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Syrjanen R, Greene SL, Weber C, Smith JL, Hodgson SE, Abouchedid R, Gerostamoulos D, Maplesden J, Knott J, Hollerer H, Rotella JA, Graudins A, Schumann JL. Characteristics and time course of benzodiazepine-type new psychoactive substance detections in Australia: results from the Emerging Drugs Network of Australia - Victoria project 2020-2022. Int J Drug Policy 2023; 122:104245. [PMID: 37944339 DOI: 10.1016/j.drugpo.2023.104245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The emergence of benzodiazepine-type new psychoactive substances (NPSs) are a growing international public health concern, with increasing detections in drug seizures and clinical and coronial casework. This study describes the patterns and nature of benzodiazepine-type NPS detections extracted from the Emerging Drugs Network of Australia - Victoria (EDNAV) project, to better characterise benzodiazepine-type NPS exposures within an Australian context. METHODS EDNAV is a state-wide illicit drug toxicosurveillance project collecting data from patients presenting to an emergency department with illicit drug-related toxicity. Patient blood samples were screened for illicit, pharmaceutical and NPSs utilising liquid chromatography-tandem mass spectrometry. Demographic, clinical, and analytical data was extracted from the centralised registry for cases with an analytical confirmation of a benzodiazepine-type NPS(s) between September 2020-August 2022. RESULTS A benzodiazepine-type NPS was detected in 16.5 % of the EDNAV cohort (n = 183/1112). Benzodiazepine-type NPS positive patients were predominately male (69.4 %, n = 127), with a median age of 24 (range 16-68) years. Twelve different benzodiazepine-type NPSs were detected over the two-year period, most commonly clonazolam (n = 82, 44.8 %), etizolam (n = 62, 33.9 %), clobromazolam (n = 43, 23.5 %), flualprazolam (n = 42, 23.0 %), and phenazepam (n = 31, 16.9 %). Two or more benzodiazepine-type NPSs were detected in 47.0 % of benzodiazepine-type NPS positive patients. No patient referenced the use of a benzodiazepine-type NPS by name or reported the possibility of heterogenous product content. CONCLUSION Non-prescription benzodiazepine use may be an emerging concern in Australia, particularly amongst young males. The large variety of benzodiazepine-type NPS combinations suggest that consumers may not be aware of product heterogeneity upon purchase or use. Continued monitoring efforts are paramount to inform harm reduction opportunities.
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Affiliation(s)
- Rebekka Syrjanen
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Shaun L Greene
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia.
| | - Courtney Weber
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia; East Metropolitan Health Service, Department of Health, Perth, Australia
| | - Jennifer L Smith
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Australia; East Metropolitan Health Service, Department of Health, Perth, Australia
| | - Sarah E Hodgson
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rachelle Abouchedid
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Dimitri Gerostamoulos
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia
| | - Jacqueline Maplesden
- St Vincent's Hospital Melbourne, Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jonathan Knott
- The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Melbourne Health, Emergency Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Hans Hollerer
- Western Health, Emergency Department, Footscray Hospital, Footscray, Victoria, Australia
| | - Joe-Anthony Rotella
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia; Northern Health, Emergency Department, The Northern Hospital, Epping, Victoria, Australia
| | - Andis Graudins
- Monash Health, Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Dandenong, Victoria, Australia; Monash University, Department of Medicine, Clinical Sciences at Monash Health, FMNHS
| | - Jennifer L Schumann
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia; Monash University, Monash Addiction Research Centre, Frankston, Victoria, Australia
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Syrjanen R, Schumann J, Fitzgerald J, Gerostamoulos D, Abouchedid R, Rotella JA, Knott J, Maplesden J, Hollerer H, Hannon L, Bourke E, Hodgson SE, Greene SL. The Emerging Drugs Network of Australia - Victoria Clinical Registry: A state-wide illicit substance surveillance and alert network. Emerg Med Australas 2023; 35:82-88. [PMID: 36053993 DOI: 10.1111/1742-6723.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With an increasingly dynamic global illicit drug market, including the emergence of novel psychoactive substances, many jurisdictions have moved to establish toxicosurveillance systems to enable timely detection of harmful substances in the community. This paper describes the methodology for the Emerging Drugs Network of Australia - Victoria (EDNAV) project, a clinical registry focused on the collection of high-quality clinical and analytical data from ED presentations involving illicit drug intoxications. Drug intelligence collected from the project is utilised by local health authorities with the aim to identify patterns of drug use and emerging drugs of concern. METHODS The project involves 10 public hospital EDs in Victoria, Australia. Patients 16 years and over, presenting to a network ED with a suspected illicit drug-related toxicity and a requirement for venepuncture are eligible for inclusion in the study under a waiver of consent. Clinical and demographic parameters are documented by site-based clinicians and comprehensive toxicological analysis is conducted on patient blood samples via specialised forensic services. All data are then deidentified and compiled in a project specific database. RESULTS Cases are discussed in weekly multidisciplinary team meetings, with a view to identify potentially harmful substances circulating in the community. High-risk signals are escalated to key stakeholders to produce timely and proportionate public health alerts with a focus on harm minimisation. CONCLUSIONS The EDNAV project represents the first centralised system providing near real-time monitoring of community drug use in Victoria and is fundamental in facilitating evidence-based public health intervention.
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Affiliation(s)
- Rebekka Syrjanen
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Schumann
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - John Fitzgerald
- Department of Criminology, School of Social and Political Sciences, Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachelle Abouchedid
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia.,Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, The Northern Hospital, Northern Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Melbourne, Victoria, Australia
| | - Jacqueline Maplesden
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hans Hollerer
- Emergency Department, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Liam Hannon
- Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia
| | - Elyssia Bourke
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Ballarat Base Hospital, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia
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