Pattern and characteristics of ecstasy and related drug (ERD) presentations at two hospital emergency departments, Melbourne, Australia, 2008–2010
- Danielle Horyniak1,2,
- Louisa Degenhardt3,4,
- De Villiers Smit5,
- Venita Munir6,
- Jennifer Johnston7,
- Craig Fry8,9,
- Paul Dietze1,2
- 1Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
- 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- 3National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- 4Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
- 5Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
- 6Emergency Department and Emergency Practice Innovation Centre, St Vincent's Health, Melbourne, Victoria, Australia
- 7Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- 8Centre for Cultural Diversity and Wellbeing, Faculty of Arts, Education and Human Development, Victoria University, Melbourne, Victoria, Australia
- 9Centre for Health & Society, School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
- Correspondence to Danielle Horyniak, Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia;
- Received 22 November 2012
- Revised 11 January 2013
- Accepted 13 January 2013
- Published Online First 12 February 2013
Objective To describe patterns and characteristics of emergency department (ED) presentations related to the use of ecstasy and related drugs (ERDs) in Melbourne, Australia.
Methods Retrospective audit of ERD-related presentations from 1 January 2008 to 31 December 2010 at two tertiary hospital EDs. Variation in presentations across years was tested using a two-tailed test for proportions. Univariate and multivariate logistic regressions were used to compare sociodemographic and clinical characteristics across groups.
Results Most of the 1347 presentations occurred on weekends, 24:00–06:00. Most patients arrived by ambulance (69%) from public places (42%), private residences (26%) and licensed venues (21%). Ecstasy-related presentations decreased from 26% of presentations in 2008 to 14% in 2009 (p<0.05); γ-hydroxybutyrate (GHB) presentations were most common overall. GHB presentations were commonly related to altered conscious state (89%); other presentations were due to psychological concerns or nausea/vomiting. Compared with GHB presentations, patients in ecstasy-related presentations were significantly less likely to require intubation (OR 0.04, 95% CI 0.01 to 0.18), but more likely to result in hospital admission (OR 1.77, 95% CI 1.08 to 2.91). Patients in amphetamine-related cases were older than those in GHB-related cases (median 28.4 years vs 23.9 years; p<0.05), and more likely to have a history of substance use (OR 4.85, 95% CI 3.50 to 6.74) or psychiatric illness (OR 6.64, 95% CI 4.47 to 9.87). Overall, the median length of stay was 3.0 h (IQR 1.8–4.8), with most (81%) patients discharged directly home.
Conclusions Although the majority of ERD-related presentations were effectively treated, with discharge within a short time frame, the number and timing of presentations places a significant burden on EDs. ERD harm reduction and improved management of minor harms at licensed venues could reduce this burden.