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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 JL, Lyons T, McKinnon G, Hodgson SE, Abouchedid R, Gerostamoulos D, Koutsogiannis Z, Fitzgerald J, Greene SL. A risk-based approach to community illicit drug toxicosurveillance: operationalisation of the Emerging Drugs Network of Australia - Victoria (EDNAV) project. Int J Drug Policy 2023; 122:104251. [PMID: 37952318 DOI: 10.1016/j.drugpo.2023.104251] [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: 07/10/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The Emerging Drugs Network of Australia - Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. METHODS Risk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 - August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. RESULTS A total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. CONCLUSIONS Continued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making.
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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
| | - 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
| | - Tom Lyons
- The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, Australia
| | - Ginny McKinnon
- The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, 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
| | - Zeff Koutsogiannis
- 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
| | - John Fitzgerald
- The University of Melbourne, Melbourne School of Population and Global Health, Parkville, 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.
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Hodgson SE, Wong A. Utility of NT-proBNP monitoring in prolonged coma following massive baclofen exposure. Emerg Med Australas 2023; 35:359-361. [PMID: 36529482 DOI: 10.1111/1742-6723.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Anselm Wong
- Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, Australia
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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4
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Syrjanen R, Greene SL, Castle JW, Di Rago M, Hodgson SE, Abouchedid R, Graudins A, Schumann JL. Non-fatal intoxications involving the novel benzodiazepine clonazolam: case series from the Emerging Drugs Network of Australia - Victoria project. Clin Toxicol (Phila) 2023; 61:290-293. [PMID: 36988452 DOI: 10.1080/15563650.2023.2183105] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Clonazolam is an unregistered novel benzodiazepine which emerged in global illicit drug markets in 2014. We describe the clinical features of four cases of non-fatal clonazolam mono-intoxications from patients presenting to emergency departments in Australia. CASES Four patients aged between 16 and 19 years presented to hospital with a sedative toxidrome (Glasgow Coma Scale range 8-13) and elevated heart rate (median heart rate 100 beats per minute, range 92-105) following reported benzodiazepine exposure. Three patients reported the use of a large quantity (7-20 tablets) of Xanax®, a brand of alprazolam not commercially available in Australia. Two patients required nasopharyngeal airway insertion following the development of airway obstruction. The median time to return of a normal conscious state (Glasgow Coma Scale 15) was 23 h (range 5-30 h). Clonazolam (range 0.2-2.1 µg/L) and its main metabolite 8-aminoclonazolam (range 5.9-19.1 µg/L) were the only substances detected by liquid chromatography-tandem mass spectrometry in blood samples of all patients. CONCLUSION Clonazolam intoxication resulted in sedation with mild sinus tachycardia. Three patients who reported multiple tablet exposures experienced prolonged sedation, and two of these patients developed airway obstruction. In this series, clonazolam was unknowingly ingested through possible illicit substitution within an unregulated counterfeit benzodiazepine product.
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Affiliation(s)
- Rebekka Syrjanen
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 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
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jared W Castle
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, 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
| | - Andis Graudins
- Monash Health, Emergency Department, Dandenong Hospital, Dandenong, Victoria, Australia
- Department of Medicine, Clinical Sciences at Monash Health, FMNHS, Monash University, Victoria, Australia
| | - Jennifer L Schumann
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
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5
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Hodgson SE, McKenzie C, May TW, Greene SL. A comparison of the accuracy of mushroom identification applications using digital photographs. Clin Toxicol (Phila) 2023; 61:166-172. [PMID: 36794335 DOI: 10.1080/15563650.2022.2162917] [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: 09/21/2022] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To compare the accuracy of three popular mushroom identification software applications in identifying mushrooms involved in exposures reported to the Victorian Poisons Information Centre and Royal Botanic Gardens Victoria. BACKGROUND Over the past 10 years, an increasing number of software applications have been developed for use on smart phones and tablet devices to identify mushrooms. We have observed an increase in poisonings after incorrect identification of poisonous species as edible, using these applications. DESIGN We compared the accuracy of three iPhone™ and Android™ mushroom identification applications: Picture Mushroom (Next Vision Limited©), Mushroom Identificator (Pierre Semedard©), and iNaturalist (iNaturalist, California Academy of Sciences©). Each app was tested independently by three researchers using digital photographs of 78 specimens sent to the Victorian Poisons Information Centre and Royal Botanic Gardens Victoria over a two-year period, 2020-2021. Mushroom identification was confirmed by an expert mycologist. For each app, individual and combined results were compared. RESULTS Picture Mushroom was the most accurate of the three apps and correctly identified 49% (95% CI [0-100]) of specimens, compared with Mushroom Identificator (35% [15-56]) and iNaturalist (35% [0-76]). Picture Mushroom correctly identified 44% of poisonous mushrooms [0-95], compared with Mushroom Identificator (30% [1-58]) and iNaturalist (40% [0-84), but Mushroom Identificator identified more specimens of Amanita phalloides correctly (67%), compared to Picture Mushroom (60%) and iNaturalist (27%). Amanita phalloides was falsely identified, twice by Picture Mushroom and once by iNaturalist. CONCLUSIONS Mushroom identification applications may be useful future tools to assist clinical toxicologists and the general public in the accurate identification of mushrooms species but, at present, are not reliable enough to exclude exposure to potentially poisonous mushrooms when used alone.
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Affiliation(s)
- Sarah E Hodgson
- Victorian Poisons Information Centre, Austin Health, Melbourne, Australia
- Emergency Department, Austin Health, Melbourne, Australia
| | - Christine McKenzie
- Victorian Poisons Information Centre, Austin Health, Melbourne, Australia
| | - Tom W May
- Royal Botanic Gardens Victoria, Melbourne, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Health, Melbourne, Australia
- Emergency Department, Austin Health, Melbourne, Australia
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6
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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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Syrjanen R, Schumann J, Hodgson SE, Abouchedid R, Rotella JA, Graudins A, Greene SL. From signal to alert: A cluster of exposures to counterfeit alprazolam tablets containing five novel benzodiazepines. Emerg Med Australas 2023; 35:165-167. [PMID: 36271800 DOI: 10.1111/1742-6723.14108] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To illustrate the toxicosurveillance role of the Emerging Drugs Network of Australia - Victoria (EDNAV) project in informing timely harm minimisation interventions. METHODS Utilisation of an ethics approved clinical registry storing de-identified clinical and analytical data on Victorian ED illicit drug-related presentations. RESULTS In April 2022, six adults presented to hospital with varying levels of sedation, following the use of counterfeit benzodiazepines. Comprehensive toxicological analysis identified five separate novel benzodiazepines within blood samples from each patient. A public 'Drug Alert' was subsequently issued, and local emergency physicians were notified. CONCLUSION Toxicosurveillance projects, such as EDNAV, are critical to the continued monitoring and reporting of illicit substance use in the community.
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Affiliation(s)
- Rebekka Syrjanen
- Monash University, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Toxicology, Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Jennifer Schumann
- Monash University, Melbourne, Victoria, Australia.,Department of Toxicology, Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, 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
| | - Rachelle Abouchedid
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Bendigo Hospital, Bendigo Health, Bendigo, Victoria, Australia
| | - Joe-Anthony Rotella
- 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, The Northern Hospital, Northern Health, Melbourne, Victoria, Australia
| | - Andis Graudins
- Emergency Department, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Facility of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Austin Hospital, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Hodgson SE, Graudins A. Oral iron overdose following intravenous iron infusion: to chelate or not? Clin Toxicol (Phila) 2022; 60:1285-1287. [PMID: 36154547 DOI: 10.1080/15563650.2022.2112691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S E Hodgson
- Victorian Poisons Information Centre, Austin Health, Victoria, Australia.,Emergency Department, Austin Health, Victoria, Australia
| | - A Graudins
- Victorian Poisons Information Centre, Austin Health, Victoria, Australia.,Monash Clinical Toxicology Unit, Emergency Medical Service, Monash Health, Victoria, Australia.,Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Emergency Research Collaborative, Monash University, Dandenong, Australia
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9
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Hodgson SE, Wong A. Comment on Single bag high dose intravenous N-acetylcysteine associated with decreased hepatotoxicity compared to triple bag intravenous N-acetylcysteine in high-risk acetaminophen ingestions. Clin Toxicol (Phila) 2021; 60:662-663. [PMID: 34791959 DOI: 10.1080/15563650.2021.2004157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Anselm Wong
- Emergency Department, Austin Health, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Department of Critical Care, Melbourne Medical School, University of Melbourne, Victoria, Australia
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10
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Hodgson SE, Sulaeman SJ, Stanley B, Koutsogiannis Z, Braitberg G. Toceranib: Isolated acute liver injury following ingestion of a canine tyrosine kinase inhibitor treated with N-acetylcysteine. Clin Toxicol (Phila) 2021; 60:538-539. [PMID: 34581252 DOI: 10.1080/15563650.2021.1982960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S E Hodgson
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Australia.,Emergency Department, Austin Health, Heidelberg, Australia
| | - S J Sulaeman
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Australia.,Monash Toxicology and Emergency Department, Monash Health, Clayton, Australia
| | - B Stanley
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Australia
| | - Z Koutsogiannis
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Australia.,Emergency Department, Austin Health, Heidelberg, Australia
| | - G Braitberg
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Hodgson SE, Harding AM, Bourke EM, Taylor DM, Greene SL. A prospective, randomized, double-blind trial of intravenous chlorpromazine versus intravenous prochlorperazine for the treatment of acute migraine in adults presenting to the emergency department. Headache 2021; 61:603-611. [PMID: 33797074 DOI: 10.1111/head.14091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/05/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the efficacy of intravenous chlorpromazine versus intravenous prochlorperazine for the treatment of acute migraine in adults presenting to the emergency department (ED). BACKGROUND Migraine is a common, incapacitating neurological condition. Although chlorpromazine and prochlorperazine are known to be safe, efficacious treatments for migraine, they have never been directly compared. DESIGN We performed a prospective, randomized, double-blind clinical trial at a tertiary hospital in Melbourne, Australia. Adults aged 18-65 years, who presented with migraine, were eligible for recruitment. Sixty-six patients were randomized to either chlorpromazine 12.5 mg or prochlorperazine 12.5 mg, both infused in 500 ml of sodium chloride 0.9% over 30 min. Headache severity score, nausea severity score, and the presence of photophobia and phonophobia were assessed at 0, 30, 60, and 120 min. Adverse effects and the need for rescue therapy were recorded. The primary outcome was a reduction in headache severity score from baseline at 60 min post-commencement of the study medicine infusion. RESULTS Sixty-five patients were included in the analysis. There was a median reduction in headache severity score at 60 min of 3.0 (interquartile range 1.0-4.0) in the chlorpromazine arm versus 2.0 (1.0-4.0) in the prochlorperazine arm (median difference -0.5 (95% confidence interval, -1.9 to 0.9)). We saw no evidence of a difference in secondary outcomes at 30, 60, or 120 min. Side effects were reported in 16/32 (50%) patients in the chlorpromazine group versus 7/33 (21%) in the prochlorperazine group (p = 0.020). Rescue therapy was required in 7/32 (22%) patients in the chlorpromazine group versus 12/33 (36%) in the prochlorperazine group (p = 0.277). CONCLUSIONS Both chlorpromazine and prochlorperazine are efficacious treatments for acute migraine in adult patients presenting to the ED. This trial found no evidence of superiority of either agent over the other. Caution should be used when prescribing these medicines in the borderline hypotensive patient; in that circumstance, prochlorperazine should be preferentially used.
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Affiliation(s)
- Sarah E Hodgson
- Emergency Department, Austin Health, Melbourne, VIC, Australia
| | - Andrew M Harding
- Emergency Department, Austin Health, Melbourne, VIC, Australia.,Pharmacy Department, Austin Health, Melbourne, VIC, Australia
| | | | - David M Taylor
- Emergency Department, Austin Health, Melbourne, VIC, Australia.,Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia
| | - Shaun L Greene
- Emergency Department, Austin Health, Melbourne, VIC, Australia.,Victorian Poisons Information Centre, Austin Health, Melbourne, VIC, Australia
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Blake KE, Dalbow MH, Concannon JP, Hodgson SE, Brodmerkel GJ, Panahandeh AH, Zimmerman K, Headings JJ. Clinical significance of the preoperative plasma carcinoembryonic antigen (CEA) level in patients with carcinoma of the large bowel. Dis Colon Rectum 2001; 25:24-32. [PMID: 7056138 DOI: 10.1007/bf02553544] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preoperative levels of perchloric acid extractable plasma CEA were measured in 911 patients with complaints of the digestive system. A final diagnosis of benign disease was made for 579 patients; 332 patients were found to have cancer. Data for the preoperative CEA values were examined for clinical significance as an aide to diagnosis, preoperative disease staging, and prognosis. The results of our analysis support the conclusions of many investigators that the CEA assay is not a clinically useful diagnostic test, but it shows limited value in preoperative staging and a somewhat stronger correlation with prognosis.
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Sinard RJ, Tobin EJ, Mazzaferri EL, Hodgson SE, Young DC, Kunz AL, Malhotra PS, Fritz MA, Schuller DE. Hypothyroidism after treatment for nonthyroid head and neck cancer. Arch Otolaryngol Head Neck Surg 2000; 126:652-7. [PMID: 10807335 DOI: 10.1001/archotol.126.5.652] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To determine the incidence of posttreatment hypothyroidism in patients treated with surgery with or without radiotherapy for advanced-stage nonthyroid head and neck cancer and to make recommendations for its detection. DESIGN A prospective study to assess the incidence and time frame of occurrence of hypothyroidism in patients by primary tumor site and treatment modality. Thyroid function tests were performed preoperatively, at the first postoperative visit, and then approximately every 6 months. Patients were followed up for up to 3 years. SETTING Arthur G. James Cancer Hospital and Research Institute, Columbus, Ohio. PATIENTS A total of 251 patients with nonthyroid head and neck cancer were originally enrolled; 198 patients with evaluable data were studied to determine the incidence of posttreatment hypothyroidism. Approximately 80% of the patients had advanced stage (III or IV) or recurrent cancer. RESULTS The overall incidence of posttreatment hypothyroidism was 15% in 198 patients followed up for a mean of approximately 12 months. Hypothyroidism developed in 12% of patients treated with nonlaryngeal surgery and radiotherapy. The group undergoing total laryngectomy (with thyroid lobectomy) and radiotherapy had a 61% incidence of hypothyroidism. The average time to detection of hypothyroidism was 8.2 months. CONCLUSIONS Approximately 15% of patients treated for advanced head and neck cancer with surgery and radiotherapy will develop hypothyroidism. Those treated with total laryngectomy and radiotherapy are at greatest risk.
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Affiliation(s)
- R J Sinard
- Department of Otolaryngology, Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus 43210, USA
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Rossie KM, Taylor J, Beck FM, Hodgson SE, Blozis GG. Influence of radiation therapy on oral Candida albicans colonization: a quantitative assessment. Oral Surg Oral Med Oral Pathol 1987; 64:698-701. [PMID: 3320843 DOI: 10.1016/0030-4220(87)90171-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An increase in quantity of oral Candida albicans was documented in patients receiving head and neck radiation therapy during and after therapy, as assessed by an oral-rinse culturing technique. The amount of the increase was greater in denture wearers and directly related to increasing radiation dose and increasing volume of parotid gland included in the radiation portal. A significant number of patients who did not carry C. albicans prior to radiation therapy developed positive cultures by 1 month after radiation therapy. The percentage of patients receiving head and neck radiation therapy who carried C. albicans prior to radiation therapy did not differ significantly from matched dental patient controls.
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Abstract
The Ohio State University Registry recorded 1208 uterine corpus malignancies between 1940 and 1983. Thirty cases occurred in women with a history of pelvic irradiation. Eight patients had previously been irradiated for pelvic malignancy, four of whom presented with advanced stage sarcomas and died of their disease within 14 months. This represents an increase over the expected sarcoma prevalence which is less than 5%. In contrast, the majority of women (20 of 22) previously irradiated for benign conditions were diagnosed with endometrial adenocarcinoma. In 18, the adenocarcinoma was diagnosed as Stage I, and the prognosis was only slightly less favorable than for nonirradiated women. No significant effect of age at the time of irradiation was apparent. This study of women with a history of pelvic irradiation who later developed uterine cancer demonstrates a tendency for patients previously irradiated for pelvic malignancy to present with advanced stage, extremely aggressive uterine tumors compared to those previously irradiated for benign conditions.
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Hodgson SE, Heath H. Asymptomatic primary hyperparathyroidism: treat or follow? Mayo Clin Proc 1981; 56:521-3. [PMID: 7266062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Cancericidal doses of irradiation therapy to be the head and neck may be followed by paralysis of cranial nerves due to fibrosis of tissue about the nerves and infiltration of the nerves with fibrous tissue. The hypoglossal nerve is particularly prone to this delayed effect of irradiation therapy and a case is presented here in which there was bilateral hypoglossal paresis appearing three years after therapy.
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Concannon JP, Dalbow MH, Hodgson SE, Headings JJ, Markopoulos E, Mitchell J, Cushing WJ, Liebler GA. Prognostic value of preoperative carcinoembryonic antigen (CEA) plasma levels in patients with bronchogenic carcinoma. Cancer 1978; 42:1477-83. [PMID: 709518 DOI: 10.1002/1097-0142(197809)42:3+<1477::aid-cncr2820420818>3.0.co;2-e] [Citation(s) in RCA: 80] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Concannon JP, Dalbow MH, Davis W, Hodgson SE, Mitchell J, Markopoulos E. Immunoprofile studies for patients with bronchogenic carcinoma--III. Multivariate analysis of immune tests in correlation with survival. Int J Radiat Oncol Biol Phys 1978; 4:255-61. [PMID: 646868 DOI: 10.1016/0360-3016(78)90146-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Liebler GA, Concannon JP, Magovern GJ, Dalbow MH, Hodgson SE. Immunoprofile studies for patients with bronchogenic carcinoma. I. Correlation of pretherapy studies with survival. J Thorac Cardiovasc Surg 1977; 74:506-18. [PMID: 302883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The general immune competence of 146 patients with bronchogenic carcinoma was measured, prior to irradiation therapy, by determining dinitrochlorobenzene (DNCB) reactivity, delayed cutaneous hypersensitivity (DCH) response to microbial antigens, peripheral lymphocyte counts, peripheral T and B lymphocyte counts, and the response of patient's lymphocytes to stimulation by phytohemagglutinin (PHA), concanavallin A (Con A) and pokeweed mitogen (PWM). Analyses were performed by the life-table method to determine the correlation of the immune status of these patients with survival rates. Statistically significant differences in survival were noted between the groups of patients with normal values when compared with the patients with abnormal values for the majority of the tests of general immunity. A stage of disease correlation with survival rate was noted for all groups of patients with abnormal immune measurements, but it was absent for many of the immune parameters when patients with normal values were compared. The effects of histology, age, and sex did not appear to influence the survival data as significantly as did the immune status of the patient. These data indicate that measurements of general immune competence may be of significant prognostic value for the management of patients with bronchogenic carcinoma. The measurement of DNCB reactivity shows the strongest correlation with survival rate.
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Concannon JP, Dalbow MH, Weil C, Hodgson SE. Radiation and actinomycin D mortality studies: circadian variations in lethality due to independent effects of either agent. Int J Radiat Biol Relat Stud Phys Chem Med 1973; 24:405-11. [PMID: 4542926 DOI: 10.1080/09553007314551261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Concannon JP, Dalbow MH, Hagemann RF, Frich JC, Hodgson SE, Weil CS, Martinelli R. Radiation and actinomycin D mortality studies in C57BL 6 mice. II. Combined treatment and gastrointestinal lethality. Cancer 1973; 32:553-61. [PMID: 4726963 DOI: 10.1002/1097-0142(197309)32:3<553::aid-cncr2820320307>3.0.co;2-c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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