Loading

Journal of Substance Abuse and Alcoholism

Low Self-Reporting of Addictive or Recreative Substances in Overdoses Requires Report of the Results of Toxicological Analysis in Suspected Overdoses

Review Article | Open Access | Volume 4 | Issue 2

  • 1. Cognitive Action Group, University Paris Descartes, France
  • 2. Department of anesthesiology, University Paris Descartes, France
  • 3. Department of Pharmacovigilance, Centre hospitalier universitaire de Saint-Etienne, France
  • 4. Labo tox Necker, Université René, France
  • 5. Labo tox Larib, Université René, France
  • 6. Labo tox Garches, Université René, France
+ Show More - Show Less
Corresponding Authors
Frederic J. Baud, Department of anesthesiology, University Paris Descartes, Adult Intensive Care Unit, Necker Hospital, 149, rue de Sevres, 75015, Paris, France Tel: 33-6 62-76-56-02
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.

KEYWORDS

• Poisonings

• Drugs

• Toxicological analysis

CITATION

Alaywa K, Beller CL, Jouffroy R, Cisternino S, Laprevote O, et al. (2016) Low Self-Reporting of Addictive/Recreative Substances in Overdoses Requires Report of the Results of Toxicological Analysis in Suspected Overdoses. J Subst Abuse Alcohol 4(2): 1049.

ABBREVIATIONS

IDF: Ile De France; ICU: Intensive Care Unit; TA: Toxicological Analysis; SID: Supposed Ingested Drug

INTRODUCTION

Severe acute poisonings are a frequent cause of admission to the emergency and intensive care services [1], in both developed countries and in developing countries. They result in 14% of the activity of ICUs in Ile de France (IDF) [2].

Today in France, exhaustive data regarding the involvement of various toxicants, including medicinal drugs and addictive/ recreative substances in these poisonings is difficult to obtain with a great likelihood of accuracy. Indeed, during the course of an overdose, the drugs used are frequently self-reported by the patient or his relatives. In contrast, regarding the use of addictive/recreative drugs, there is a tremendous far lower self-report of the spectrum of chemical used in this addictive/ recreative behavior. However, knowing the most frequently involved substances is essential to guide the management of poisoned patients and guide the toxicological analysis that could be useful in the diagnosis, prognosis and treatment and even prevention of these serious poisoning [3].

The final diagnosis in acute human poisonings is an ongoing process during the course of the poisoning, starting by collection of information, including on the supposed ingested substance(s) and the dose(s). In an emergency medical setting, both items are either self-reported by the conscious cooperative patients, or reported by relatives or paramedics in symptomatic patients, ii) Signs and symptoms observed by witnessers, caregivers, paramedics, and attending physicians on arrival to hospital, that usually allows to refine a toxidrome suggestive of a class of chemicals iii) after admission to hospital, effects of antidotes an number of which are specific antagonists, including naloxone and flumazenil as well as iv) the results of toxicological analysis (TA). However, in addition to toxscreen, the definitive diagnosis requires frequently days and even weeks prior emission to final validated results [2].

A mono centric study of intra tertiary university hospital in Paris over a period of six years, from January 2007 to December 2012 on severe acute drug poisonings as defined by a clinical status needed admission to intensive care unit (ICU) during the course of the poisoning. During this period of time, 1971 consecutive stays were collected, medicinal drugs were self-reported in 81.8 %of the cases, addictive / recreational substances were self-reported in 10.7%, and non-drug substances in 2.7%Substances other were unknown in 4.6% [4].

Analysis of the “top 30” of the most frequently reported substances over this period of time showed that ethanol remained at the top in terms of annual frequency of occurrences, followed by paracetamol. There were a predominance of the class of benzodiazepines including alprazolam, bromazepam, diazepam, clonazepam, oxazepam, prazepam, and benzodiazepine-related drugs, including zopiclone and zolpidem.

The annual analysis of the distribution of poisoning over this period allowed the detection of disappearance and appearance effects of a number of substances. However, in 2010 and only for this year, the occurrence of meprobamate was greater than that of paracetamol. As for dextropropoxyphen after official withdrawal in 2010, dextropropoxyphen was still a cause of severe overdose in 2011, suggesting people stockpiled the drug before withdrawal.

The median drug ingested self-reported by the patients was 3. We looked for any possible interaction between drugs used in self-poisoning. The study of interactions was restricted to cytochromes P450 2A, 2D, 2E, 3A and 3C, 27. The most frequent mechanism was substrate competition. In contrast, enzyme inhibition and possible induction were far less frequent. The ratio of magnitude of competition, inhibition, and induction were 10, 1 and 1, respectively [4].

The toxicological analysis remains the gold standard for the definitive diagnosis of poisonings. However, the added value of TA remains unclear in the different conditions of overdoses including medicinal drug and addictives/recreatives substances overdose. A retrospective, monocentric, clinical, , and observational study was performed in overdoses admitted between the first of January 2014 up to the 17th of April 2015 using complementary facilities provided by three University Toxicological Laboratory in order to clarify the value of TA.

In this study, the supposed ingested drugs were classified in one of the three following groups:

a. SID+ TA+: In this group we included the occurrences of substances that were self-reported and were found by TA

b. SID- TA+: In this group we included the occurrences of substances that were not self-reported but were found by TA

C. SID+, not searched: in this group we included the occurrences of substances that were supposed ingested by the patient but have not been searched by TA

In the SID+, TA+ group, there were a total of 74 occurrences resulting in 51 occurrences (70%) of medicinal drugs and 23 occurrences (30%) of addictive/recreative substances. In the SID+, not searched group there were 142 occurrences (96%) of medicinal drugs and 8 occurrences (4%) of addictive/recreative substances (Table 1).

Table 1: Results of analytical toxicology in terms of detection with and without quantification in response to the supposed ingested addicitive/ recreative substances.

SID+ involving addictive/recreative 
substances
TA+ NOT SEARCHED
ACETONE   1
HEROINE   2
CANNABIS 1  
COCAINE 7 1
ETHANOL 13  
GHB 1 2
MDMA 1 1
MEPHEDRONE   1
TOTAL (occurrences) 23 8

The SID-, TA+ group corresponded to the group of substances that were not reported by the patients but were detected by TA. In this group, TA unveiled 263 occurrences resulting in 116 occurrences of medicinal drugs and 147 occurrences of addictive/ recreative substances (Table 2).

Table 2: Addictive/recreative substances that were found by TA meanwhile not being suspected as reported by the paramedics, rescuers, and medically staffed ambulance in comatose patient or not self-reported by the patient in conscious patients.

SID- involving addictive/
recreative substances
OCCURRENCES
6 MAM 1
COCAINE 35
ETHANOL 37
MDMA 34
THC 40
TOTAL (occurrences) 147
DISCUSSION AND CONCLUSION

Regarding the medicinal drugs, the three laboratories unveiled substances not supposed ingested by history but ingested at a dose resulting in toxic blood concentrations in 15% of cases of medicinal drugs. These findings suggest a rather low rate of efficiency of analytical toxicology even cumulating the capabilities of three toxicological laboratories using modern methodology [5].

Conversely, TA using modern technology is highly efficient methods unveiling exposure to unsuspected addictive/recreative substances and provided highly valuable information to the clinician. The added clinical value of hair analysis regarding the recent past history of use and abuse of recreative and addictive substances remained to be assessed.

Alaywa K, Beller CL, Jouffroy R, Cisternino S, Laprevote O, et al. (2016) Low Self-Reporting of Addictive/Recreative Substances in Overdoses Requires Report of the Results of Toxicological Analysis in Suspected Overdoses. J Subst Abuse Alcohol 4(2): 1049.

Received : 31 May 2016
Accepted : 29 Sep 2016
Published : 01 Oct 2016
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X