Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases

Abstract

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.

Keywords:

• Cocaine
• crack
• acute toxicity
• emergency department
• epidemiology
• clinical picture
• management

Acknowledgements

Euro-DEN Plus Research Group corporate authors: Jacek Sein Anand (Division of Clinical Toxicology, Medical University of Gdansk, Poland; Pomeranian Center of Toxicology, Gdansk, Poland; E-mail: [email protected]), Jeffrey Bonnici (Emergency Department, Mater Dei Hospital, Msida, MSD 2090, Malta; E-mail: [email protected]), Blazena Caganova (National Toxicological Information Centre, University Hospital, Bratislava, Slovakia; E-mail: [email protected]), Florian Eyer (Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Germany), Gesche Jürgens (Zealand University Hospital Roskilde, Clinical Pharmacology Unit, Roskilde, Denmark; E-mail: [email protected]), Piotr Maciej Kabata (Pomeranian Centre of Toxicology, Gdansk, Poland; Medical University Gdansk, Department of Clinical Toxicology, Gdansk, Poland; E-mail: [email protected]), Evangelia Liakoni (Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Switzerland), Matthias E Liechti (Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Switzerland), Bruno Mégarbane (Department of Medical and Toxicological Critical Care, Lariboisi`re Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France), Adrian Moughty (Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland), Niall O'Connor (Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland), Raido Paasma (Foundation Pärnu Hospital, Pärnu Estonia), Per Sverre Persett (Department of Acute Medicine, Medical Division, Oslo University Hospital, Norway; E-mail: [email protected]), Kristiina Põld (Emergeny Medicine Department, North-Estonia Medical Centre, Tallinn, Estonia), Julia Radenkova-Saeva (University Hospital for Emergency Medicine “N.I.Pirogov”, Sofia, Bulgaria), Irene Scholz (Clinical Pharmacology & Toxicology, University Hospital Bern, Bern, Switzerland), Odd Martin Vallersnes (Department of General Practice, University of Oslo, Oslo, Norway; 2. Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway), W Stephen Waring (Acute Medical Unit, York Teaching Hospitals NHS Foundation Trust, York, UK), and Sergej Zacharov (Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic).

Additional information

Funding

Present study was in part possible due to a grant of Generalitat de Catalunya [Catalan Government, GRC 2009/1385, 2014/0313 y 2017/1424], and a grant of the DPIP/ISEC Programme of the European Union [JUST/2012/DPIP/AG/3591]; Institute for Social and Economic Change.