Low Self-Reporting of Addictive or Recreative Substances in Overdoses Requires Report of the Results of Toxicological Analysis in Suspected Overdoses - Abstract
Acute poisonings are a common cause of presentation in intensive care units (ICU) while there is no national registry of poisonings in France. Regarding the database we have collected from 2007 to 2012, medicines (81.8%) and addictives / recreatives substances (10.7%) were the most frequently reported substances. The withdrawal of substances exhibiting toxicity in the post-marketing phase occurred frequently, including meprobamate, dextropropoxyphen meanwhile the total number of annually admitted poisoned patients did not decrease. The lack of decrease of the total number of acute poisonings admitted in ICU supports the hypothesis of a mechanism of replacement of toxic drugs by others. In addition the replacement, the database highlighted possible drug-drug interactions that resulted essentially in competition of different substrates to the same cytochrome, far more frequently than inhibition or induction.Gathering facilities provided by three University Tox Labs resulted in a low added value of TA in medicinal drug poisonings. TA was of limited value for the definitive diagnosis of the majority of medicinal drug poisonings and did not allow clarifying drug-drug interaction. Conversely, TA was highly efficient to unveil the exposure of unreported addictive/re creative substances.