OBJECTIVE: To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata. METHODS: We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset (22 EDs in 14 European countries) between October 2013 and December 2016 (39 months). Drugs were grouped as: opioids, cocaine, cannabis, amphetamines, gamma-hydroxybutyrate (GHB), hallucinogens, new psychoactive substances (NPS), benzodiazepines and ketamine. Descriptive data by age and sex are presented and compared among age/sex categories and among drug families. RESULTS: Of 17,371 patients were included during the 39-month period, 17,198 (99.0%) had taken at least one of the investigated drugs (median age: 31 years; 23.9% female; ethanol co-ingestion recorded in 41.5%, unknown in 31.2%; multiple drug use in 37.9%). Opioids (in 31.4% of patients) and amphetamines (23.3%) were the most frequently involved and hallucinogens (1.9%) and ketamine (1.7%) the least. Overall, female patients were younger than males, both in the whole cohort (median age 29 vs. 32 years; p < 0.001) and in all drug groups except benzodiazepines (median age 36 vs. 36 years; p = 0.83). The relative proportion of each drug group was different at every age strata and some patterns could be clearly described: cannabis, NPS and hallucinogens were the most common in patients <20 years; amphetamines, ketamine and cocaine in the 20- to 39-year group; GHB/GBL in the 30- to 39-year group; and opioids and benzodiazepines in patients ≥40 years. Ethanol and other drug co-ingestion was more frequent at middle-ages, and multidrug co-ingestion was more common in females than males. CONCLUSION: Differences in the drugs involved in acute drug toxicity presentations according to age and sex may be relevant for developing drug-prevention and education programs for some particular subgroups of the population based on the increased risk of adverse events in specific sex and/or age strata.

Acute Medical Unit York Teaching Hospitals NHS Foundation Trust York UK

Clinical Pharmacology and Toxicology Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Clinical Pharmacology Unit Zealand University Hospital Roskilde Roskilde Denmark

Clinical Toxicology Faculty of Life Sciences and Medicine King's College London London UK

Clinical Toxicology Guy's and St Thomas' NHS Foundation Trust and King's Health Partners London UK

Department and Clinical Pharmacology Bispebjerg University Hospital Copenhagen Denmark

Department of Clinical Toxicology Klinikum rechts der Isar Technical University of Munich Munich Germany

Department of Clinical Toxicology Medical University of Gdansk Gdansk Poland

Department of Emergency Medicine Our Lady of Lourdes Hospital Drogheda Republic of Ireland

Department of General Practice University of Oslo Oslo Accident and Emergency Outpatient Clinic City of Oslo Health Agency Oslo Norway

Department of Medical and Toxicological Critical Care Lariboisière Hospital INSERM UMRS 1144 Paris Diderot University Paris France

Department of Occupational Medicine Toxicological Information Centre Charles Universtity and General Hospital University Prague Czech Republic

Department of Prehospital Medicine Oslo University Hospital Oslo Norway

Division of Clinical Pharmacology and Toxicology Basel University Hospital and University of Basel Basel Switzerland

Emergency Department Hospital Clínic IDIBAPS Barcelona Spain

Emergency Department Hospital Son Espases Palma de Mallorca Spain

Emergency Department Mater Dei Hospital Msida Malta

Emergency Department Mater Misericordiae University Hospital Dublin Republic of Ireland

European Monitoring Centre for Drugs and Drug Addiction Lisbon Portugal

Foundation Pärnu Hospital Pärnu Estonia

Medical School Universitat de Barcelona Barcelona Spain

National Toxicological Information Center University Hospital Bratislava Slovakia

North Estonia Medical Centre Tallin Estonia

Pomeranian Centre of Toxicology Gdansk Poland

The National CBRNe Centre of Medicine Department of Acute Medicine Medical Division Oslo University Hospital Oslo Norway

University Hospital for Emergency Medicine N 1 Pigorov Sofia Bulgaria

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