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EMCDDA activities in the area of hospital emergency data

 

EMCDDA activities in the area of hospital emergency data

Emergencies arrowThe EMCDDA has been working on drug-related emergencies since it started monitoring drug-related harms twenty years ago.

A unique insight into acute health harms is provided by hospital emergency data, which widen the scope of monitoring health consequences of drug use, beyond other more established indicators. Read more >>

Introduction

Patients in emergenciesThe EMCDDA has been working on drug-related emergencies since it started monitoring drug-related harms twenty years ago.

Purpose and value of monitoring non-fatal acute emergencies

A unique insight into acute health harms is provided by hospital emergency data, which widen the scope of monitoring health consequences of drug use, beyond other more established indicators. Emergency data can serve as an indicator of high-risk drug use trends, as a source to characterise some sub-populations of drug users, for detecting and monitoring new patterns of use or abuse of substances (such as new synthetic drugs), or new trends regarding traditional drugs, for example new epidemics in heroin use. Emergency data can also assess the risk factors for some serious consequences of drug use (i.e. fatal overdoses) and monitor how prescribed drugs impact on emergency room attendance for drug problems. Data from emergency settings contribute to early warning systems, as they often capture signals earlier than other monitoring systems based on mortality or treatment data.

Few countries in Europe have set up monitoring systems, and are able to report trends, numbers, and characteristics of acute non-fatal drug-related intoxications. These systems mirror to a certain extent other systems, such as the Drug Abuse Warning Network (DAWN) in the United States which ran for many years until its closure in 2011. http://www.samhsa.gov/data/emergency-department-data-dawn/about

Current projects

There is currently limited systematic data on acute drug toxicity in Europe which represents a public health gap in our understanding of the implications of drug use. The potential of this indicator to complement other, more established, indicators on the drug situation has been explored in several reports and papers. Over the years, national experts have discussed the methodological aspects of this topic (see presentations and other outputs). An analysis of the available data on cocaine-related emergencies and the review of the monitoring of drug-related acute emergencies in 30 European countries also received special attention in 2014 (see report and video). Work to monitor the burden of cannabis-related emergencies is also on-going.

An essential aspect of the work of the agency in this area is its collaboration with the European Drug Emergencies Network (Euro-DEN — Euro-DEN Plus) project. This project, which was EU-funded from 2013–15 and is now supported by the EMCDDA, involves the collection of data on emergency department presentations with acute drug toxicity from 20 sentinel centres in 15 countries. More centres are currently being recruited to increase the European value and representativeness of this data. The project aims to provide more detailed information on the harms associated with the use of both ‘established’ drugs and new psychoactive substances. The EMCDDA supports the continuation of the network’s activities, and in April 2016 the agency will host the technical meeting of the extended Euro-DEN Research Group.

These activities fit into the agency’s work programme which aims to ‘improve reporting capacity for non-fatal health consequences of drug use’. More broadly, this contributes to one of the work programme’s key objectives of ‘maximising the value of key indicator information through analysis to provide a comprehensive, relevant and multi-source understanding of contemporary patterns of drug use, trends and related health and social consequences and responses.’

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Key documents

Cover

Emergency health consequences of cocaine use in Europe. A review of the monitoring of drug-related acute emergencies in 30 European countries

This study reveals the substantial levels of morbidity related to cocaine use, translated into the large number of cocaine cases seen in various emergency settings in European countries. This health burden is often not captured by other traditional drug indicators. The report also points to the potential for early prevention, assessment and referral opportunities that may currently be overlooked, including the referral of some patients who may benefit from specific counselling or treatment.

Hospital and emergency services data - London (UK) and Palma de Mallorca (SP) - Contract report

Recreational drug use is common in Europe, however there is no systematic collection of data on acute recreational drug toxicity. The EMCDDA held an expert meeting in November 2007 to explore ‘the use of health emergency data to help detect, track and understand emerging drug trends’. The lead investigators were awarded a contract to undertake a feasibility study in two different member states to explore methods for collecting this data in two different units in busy nightlife areas. The lead centre (Guy’s and St Thomas’ NHS Foundation Trust, London, UK) identified a partner centre (Hospital Son Dureta, Palma, Mallorca) to participate in this study. A data collection tool was designed to collect data prospectively on all cases presenting to the two centres with acute recreational drug toxicity in June and July 2009. This report details the collation and analysis of this data and the differences between the centres (types of recreational drugs used, place of drug use, home location of individuals presenting and patterns of acute toxicity seen). This project formed the basis for the Euro-DEN project.

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Review and Synthesis of Scientific Literature on Drug-related Non-fatal Emergencies

The EMCDDA work programme in epidemiology has been willing to widen its scope on health consequences of drug use. Within the purpose of its working program on early warning systems for identification of health problems linked to the use of new substances or new patterns of use, EMCDDA was interested in exploring what work had been done in the European Union of the indirect indicator of drug use: Emergency Room (ER) drug-related non-fatal episodes. The aim of this report was to provide a detailed review of epidemiological studies on drug-related emergencies implemented in the European Union, and to synthesise information generated by all of them in order to provide some clues for an early warning system network.

Expert Meetings/Conferences

  • Euro-DEN Research Group Meeting 7-8 April 2016, Lisbon. The report is now available.

  • Euro-DEN presentation at the European Commission Horizontal Drugs Group meeting, Brussels, 3 November 2015.

  • Lisbon Addictions 2015, First European conference on addictive behaviours and dependencies, 23-25 Sept, Lisbon Symposium session The European Drug Emergencies Network (Euro-DEN): insights into acute drug emergencies in Europe

    • General overview of the Euro-DEN dataset: Emergency Room presentations with acute drug toxicity over one year in 16 sentinel centres in Europe.
      Paul Dargan, United Kingdom
    • New Psychoactive Substances (NPS) in Euro-DEN: epidemiology and patterns of toxicity associated with NPS.
      David Wood, United Kingdom
    • Cannabis presentations in Euro-DEN: An overview of the Euro-DEN data on cannabis-related presentations and cannabis cardiotoxicity.
      Alison Dines, United Kingdom
    • Implications of the benzodiazepines: geographical patterns in the benzodiazepines responsible for toxicity around Europe and the pattern of toxicity seen in individuals with acute benzodiazepine toxicity resulting from non-medical misuse.
      Christopher Yates, Spain
    • Emergency health consequences of cannabis use in Europe: a need for more unified approach in data collection?
      Marcis Trapencieris, Latvia
       
  • EURO-DEN Steering Committee Meeting hosted by the EMCDDA, 27 February 2015

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Outputs

We list below several selected outputs of the work done so far in this area, including guidelines, contributions to the EMCDDA series ‘Perspectives on Drugs’, abstracts submitted by the Euro-DEN research network to recent clinical toxicology conferences, along with publications in peer reviewed journals based on Euro-DEN findings, but also on reviews of the data reported to the EMCDDA by the Reitox national focal points.

Video and training material

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Publications

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Abstracts

  • Heyerdahl F, Hovda KE, Giraudon I, Yates CB, Valnoha JE, Sedefov R, Dines A, Wood DM, Dargan PI, A survey to establish current European data collection on emergency room presentations with acute recreational drug toxicity.
    Clin Toxicol (Phila) 2014;52:370-371.

  • Wood DM, Dargan PI,Toxicosurveillance of Novel Psychoactive Substances: An emergency department perspective and the role of the European Drug Emergencies Network (Euro-DEN) project.
    Clin Toxicol (Phila) 2014; 52: 350

  • Dargan PI, Assessing the pattern of acute toxicity associated with NPS: problems, solutions and the Euro-DEN project.
    Research and Advances in Psychiatry 2014;Suppl 1:17.

  • Dines AM, Dargan PI, Heyerdahll F, Hovda KE, Yates C, Giraudon I, Archer JRH, Sedefov R, Wood DM, Four months surveillance of recreational drug use in Europe: first report from the European Drug Emergencies Network (Euro-DEN) project, Clin Toxicol (Phila) 2014;52:703

  • Yates C, Dines AM, Wood DM, Hovda KE, Heyerdahl F, Giraudon I, Sedefov R, Dargan PI on behalf of the Euro-DEN group, Emergency Department presentations following recreational use of baclofen, gabapentin and pregabalin: a Euro-DEN case series, Clin Toxicol (Phila) 2015;53:372-373.

  • Dines AM, Dargan PI, Hovda KE, Heyerdahl F, Yates C, Giraudon I, Wood DM on behalf of the Euro-DEN Research Group.
    Deaths involving recreational drugs and novel psychoactive substances reported to the European Drug Emergencies Network (Euro-DEN): a review of the first nine months, Clin Toxicol (Phila) 2015;53:370-371.

  • Dargan PI, Dines AM, Heyerdahl F, Yates C, Giraudon I, Hovda KE, Wood DM on behalf of the Euro-DEN Research Group, Mixed benzodiazepine-heroin acute toxicity is associated with more severe toxicity than heroin toxicity not associated with benzodiazepine use, Clin Toxicol (Phila) 2015;53:369.

  • Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI on behalf of the Euro-DEN research group, Psychosis associated with acute poisoning by recreational drugs and novel psychoactive substances: a European case series from the Euro-DEN project, Clin Toxicol (Phila) 2015;53:364.

  • Vallersnes OM; Dines AM; Wood DM; Yates C; Heyerdahl F; Hovda KE; Giraudon I; Euro-DEN Research Group; Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry 2016; In press

  • Wood DM, Dines AM, Heyerdahl F, Yates C, Giraudon I, Hovda KE, Dargan PI on behalf of the Euro-DEN Research Group, The cathinones are the most commonly reported Novel Psychoactive Substances (NPS) associated with Emergency Department presentations with acute drug toxicity reported to the European Drug Emergencies Network (Euro-DEN), Clin Toxicol (Phila) 2015;53:355-356.

  • Dines AM, Wood DM, Yates C, Heyerdahl F, Giraudon I, Sedefov R, Hovda KE, Euro-DEN Research Group, Dargan PI, The European Drug Emergencies Network (Euro-DEN) Project – a model for multi-centre data collection on acute recreational drug toxicit, Clin Toxicol (Phila) 2015;53:647-648.

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Page last updated: Thursday, 04 August 2016