title: Presentations to an urban emergency department in Bern, Switzerland associated with acute recreational drug toxicity.
abstract: BACKGROUND
  Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are only available from the University Hospital of Basel. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period.
  
  
  METHODS
  Retrospective analysis of cases presenting from May 2012 to April 2016 at the emergency department of the University Hospital of Bern, Switzerland, with symptoms/signs consistent with acute toxicity of recreational drug use. The cases were retrieved using a comprehensive full-text search algorithm of the electronic health records. Isolated ethanol intoxications were excluded.
  
  
  RESULTS
  During the study period, 503 of the 157,328 emergency department attendances were directly related to acute toxicity of substances used recreationally. The mean patient age was 33 years (range 16-74), 68% were male. Alcohol co-ingestion was reported in 54% of the cases, and use of more than one recreational drug in 37% of the cases. Most presentations were related to cocaine (29%), cannabis (26%), heroin (20%) and benzodiazepines/sedatives (18%). Urine drug screening immunoassay was available in 277 cases (55%). The most frequently detected substances were cannabis (29%), cocaine (22%), benzodiazepines (21%) and opioids excluding methadone (20%). There were only two intoxications with novel psychoactive substances (NPSs): One with methylone and one with 2,5-dimethoxy-4(n)-propylphenethylamine (2C-P). The majority of patients (58%) displayed impaired consciousness (Glasgow Coma Scale (GCS) <15) upon presentation and/or pre-hospital; 21% were unconscious (GCS <8). Other frequent symptoms were agitation (36%), tachycardia (29%), and anxiety (24%). Severe complications included two fatalities, three acute myocardial infarctions, two intracranial haemorrhages, as well as psychosis and seizures in 71 and 26 cases, respectively.
  
  
  CONCLUSIONS
  Most medical problems related to recreational drug use were associated with cocaine and cannabis use and were mainly characterised by central nervous system depression, sympathomimetic toxicity and/or psychiatric disorders. Presentations related to acute toxicities of NPSs appear to be uncommon, while prescription drugs were after classical recreational drugs the substances most commonly reported.
authors.affiliation: Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Evangelia.liakoni@insel.ch.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Liakoni
authors.affiliation: Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Müller
authors.affiliation: Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Stoller
authors.affiliation: Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Meret
authors.initials: M
authors.lastname: Ricklin
authors.affiliation: Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Liechti
authors.affiliation: Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013557:Switzerland / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs
keywords: Acute toxicity; Emergency room; Prescription drug abuse; Psychoactive substances; Recreational drugs