Rising prescription stimulant poisoning in Australia: a retrospective case series

Figures & data

Figure 1. Total number of stimulant presentations over the four-year period (2018–2021) comparing dexamfetamine, lisdexamfetamine and methylphenidate.

Table 1. Baseline characteristics of 186 presentations with stimulant poisonings over four-year period 2018–2021.

Number of patients	178
Patient re-presentations	8
Median re-presentations (range)	1 (1-1)
Median age	17 years
IQR (range)	15–26 years (11–55 years)
Male sex	97 (54%)
Stimulant was prescribed medication	106 (60%)
Number of presentations	186
Exposure intent
Deliberate self-poisoning	141 (76%)
Recreational	45 (24%)
Stimulant
Dexamfetamine	44 (23%)
Lisdexamphetamine	50 (27%)
Methylphenidate	92 (49%)
IR	44 (48%)
SR	48 (52%)
Route of exposure
Oral	178 (96%)
Nasal insufflation	4 (2%)
Intravenous	4 (2%)
Co-ingestions	101 (54%)
Antidepressant	47 (25%)
Ethanol	31 (17%)
Antipsychotic	20 (11%)
Over the counter analgesics	20 (11%)
Benzodiazepines	18 (10%)

Table 2. Clinical features of 85 presentations with isolated stimulant exposures.

	All stimulants n = 85	Dexamfetamine n = 22	Methylphenidate IR, n = 18	Methylphenidate SR, n = 23	Lisdexamfetamine n = 22
Median age Range Male sex	16 11–51 48 (56%)	33 19–51 16 (73%)	16 12–45 6 (33%)	14 11–24 13 (57%)	16 11–28 13 (59%)
Exposure intent Deliberate self-poisoning Recreational	49 (58%) 36 (42%)	9 (41%) 13 (59%)	10 (56%) 8 (44%)	14 (61%) 9 (39%)	16 (73%) 6 (27%)
Dose reported Median DE dose IQR Range	74 (87%) 135 mg 50–270 mg 15–4500 mg	13 (59%) 60 mg 40–200 mg 20–4500 mg	16 (89%) 50 mg 38–114 mg 15–500 mg	23 (100%) 144 mg 95–312 mg 30–1700 mg	22 (100%) 258 mg 171–360 mg 48–800 mg
Clinical findings
Tachycardia	59 (69%)	16 (73%)	12 (67%)	18 (78%)	13 (59%)
Hypertension	40 (47%)	11 (50%)	7 (39%)	10 (43%)	12 (55%)
Tachypnoea	25 (29%)	5 (23%)	8 (44%)	5 (22%)	7 (32%)
Hyperthermia	5 (6%)	1 (5%)	2 (11%)	1 (4%)	1 (5%)
Agitation  Severe agitation^a	49 (58%) 23 (27%)	20 (91%) 10 (45%)	7 (39%) 4 (22%)	9 (39%) 1 (4%)	13 (59%) 8 (36%)
Mydriasis	28 (33%)	7 (32%)	4 (22%)	6 (26%)	11 (50%)
Pressured speech	26 (31%)	9 (41%)	5 (28%)	7 (30%)	5 (23%)
Twitchiness	24 (28%)	9 (41%)	3 (17%)	8 (35%)	4 (18%)
Hallucinations	21 (25%)	12 (55%)	3 (17%)	3 (13%)	3 (14%)
Poisoning Severity Score
0: Asymptomatic	4 (5%)	1 (5%)	1 (6%)	1 (4%)	1 (5%)
1: Minor	49 (58%)	9 (41%)	11 (61%)	16 (70%)	13 (59%)
2: Moderate	30 (35%)	11 (50%)	6 (33%)	6 (26%)	7 (32%)
3: Severe	2 (2%)	1 (5%)	0	0	1 (5%)
4: Death	0	0	0	0	0
Complications
AKI	8 (9%)	2 (9%)	3 (17%)	0	3 (14%)
Rhabdomyolysis	3 (4%)	1 (3%)	0	0	2 (9%)
Disposition
Remained in ED	29 (34%)	7 (32%)	10 (56%)	6 (26%)	6 (27%)
ED SSW	42 (49%)	15 (68%)	8 (44%)	9 (39%)	10 (46%)
HDU/ICU	3 (4%)	0	0	1 (4%)	2 (9%)
Ward	11 (13%)	0	0	7 (30%)	4 (18%)
Median LOS (IQR)	11 h (5–19 h)	17 h (9–21 h)	5 h (3–8 h)	13 h (6–18 h)	11 h (6–21 h)

DE dexamfetamine equivalent, AKI acute kidney injury, ED emergency department, ED SSW emergency department short stay ward, HDU high dependency unit, ICU intensive care unit, LOS length of stay.

^aReceived parenteral sedation.

Figure 2. Number of stimulant presentations over four-year period comparing deliberate-self poisonings and recreational exposures.

Data availability

Data available on request from the authors.