Drug dependent individuals dealt with by London casualty departments

Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service

Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs.

After antagonization of acute opiate overdose: a survey at hospitals in Vienna

This study describes the clinical management and characteristics of people who, following acute opioid overdose, are taken to hospital after efficient antagonization by the pre-hospital emergency service. In addition, it defines areas of interest for further research. Over a 4-month period (September-December 1993) we collected data by a structured protocol sheet on patients' characteristics, anamnestic data on abuse and emergencies, clinical presentation, treatment by specific antidote and routine laboratory investigations. Outcome was verified by retrospective review of prehospital and forensic data. We studied 77 subjects, predominantly young males, who were involved in 83 emergencies, mostly occurring at weekends. In more than 60% of cases a single administration of specific antidote sufficed to stabilize the patients; 64% of patients left hospital against medical advice after an average stay of less than 6 hours; 46% denied daily opioid abuse and half the subjects, especially younger drug-users, seemed interested in counselling. This hospital-based study did not provide reliable data on the epidemiology of opioid overdose. Clinical management is determined by experience, pragmatism and beliefs. Efforts towards secondary prevention of drug problems at emergency departments might be warranted, and further research on pattern and management of opioid overdose is needed.

Prehospital opiate emergencies in Vienna

To establish baseline data on prehospital emergencies caused by opiates during a 4-month period, a retrospective analysis of run records of the Emergency Medical System in Vienna, the capital of Austria, was conducted. During the study period, there were 308 opioid emergencies involving 240 persons, an average of 2.5 overdoses per day. Severely compromised patients were treated in 67.8% of the 308 emergencies, and 79.3% of emergencies were transported to hospital; 52.5% of the involved persons were younger than 22 years of age. Sex distribution and periodicity and frequency of emergencies differed among age groups. A subgroup of individuals involved repeatedly in emergencies was identified, partly showing temporal clustering of fatal and nonfatal overdoses. Persons involved in opiate emergencies belong to heterogenous subgroups. At a local level, research should be initiated to clarify the pattern and impact of these emergencies on overall drug abuse prevention.

Classification of overdose/self-poisoning presentations to an accident and emergency department

A simple classification system of overdoses presenting to a hospital emergency department is described. Five major overdose categories were developed (accidental, suicidal behavior, recreational/experimentation, compulsive use, and an indeterminate category), which were divided into 10 subcategories. A prospective survey at an inner-city hospital in Sydney classified 199 consecutive self-poisoning presentations as being due to compulsive drug use in 38% of cases; suicidal gesture as a reaction to stress, 17%; adverse reactions to recreational or experimental use, 15%; suicidal gesture to influence others, 7%; genuine accident or noncompliance with medication, 6%; genuine suicide attempt, 3%; and pseudo-overdose, 3%. The reason for the overdose was uncertain in the remainder of the cases. Additional data are also presented, including the types of drugs involved in each overdose category. Categories of overdose may be useful in psychosocial assessment for follow-up interventions, assist in research, and help reduce negative attitudes toward overdoses.

Monitoring changing patterns of drug dependence in accident and emergency departments

A survey was made of drug dependent individuals attending the Accident and Emergency Departments in Greater London in July 1982 and the results were compared with those of an identical survey in July 1975. There was a significant reduction in the number of incidents involving drug dependent patients, the majority of whom attended hospital after a drug overdose; the proportion of suicidal attempts increased significantly in 1982. Barbiturates were taken less frequently in 1982, but heroin and anxiolytics were taken more often. Possible reactions to these findings are discussed and the continuing role of the Accident and Emergency Departments in monitoring changing patterns of drug abuse in emphasised.

Unemployment and illegal drug use: concordant evidence from a prospective study and national trends

Data from a previous study of 1036 young people in the Lothian region that indicated an association between unemployment and illegal drug use were examined in more depth to investigate the inter-relation between duration of unemployment and the use of illegal drugs, alcohol, and tobacco. After factors such as social class background and educational qualifications had been taken into account a weak but significant association was found between duration of unemployment and illegal drug use. No such association was found for alcohol or tobacco. Similar results were obtained from an analysis of national statistics related to unemployment and illegal drug use. Both sets of data thus indicate that illegal drug use is moderately associated with unemployment.

British policies on opiate addiction: ten years working of the revised response, and options for the future

It is now ten years since the Drug Clinics were set up. In the early 1960's a long established equilibrium broke down, and the number of narcotic addicts known to the Home Office began to rise steeply. The new addicts were predominantly in their early 20's, and drugs were being obtained either from the over-generous prescribing of a handful of doctors or from the spill-over of this prescribing to the black market (Bewley, 1965 (1), 1966 (2)). Heroin was the essential agent of this epidemic, with cocaine as the major ancillary.

Mortality among drug addicts in Greater London

During January 1970 to December 1974, 134 deaths in people aged 10-50 years investigated by coroners in Greater London were recorded as being due to drug addiction. Over three-quarters of the addicts were under 30, and 105 (78%) were male; 55 (41%) were unknown to the Home Office. Barbiturate overdose accounted for over half of the deaths, though two-thirds of these were in people registered as addicts to notifiable drugs. Since the Home Office index is concerned with addiction to one class of drugs only, it fails to reflect accurately the prevalence of all serious forms of addiction. Owing to the continuous change in drug-taking behaviour, however, probably no one method of assessment can provide a complete picture, and thus complementary research methods are essential.

Distribution of drug-related problems among London casualty departments

A survey of patients with drug-related problems seen in London casualty departments during the course of one month revealed 1,706 separate incidents. In 477 cases the patients were dependent on drugs, and more than 40 per cent were dealt with by only five hospitals, all in the West End of London. The remaining 1,229 incidents involved nondependent patients who had taken a drug overdose, and these cases were distributed more evenly between hospitals all over the Greater London area. The implications of this study for service planning and for further monitoring of the patterns of drug misuse are discussed.