Follow-up after acute poisoning by substances of abuse: a prospective observational cohort study

Figures & data

Figure 1. Participants, inclusion, and exclusion.

Table 1. Follow-up initiated after treatment for acute poisoning by substances of abuse.

	Addiction emergencyclinic n (%)	Addiction outpatientclinic n (%)	Psychiatric outpatientclinic n (%)	General practitionern (%)	Social servicesn (%)	Homeless sheltern (%)	Other follow-upn (%)	Discharge withoutfollow-up^b n (%)	Self dischargen (%)	Total cases^cn (%)
Males	89 (77)	22 (50)	39 (52)	56 (62)	63 (77)	56 (76)	65 (70)	727 (66)	224 (69)	1312 (67)
Age^a	45 (34–54)	37 (23–46)	28 (22–46)	39 (29–54)	49 (32–62)	39 (31–48)	30 (22–43)	33 (22–47)	42 (29–52)	37 (24–49)
Suicide attempt	8 (7)	4 (9)	36 (48)	11 (12)	4 (5)	–	2 (2)	5 (<0.5)	12 (4)	78 (4)
Main toxic agent
Ethanol	74 (64)	18 (41)	29 (39)	51 (56)	41 (50)	13 (18)	42 (45)	751 (69)	187 (58)	1188 (61)
Opioids	25 (22)	10 (23)	13 (17)	18 (20)	28 (34)	53 (72)	26 (28)	192 (18)	88 (27)	437 (22)
Benzodiazepines	8 (7)	6 (14)	27 (36)	13 (14)	7 (9)	2 (3)	11 (12)	46 (4)	14 (4)	129 (7)
Central stimulants	5 (4)	6 (14)	2 (3)	5 (5)	2 (2)	3 (4)	6 (6)	48 (4)	14 (4)	90 (5)
GHB	2 (2)	2 (5)	1 (1)	2 (2)	1 (1)	–	4 (4)	22 (2)	12 (4)	45 (2)
Other/unknown	2 (2)	2 (5)	3 (4)	2 (2)	3 (4)	3 (4)	4 (4)	37 (3)	9 (3)	63 (3)
Total cases^c	116 (100)	44 (100)	75 (100)	91 (100)	82 (100)	74 (100)	93 (100)	1096 (100)^b	324 (100)	1952 (100)

a Median (IQR).

b Including 362/1096 (33%) cases in which the patient did not want any follow-up.

c In each case, the patient may have been referred to more than one category of follow-up. There was no overlap in referrals to addiction emergency clinic, addiction outpatient clinic and psychiatric outpatient clinic.

Table 2. Cases in which the patient was discharged without follow-up.

	Seen by Psychiatric Emergency Servicebefore discharge n (%)	Seen by Emergency Social Service beforedischarge n (%)	Patient did not want any follow-up n (%)	All other discharges not offered follow-up n (%)	Total discharged without follow-up n (%)
Males	5 (45)	168 (55)	260 (72)	308 (70)	727 (66)
Age^a	45 (32–56)	20 (19–22)	42 (30–52)	37 (27–49)	33 (22–47)
Suicide attempt	4 (36)	1 (<0.5)	2 (1)	1 (<0.5)	5 (<0.5)
Main toxic agent
Ethanol	5 (45)	228 (75)	231 (64)	296 (67)	751 (69)
Opioids	3 (27)	40 (13)	77 (21)	80 (18)	192 (18)
Benzodiazepines	–	9 (3)	18 (5)	21 (5)	46 (4)
Central stimulants	3 (27)	13 (4)	17 (5)	19 (4)	48 (4)
GHB	–	3 (1)	14 (4)	5 (1)	22 (2)
Other/unknown	–	11 (4)	5 (1)	21 (5)	37 (3)
Total	11 (100)^b	304 (100)	362 (100)^c	442 (100)	1096 (100)

a Median (IQR).

b Among these 11 cases, two were also seen by the Emergency Social Service.

c Among these 362 cases, four were seen by the Psychiatric Emergency Service, and 17 by the Emergency Social Service.

Table 3. Cumulative attendance rates for cases in which the patient was referred to specialist health services.

	Within one weekn (%)	Within one monthn (%)	Within three monthsn (%)	Did not presentn (%)	Total referralsn (%)
Addiction emergency clinic^a	101 (87)	104 (90)	105 (91)^b	11 (9)	116 (100)
Addiction outpatient clinic	19 (43)	30 (68)	35 (80)	9 (20)	44 (100)
Psychiatric outpatient clinic	36 (48)	49 (65)	60 (80)	15 (20)	75 (100)
Total	156 (66)	183 (78)	200 (85)	35 (15)	235 (100)

a In 89/116 (77%) cases, the patient presented the same or following day.

b In 84/105 (80%) cases the patient was admitted, the remaining 21/105 (20%) were treated as outpatients.

Table 4. Factors associated with consulting a GP within the first month following acute poisoning with substances of abuse.

		GP consultation	Crude			Adjusted
	n (%)	n (%)	Odds ratio	95% CI	p	Odds ratio	95% CI	p
Gender
Males^a	1312 (67)	307 (23)	–	–	–	–	–	–
Females	640 (33)	220 (34)	1.72	1.39–2.11	<0.001	1.83	1.47–2.28	<0.001
Age^b	–	–	1.01	1.00–1.02	0.015	1.01	1.00–1.02	0.002
Suicide attempt^c	78 (4)	38 (49)	2.69	1.71–4.24	<0.001	1.09	0.62–1.91	0.78
Main toxic agent
Ethanol^a	1188 (61)	295 (25)	–	–	–	–	–	–
Opioids	437 (22)	119 (27)	1.13	0.88–1.45	0.33	1.24	0.95–1.62	0.11
Benzodiazepines	129 (7)	58 (45)	2.47	1.71–3.58	<0.001	2.08	1.35–3.20	0.001
Central stimulants	90 (5)	29 (32)	1.44	0.91–2.28	0.12	1.57	0.98–2.53	0.062
GHB	45 (2)	10 (22)	0.87	0.42–1.77	0.69	0.95	0.46–1.98	0.89
Other/unknown	63 (3)	16 (25)	1.03	0.58–1.85	0.92	1.08	0.60–1.97	0.79
Referred to specialist health services^c	235 (12)	93 (40)	1.94	1.46–2.57	<0.001	1.70	1.24–2.34	0.001
Advised to contact GP^c	91 (5)	45 (49)	2.80	1.83–4.28	<0.001	2.52	1.61–3.92	<0.001
Advised to contact social services^c	82 (4)	17 (21)	0.70	0.41–1.20	0.19	0.67	0.38–1.17	0.15
Allotted place in homeless shelter^c	74 (4)	25 (34)	1.40	0.86–2.29	0.18	1.45	0.86–2.43	0.17
Self-discharged^c	324 (17)	77 (24)	0.82	0.62–1.08	0.15	0.91	0.68–1.23	0.55
Total cases	1952 (100)	527 (27)	–	–	–	–	–	–

Statistically significant adjusted odds ratios are listed in bold types.

The adjusted odds ratios were adjusted for all the other variables included in the table. CI: confidence interval; GP: general practitioner.

a Reference group.

b Continuous variable.

c The reference groups are: not suicide attempt, not referred/advised/allotted, or not self-discharged (reference groups not shown).