculty of Life Sciences and Medicine, King's College, London, UK
  4. 4 Victorian Poisons Information Centre, Austin Hospital, Melbourne, Victoria, Australia
  5. 5 Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr James T Harnett, Emergency Department, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK; j.harnett{at}nhs.net

Abstract

Background Methamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL).

Methods We retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series.

Results A total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014–2018 case series, 94.9% were male with a median (range) age of 35.1 (16–67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care.

Conclusion ED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.

  • toxicology
  • poisoning
  • overdose
  • drug abuse

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/emermed-2020-209550

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Jo Daniels

    • Contributors JH made primary contributions to data collection and analysis, interpretation of results and writing of the manuscript. AD and SG assisted with database interrogation and analysis. All authors contributed to interpretation of results and revision of the manuscript, and all approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.