A cloud on the horizon-a survey into the use of electronic vaping devices for recreational drug and new psychoactive substance (NPS) administration

BACKGROUND

There is limited published scientific data on vaping recreational drugs other than cannabis. A recent review suggested that 15% of people vaping cannabis have also vaped a synthetic cannabinoid receptor agonist (SCRA) and identified over 300 Internet reports of e-liquid manufacture of recreational drugs and/or new psychoactive substances (NPS).

AIM

To determine the prevalence of use of electronic vaping devices for recreational drug and NPS delivery in the UK.

DESIGN

A voluntary online survey using a convenience sample of UK adult participants (aged 16 years old and over) identified by a market research company.

METHODS

Data was collected regarding demographics, smoking history, electronic vaping device history and recreational drug/NPS use and route of administration.

RESULTS

There were 2501 respondents. The mean (±SD) age was 46.2 ± 16.8 years old. The commonest lifetime recreational drug used was Cannabis (818, 32.7%). The majority of respondents had smoked (1545, 61.8%) with 731 (29.2%) being current smokers. The most commonly used SCRA product was 'Spice Gold' (173, 6.9%) and SCRA compound was ADB-CHMICA (48, 1.9%). 861 (34.4%) had used an electronic vaping device; 340 (13.6%) having used them for recreational drug administration; 236 (9.4%) reporting current use. The commonest lifetime recreational drug to be vaped was cannabis (155, 65.7%), with electronic cigarettes (230, 48.2%) being the commonest reported route of SCRA compound administration.

CONCLUSION

9.4% of respondents currently use electronic vaping devices for recreational drug administration with 6.2% reporting lifetime cannabis vaping use. Further larger scale studies are required to help inform the appropriate treatment and primary prevention strategies.

Paracetamol (acetaminophen) pack size restrictions and poisoning severity: time trends in enquiries to a UK poisons centre

BACKGROUND AND OBJECTIVE

In September 1998, legislation was introduced in the United Kingdom to limit paracetamol pack sizes to 16 tablets of 500 mg at general sales outlets and 32 tablets of 500 mg at pharmacies. The effect of the regulations on severity of paracetamol poisoning is unclear. The aim of this study was to describe trends in the severity of paracetamol poisoning and to assess the impact of the 1998 Regulations on the enquiries to a UK poisons centre.

METHODS

We extracted data about the age, sex and number of tablets or capsules of paracetamol ingested by patients notified to Guy's and St Thomas' Poisons Unit (London, UK) between 1996 and 2004.

RESULTS AND DISCUSSION

During the study period, there were approximately 140 000 patients with suspected paracetamol poisoning, accounting for around 11% of all patients reported to the poisons unit. The median number of tablets fell from 25 to 20 for males and 20 to 16 for females after 1998. There was also a reduction in the proportion of patients who ingested 17-32 tablets (from 36% to 30%) and 33-100 tablets (from 25% to 19%).

CONCLUSION

Following the 1998 Regulations there was a decline in the severity, but not frequency, of paracetamol poisoning cases reported to Guy's and St Thomas' Poisons Unit. It is unclear whether the decline in severity was a direct consequence of the regulations.

Primary liposarcoma of the omentum: a case report and review of the literature

A case of round cell liposarcoma of omentum in a 45-year-old man is reported. The patient presented with abdominal pain, swelling and fever of 4-month duration. Abdominal ultrasonography and computed tomogram confirmed the presence of an abdominal mass, but the omental origin of the tumour was revealed only on laparotomy. In addition to the main tumour mass, multiple nodules were present in the omentum. The tumour was excised with omentum. Histopathology of the tumour revealed a round cell liposarcoma. The patient expired 9 months after operation. Eight other cases of liposarcoma of omentum reported in English literature are reviewed.

How feasible is it to conform to the European guidelines on administration of activated charcoal within one hour of an overdose?

OBJECTIVES

The European and American position statement on the use of activated charcoal recommends its administration within an hour of ingestion of a charcoal binding poison. But in reality, this time limit is difficult to follow for the majority of poisoned patients. This study aimed to examine the treatment of acutely poisoned patients with activated charcoal in an accident and emergency (A&E) department.

METHODS

63 patients who had taken potentially serious overdoses and required hospital admission from a London teaching hospital A&E department were identified over a six month period. The patients' case notes were analysed for age, sex, substances taken, and the timing of their management within the A&E department.

RESULTS

Median time of arrival after overdose was 136 minutes, and only 15 patients presented within an hour. Ten of these 15 patients were given activated charcoal, and only four of the 10 received it within the one hour limit. Sixteen patients received charcoal outside the time limit. Subanalysis of the individual cases given charcoal shows that triaging is fast (median five minutes), but a significant time delay occurs after this before charcoal is administered (median 21 minutes).

CONCLUSIONS

These results are likely to be exaggerated in rural hospitals and demonstrate the difficulty of adhering to the recommended guidelines, unless activated charcoal can be safely administered to appropriate patients in the prehospital environment.

Agenesis of gallbladder in symptomatic patients

Three women and one man among 771 patients, who underwent laparotomy with diagnosis of symptomatic gallbladder disease over a period of 5 years, were found to have agenesis of the gallbladder. Preoperative ultrasonography suggested cholelithiasis in all the four patients; three patients with jaundice had choledocholithiasis in addition. The absence of gallbladder was established by meticulous operative exploration and carefully repeated ultrasonography in postoperative period. The patients having choledocholithiasis underwent choledocholithotomy, while the fourth patient had no definitive procedure. One patient expired on 17th postoperative day following biliary leak, septicemia and liver failure. Another two patients were well and symptom free, while the fourth patient remained symptomatic. Awareness of the possibility of agenesis of gallbladder may allow the surgeon to attempt confirmation of diagnosis by non-operative methods and avoid surgical exploration in specific instances.