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Drink and injection spiking: how to approach an increase in presentations?
  1. Tess Blandamer1,2,3,
  2. Jo Daniels4,
  3. James Dear5,6,
  4. Fraser Birse1,
  5. Edward Carlton1,7,
  6. Kate Burgess8,
  7. Tom Roberts1,9
  1. 1 Emergency Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  2. 2 School of Medicine, University of Liverpool, Liverpool, UK
  3. 3 School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
  4. 4 Psychology, University of Bath, Bath, UK
  5. 5 Clinical Toxicology, National Poisons Information Service Edinburgh, Edinburgh, UK
  6. 6 Pharmacology, Therpeutics and Toxicology, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  7. 7 Translational Health Sciences, University of Bristol Medical School, Bristol, UK
  8. 8 Social Sciences and Law, University of Bristol, Bristol, UK
  9. 9 Doctoral Fellow, Royal College of Emergency Medicine, London, UK
  1. Correspondence to Tess Blandamer, The University of Liverpool, Liverpool, L69 3BX, UK; tess.blandamer62{at}


In 2021, there was a significant increase in the number of reported drink spiking incidents across the UK. The new phenomenon of spiking via injection also emerged, which gained significant media attention. Campaigns encouraged potential spiking victims to attend an ED for testing. However, there is limited published research on drink spiking and no published studies on injection spiking. One UK guideline for the management of spiking exists, advising testing ‘if clinically indicated’ and is likely underused. Therefore, patients are often managed without drug testing, psychological support or a clear onward referral pathway. This practice review will explore the background of spiking, discuss drug testing options and highlight the psychological sequelae of spiking. An example guideline for the management of spiking incidents is attached.

  • Diagnostic Tests
  • guideline
  • patient support

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  • Handling editor Mary Dawood

  • Twitter @TessBlandamer, @eddcarlton, @DrTomRoberts

  • Contributors TB wrote and edited the main body of work and organised patient author. TR and FB assisted in writing and editing the manuscript. JoD, as a consultant psychologist and therefore ‘expert author’, wrote the section on psychological sequelae and also reviewed the entire manuscript. JaD, as a consultant toxoicologist and therefore ‘expert author’, wrote sections on drugs used for drink and injection spiking and also reviewed the whole manuscript. EC reviewed the manuscript. KB is the patient author for the case used, and consent attached.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.