General Overview of the Euro-DEN Dataset: 5529 presentations with acute drug toxicity in 16 sentinel European centres Professor Paul I Dargan Guy s s and St Thomas NHS Foundation Trust and King s s College London, London, UK
Conflicts of Interest Member of the UK Advisory Council for the Misuse of Drugs (ACMD) Expert Adviser Word Health Organisation (WHO) Scientific Committee Member European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Euro-DEN The Euro-DEN project had financial support from the DPIP/ISEC Programme of the European Union The Basel costs were co-funded by the Swiss Centre of Applied Human Toxicology (SCAHT)
Euro-DEN European Drug Emergencies Network Why Euro-DEN? EU Drugs Strategy New approaches are required to improve the knowledge of drug-related adverse consequences and assess the risks associated with drugs, in general, and new psychoactive substances (NPS) in particular
Acute Drug Toxicity Data Systematic data is available & reported on Prevalence of drug use Drug seizures Problematic drug use Drug-related deaths There is no systematic data collated on acute drug (and NPS) toxicity Despite this being a key public health indicator on the impact of drug use on the population
What data is currently collected? Survey of REITOX National Focal Points on national and/or regional data collection on acute drug toxicity
12/36 countries: national data on classical drugs 10/36 countries: national data on NPS Why is systematic data on acute drug toxicity not available?
Hospital Coding of Acute Drug Toxicity Hospital admissions (discharges) coded using ICD-10 ICD-10 codes: not available for most drugs No: amphetamine, methamphetamine, MDMA, GHB, ketamine and definitely not NPS Yes: heroin, cocaine, LSD ALSO Cases often coded by predominant clinical feature In most countries only admitted patients are fully coded 60 + % discharged from ED Therefore not possible to automate data collection on acute drug / NPS toxicity
How can we fill this public health gap? Potential acute drug toxicity data sources Data triangulation from a variety of imperfect sources to minimise the limitations and strength of the combination In vitro pharmacological studies, animal studies Internet discussion forums User and sub-population surveys Poisons Information Services Clinical reports from ED presentations Linked sentinel centres = Euro-DEN
The Euro-DEN project has financial support from the DPIP/ISEC Programme of the European Union
Euro-DEN: Three Workstreams Workstream 0: Project Oversight and Management Workstream 1: Acute Drug Toxicity Activity 1: Current European Data on Acute Drug Toxicity Hospital Presentations Activity 2: Development of the minimum dataset Activity 3: 12 month data collection in sentinel centres across Europe Workstream 2: Guidelines and training for staff in recreational settings
Development of the minimum dataset AIM: Capture key demographic, drug-related, clinical and outcome data Excel spreadsheet with ~ 60 data fields - Preformatted lists/drop downs to ensure consistency Demographics Drugs used (self-report), where the drugs were used Clinical pattern of toxicity Outcome: management, admission, length of stay, fatalities
Data Collection in 16 sentinel centres Euro-DEN minimum dataset collected on all ED presentations with acute drug toxicity - clinical features consistent with acute drug/nps toxicity Exclusions October 2013 September 2014 lone alcohol toxicity not directly related to acute drug toxicity e.g. trauma, withdrawal, infection, self-harm Drug(s) involved in presentations based on patient selfreport and clinical interpretation of the drugs used if drug screening undertaken as part of routine clinical care the results were collected
Data Collection in 16 sentinel centres October 2013 September 2014 5529 presentations RESULTS Median (IQR) 0.3% (0.2-0.7%) of all ED presentations at the Euro-DEN centres 8709 (1.6±0.97) drugs involved Significant geographical variation 70% brought to hospital by ambulance 35 arrived in cardiac arrest, 27 (0.5%) fatalities
75.4% male Age: Median 31y (IQR 24 39y) Range 11 90y
n = 8709
Disposition from ER Length of hospital stay Median 4 hr 38 min 78% discharged within 12 hrs 89% discharged within 24 hrs
Published and planned papers Cannabis series Main dataset: Clinical Toxicology In Press Other case series NPS Heroin vs heroin-benzodiazepines Benzodiazepines Psychosis case series MDMA (EMCDDA Trendsetter Meeting Oct 2015) GHB/GBL
Conclusions No current systematic data collection in Europe on acute drug toxicity significant public health gap Euro-DEN: acute drug toxicity data using sentinel centre model - 5529 cases in first year Rich dataset: demographics, drugs, clinical data, outcome Continuing as Euro-DEN Plus Recruited 3 new centres Build on the strength & size of the Euro-DEN dataset Look further at geographical and time trends Inclusion of data in European Drug Report from 2016 Present data to key stakeholders and publish in peer-reviewed literature