Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases
Language English Country England, Great Britain Media print-electronic
Document type Journal Article
- Keywords
- Cocaine, acute toxicity, clinical picture, crack, emergency department, epidemiology, management,
- MeSH
- Length of Stay statistics & numerical data MeSH
- Adult MeSH
- Hypnotics and Sedatives administration & dosage therapeutic use MeSH
- Cocaine chemistry toxicity MeSH
- Crack Cocaine chemistry toxicity MeSH
- Humans MeSH
- Cocaine-Related Disorders drug therapy epidemiology mortality MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Emergency Service, Hospital statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe epidemiology MeSH
- Names of Substances
- Hypnotics and Sedatives MeSH
- Cocaine MeSH
- Crack Cocaine MeSH
Objective: To analyse the epidemiology, clinical picture and emergency department (ED) management of a large series of patients who presented to European EDs after cocaine consumption, comparing data from powder (C1 group) and crack (C2 group) consumers. Methods: Between October 2013 and December 2016, the Euro-DEN Plus Registry recorded 17,371 consecutive acute recreational drug toxicity presentations to 22 EDs in 14 European countries. Epidemiological and demographic data, co-ingestion of alcohol and other drugs, clinical features, ED management and outcome (death) were analysed for cocaine cases, and comparison of clinical picture in C1 and C2 patients were performed adjusting for alcohol and other drug co-ingestion. Results: We included 3002 cases (C1: 2600; C2: 376; mixed consumption: 26): mean age 32(9) years, 23% female. The proportion of presentations involving cocaine varied significantly between countries (>30% in Malta, Spain, France, Denmark) and only centres in France, United Kingdom, Poland, Ireland and Malta recorded crack-related cases. Cocaine was frequently used with ethanol (74.3%, C1>C2) and other drugs (56.8%, C2>C1), the most frequent amphetamine (19.4%, C1>C2) and opioids (18.9%, C2>C1). C2 patients were more likely to have clinically significant episodes of hypotension (adjusted OR = 2.35; 95%CI = 1.42-3.89), and bradypnea (1.81; 1.03-3.16) and systolic blood pressure >180 mmHg on ED arrival (2.59; 1.28-5.25); while less likely anxiety (0.51; 0.38-0.70), chest pain (0.47; 0.31-0.70), palpitations (0.57; 0.38-0.84), vomiting (0.54; 0.32-0.90), and tachycardia on ED arrival (0.52; 0.39-0.67). Sedative drugs were given in 29.3%. The median length of hospital stay was 4:02 h, 22.1% patients were hospitalized, and 0.4% (n = 12) died. Conclusion: Cocaine is commonly involved in European ED presentations with acute recreational drug toxicity, but there is variation across Europe not just in the involvement of cocaine but in the proportion related to powder versus crack. Some differences in clinical picture and ED management exist between powder cocaine and crack consumers.
Emergency Department Hospital Clínic Barcelona; IDIBAPS Barcelona Spain
European Monitoring Centre for Drugs and Drug Addiction Lisbon Portugal
Medical School University of Barcelona Barcelona Spain
Servicio de Urgencias Hospital Son Espases Palma de Mallorca Spain
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