title: Drug Misuse in Adolescents Presenting to the Emergency Department.
abstract: OBJECTIVE
  Drug misuse is a disturbing, common practice among youth. One in 4 American adolescents reports consuming prescription medications without a clinical indication. We sought to explore current trends of drug misuse in adolescents.
  
  
  METHODS
  Using the 37 participating sites of the ToxIC (Toxicology Investigators Consortium) Case Registry, a cross-country surveillance tool, we conducted an observational cohort study of all adolescents (aged 13-18 years) who presented to emergency departments with drug misuse and required a bedside medical toxicology consultation between January 2010 and June 2013.
  
  
  RESULTS
  Of 3043 poisonings, 202 (7%) involved drug misuse (139 [69%] were males). Illicit drugs (primarily synthetic cannabinoids and "bath salts") were encountered in 101 (50%), followed by prescription medications (56 [28%]) and over-the-counter (OTC) drugs (51 [25%]). Dextromethorphan was the most commonly misused legal medication (24 [12%]). Polypharmacy exposure was documented in 74 (37%). One hundred sixty-three adolescents (81%) were symptomatic; of these, 81% had central nervous system impairments: psychosis (38%), agitation (30%), coma (26%), myoclonus (11%), and seizures (10%); and 66 (41%) displayed a specific toxidrome, most commonly sedative-hypnotic. Benzodiazepines were the most frequently administered medications (46%). Antidotes were administered to 28% of adolescents, primarily naloxone, physostigmine, N-acetyl-cysteine, and flumazenil. No deaths were recorded.
  
  
  CONCLUSIONS
  Adolescents presenting with drug misuse may be exposed to a wide range and combinations of therapeutics or illicit substances and frequently display central nervous system abnormalities, compromising the ability to obtain a reliable history. Frontline clinicians should maintain a high index of suspicion, as routine toxicology screenings fail to detect most contemporary misused legal and designer drugs.
authors.affiliation: From the *Divisions of Emergency Medicine and †Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ‡Department of Family and Community Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; §Center for Children's Environmental Toxicology, Yale-New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT; ∥Department of Surgery (Emergency Medicine), UT Southwestern School of Medicine, Dallas, TX; and ¶Department of Medicine, University of Colorado, School of Medicine, and Colorado School of Public Health, Aurora, CO.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Finkelstein
authors.forename: Gautam
authors.initials: G
authors.lastname: Goel
authors.forename: Janine R
authors.initials: JR
authors.lastname: Hutson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Armstrong
authors.forename: Carl R
authors.initials: CR
authors.lastname: Baum
authors.forename: Paul
authors.initials: P
authors.lastname: Wax
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D000076064:Drug Misuse / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D014481:United States / Q000453:epidemiology