EU Drug Market: Amphetamine — Effects, risks and harms of use

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Amphetamine is a central nervous system stimulant that causes hypertension and tachycardia, with feelings of increased confidence, sociability and energy. It also suppresses the user’s appetite and feelings of fatigue and leads to insomnia. Following oral use, the effects usually start within 30 minutes and last for hours. Later, users may feel irritable, restless, anxious, depressed and lethargic.

Acute intoxication causes serious cardiovascular disturbances as well as behavioural problems that may include agitation, confusion, paranoia, impulsivity and violence, or mental health issues such as psychosis and self-harming behaviour. Chronic use of amphetamine causes neurochemical and neuroanatomical changes, which may trigger anxiety, aggression and depression and somatic effects such as exhaustion, sleep disorders and weight loss. Dependence – as shown by increased tolerance – results in deficits in relation to memory, decision-making and verbal reasoning. These effects may outlast the drug use, although they often eventually resolve.

The use of amphetamine during pregnancy increases the risk of preterm birth and the delivery of babies who are small size for their gestational age (Ross et al., 2015). In utero amphetamine exposure is associated with an increased risk of adverse physical, cognitive, emotional and social effects, including the increased prevalence of attention deficit and hyperactivity disorders, aggression, and learning difficulties attributed to deficits in attention, memory and motivation (Eriksson et al., 2000).

Out of 19 countries with post-mortem data available in 2021, the highest numbers of deaths involving amphetamine-type stimulants were reported by Türkiye (184), Finland (49), Norway (47), Austria (41), Sweden (36) and Denmark (35). The total number of cases for the 17 countries that reported comparable data in all three years are 435 deaths in 2019, 512 in 2020 and 477 in 2021. The latest available data from Germany showed that 348 deaths involved amphetamine/methamphetamine in 2021, but it was not possible to compare this with previous years due to changes in monitoring procedures.

Overall, there are gaps and limitations in the data on deaths involving amphetamines, and any interpretation of changes over time should be approached with care. In addition, due to the small overall numbers of cases in some countries, fluctuations should be viewed with caution.

High-risk amphetamine use

The injection of amphetamine carries the same viral infection hazards (e.g. HIV and hepatitis) as are found with other injectable drugs such as heroin. Injection is reported as a common route of administration for amphetamine in a number of countries, including Finland, Norway, Poland and Sweden.

Analyses of the residues from used syringes collected in several European cities show that injection of amphetamine is mainly found in cities in the north of the EU (see Figure Percentage of detection of amphetamine in used syringes in selected cities in the EU, 2017-2022). In Helsinki, Finland, the detection of amphetamine in used syringes varied between 30 % in 2017 and 45 % in 2022. In Oslo, Norway, amphetamine was detected in 41 % of syringes in 2019 rising to 65 % in 2020, before falling to 58 % in 2021 and 53 % in 2022. In Tallinn, Estonia, which participated in the study for the first time in 2021, amphetamine was detected in over 65 % of syringes, rising to almost 80 % in 2022. Riga, Latvia, has witnessed a large recent increase in the share of used syringes containing amphetamine residues, rising from less than 20 % in 2021 to 47 % in 2022.

Percentage of detection of amphetamine in used syringes in selected cities in the EU, 2017-2022

Source: EMCDDA. The source data for this graphic is available in the source table on this page.

Amphetamine was also detected in a significant proportion of used syringes in Budapest, Hungary, in 2017 (15 %) and 2018 (18 %). However, the presence of the drug fell to 3 % and 0 %, respectively, in 2019 and 2020. In the other cities that participated in the study, the presence of amphetamine was found in less than 10 % of syringes, and usually in combination with other substances.

Treatment data

People who seek specialised drug treatment for stimulant use problems primarily use either cocaine or amphetamine. Of approximately 81 000 of those seeking help in 2021 reported to the EMCDDA treatment demand indicator, 10 346 reported that they use amphetamine. Around 62 % of amphetamine clients were from Belgium (1 075), Germany (3 846) and Poland (1 466).

About 7 % of amphetamine clients entering specialised drug treatment in Europe in 2021, or the most recent year available, reported injecting as the main route of administration, while 70 % reported sniffing, 8 % smoking and 15 % oral consumption.

People seeking treatment for problems associated with the use of amphetamines are heterogeneous in terms of their social conditions and modes of use. This heterogeneity among people with stimulant problems may have important implications both for devising the necessary responses and for reducing barriers to treatment access. Those in employment, for example, may benefit from services offered outside of normal working hours.

Overall, the number of first-time treatment entrants citing amphetamine or methamphetamine as their primary drug has been relatively stable since 2015. Similarly, the proportion of this group reporting injecting amphetamines has remained relatively constant, in contrast to the decrease in injecting that has been observed for other drugs.

Amphetamine-related emergency visits to sentinel hospitals

People with regular or dependent amphetamine use are at elevated risk of a range of causes of mortality compared with their non-drug-taking peers. They have an excess risk of death, estimated at around seven times higher than people of the same age and gender in the general population. The excess risk is even higher for certain causes of deaths, including drug poisoning (24 times higher compared to the general population); homicide (12 times); suicide (12 times); cardiovascular disease (5 times) and accidental injury (5 times) (Stockings et al., 2019).

Acute amphetamine toxicity

Based on data from 24 sentinel hospitals in 18 countries (17 EU countries and Norway), forming part of the Euro-DEN Plus network, there were 5 782 acute drug-toxicity presentations at emergency services in 2021 (see Figure Proportion of the acute drug-toxicity presentations with amphetamine involved). Amphetamine was involved in the presentations at 22 of the 24 hospitals and was the fifth most common substance reported by Euro-DEN Plus hospitals in 2021, found in 11% (596) of cases. Out of the 20 centres that reported data on the number of presentations involving amphetamine in both 2020 and 2021, 15 reported a decrease, 3 an increase and 2 a stable number.

Most of the acute drug-toxicity presentations involving amphetamine in 2021 were middle-aged men. Women represented 25% of these presentations while persons aged under 25 represented 11% (based on median proportions across the sentinel hospitals). In 11 of the 22 hospitals, none of these presentations involved persons over the age of 45. Polydrug toxicity was the norm and cases with sole amphetamine toxicity were rarely reported (representing 3 % or less of all acute drug-toxicity presentations in half of the centres). The pattern of polydrug use differed across centres: in the two hospitals located in Oslo, Norway, the main drugs co-ingested with amphetamine included heroin and benzodiazepine; while the main drugs co-ingested with amphetamine in the centres in Spain and the Netherlands included cocaine, GHB/GBL, MDMA and cannabis. Alcohol was also frequently reported to be co-ingested with amphetamine, as half of the centres reported 40 % or more of these presentations as cases of alcohol co-ingestion.

Due to the COVID-19 pandemic, there were fewer emergency room presentations (overall and drug-related) in 2020 and 2021 when compared to the previous year’s Euro-DEN data. Therefore, any interpretation of changes in the numbers and in the proportions of amphetamine-toxicity presentations should be made with caution. Other limitations of this data relate to the fact that some hospitals reported low numbers of cases, and that the data from hospitals reflect their respective local drug-use patterns and are not necessarily representative of the regional or national situations.

Proportion of the acute drug-toxicity presentations with amphetamine involved, Euro-DEN Plus sentinel hospitals, EU and Norway, 2021
Map of Europe showing the locations of hospitals where amphetamine has been found in acute drug-toxicity presentations as a relative proportion of overall presentations.

Source data

Percentage of detection of amphetamine in used syringes in selected cities in the EU, 2017-2022
City 2017 2018 2019 2020 2021 2022
Budapest 15 18 3 0 4 8
Cologne   0 3   1  
Dublin         0 2
Helsinki 36 40 31 45 44 25
Oslo     41 65 58 52
Paris 0 5 0 0 2  
Riga       7 19 47
Tallinn         66 78
Vilnius     2 6 7 7
Proportion of the acute drug-toxicity presentations with amphetamine involved, Euro-DEN Plus sentinel hospitals, EU and Norway, 2021
Country City Hospital Year All presentations Amphetamine (%)
Albania Tirana Tirana 2021 226 0
Algeria Bab El Oued Bab El Oued 2021 130 0
Algeria Oran Oran 2021 29 0
Belgium Antwerp Antwerp 2021 670 8.5
Belgium Ghent Ghent 2021 68 20.6
Bulgaria Sofia Sofia 2021 30 26.7
Cyprus Nicosia Nicosia 2021 8 12.5
Estonia Parnu Parnu 2021 18 38.9
France Paris Paris 2021 228 1.8
Germany Munich Munich 2021 74 17.6
Ireland Drogheda Drogheda 2021 43 0
Ireland Dublin Dublin 2021 588 0.3
Israel Haifa Haifa 2021 60 1.7
Italy Rozzano Rozzano 2021 26 3.8
Latvia Riga Riga 2021 41 2.4
Lebanaon Beirut Beirut 2021 5 0
Lithuania Vilnius Vilnius 2021 142 13.4
Malta Msida Msida 2021 568 0.5
Netherlands Amsterdam Amsterdam 2021 492 7.9
Netherlands Utrecht Utrecht 2021 21 9.5
Norway Oslo Oslo OAEOC 2021 1562 22.8
Norway Oslo Oslo OUH 2021 141 7.8
Poland Gdansk Gdansk 2021 50 30
Romania Bucharest Bucharest 2021 31 6.5
Serbia Belgrade Belgrade 2021 204 16.7
Slovakia Bratislava Bratislava 2021 59 6.8
Slovenia Ljubljana Ljubljana 2021 141 3.5
Spain Barcelona Barcelona 2021 209 12.9
Spain Mallorca Mallorca 2021 464 1.5
Switzerland Basel Basel 2021 278 3.2
Switzerland Geneva Geneva 2021 480 2.7
Switzerland Lugano Lugano 2021 108 0
Tunisia Tunis Tunis 2021 87 2.3
UK London London STH 2021 1083 1.3
UK London London STMW 2021 675 1.2
Table 2. Euro-DEN Plus centre information table
Country City Coordinates Centre short name Centre full name Type of service Catchment area Type of people using drugs Number of beds Estimates population served (n) Emergency department and referral Other comment
Belgium Antwerp 51.2,4.4 Antwerp ZNA Stuivenberg ED in general hospital Central and northern. Antwerp Metropolitan Area 40 km² Urban ED. With both long-term drug users and recreational use 250 500000 Patients managed by ED. With referral to ICU, internal medicine or psychiatry as required. Part of Ziekenhuis Netwerk Antwerpen (ZNA), a 2500 bed hospital on 10 sites in Antwerp Metropolitan Area
Belgium Ghent 51.1,3.7 Ghent Ghent University Hospital ED in university hospital City of Ghent Located in city with very large student population (63 000 students on a population of 263 000), very active party scene (week and weekends), a few large night clubs in the area. 1000 200,000 All poisonings are treated by the emergency physicians in the ED, if needed admitted to ITU and treated by intensivists. No dedicated toxicology department, though two toxicologists in the ED team.
Bulgaria Sofia 42.7,23.3 Sofia The University Multidisciplinary Hospital for Active Treatment and Emergency Medicine N. I. Pirogov Specialist toxicology clinic and teaching facility. Referral clinic for toxicology pathology for the country. Located in the centre of Sofia, the hospital is located near night life settings. Mostly young people - heroin users, recreational stimulant users, party goers, but there are also older people with long-term drug addiction, included clients in methadone programs. 38 (includes 10 paediatric) 1,500,000 The staff specialises in Internal Diseases, Clinical Toxicology and Emergency Medicine. The Toxicology Clinic is a teaching facility for Medical University of Sofia.  
Cyprus Nicosia 35.2,33.4 Nicosia Nicosia General Hospital ER in the main public hospital of the capital city City of Nicosia The centre is located in the main public hospital of the capital city, however it is not located near an open drug scene or nightlife settings. The users more commonly presenting are recreational stimulant users (cocaine), cannabis users as well as people with high risk use (such as heroin and methamphetamine) 419 ~200,000 Poisoned patients are initially managed within the ER and, if further treatment is needed, admitted to the general medicine wards or intensive care unit  
Czechia Prague 50.1,14.4 Prague Department of Occupational Medicine, Toxicological Information Centre, First Faculty of Medicine, Charles University and General University Hospital, Prague Emergency Department in university hospital Central part of Prague and part of Central Bohemian Region (surrounding Prague) Use of marihuana, methamphetamine and alcohol most common 1900 About 250 000 people (25% of Prague) Emergency Room physician and intensivist  
Denmark Copenhagen 55.7,12.6 Copenhagen Bispebjerg Hospital ED in teaching hospital Copenhagen and Frederiksberg     400000 Emergency patients are seen by internists or anesthesiologists. The Danish Poison Information Centre (Giftlinjen, Bispebjerg Hospital) provides advice on complex or unusual cases. The Danish Poison Information Centre has no day-to-day responsibility for patient care in the ED.
Denmark Roskilde 55.6,12.1 Roskilde Clinical Pharmacology Unit, Zealand University Hospital, Roskilde Emergency Department in teaching hospital            
Estonia Pärnu 58.4,24.5 Parnu Pärnu Hospital ED in general hospital Western part of Estonia. Population served increases significantly in the summer with tourists from other parts of Estonia and abroad.     100,000 Poisoned patients are initially managed within the Emergency Room and, if further treatment is needed, may be admitted to the general medicine wards or intensive care unit.  
Estonia Tallinn 59.4,24.7 Tallinn North Estonia Medical Centre ED in general hospital     1230   Patients are initially treated by the emergency medicine doctors in ER and if further treatment is needed, the patients are transferred to intensive care or general medicine wards.  
Finland Helsinki 60.2,24.9 Helsinki Malmi Hospital ER in general hospital Eastern, south-eastern, north-eastern, and northern areas of Helsinki.   3000 2.2 million Treated by ER clinicians and referred to medical wards or ICU if required For patient >16 years
France Paris 48.9,2.3 Paris Emergency Department, Lariboisière Hospital, Assistance Publique – Hôpitaux de Paris ED in teaching hospital Central Paris Next to ‘Gare du Nord’ (the largest and most crowded railway station in Europe), poor North-east area of Paris, located near a safe consumption room (next door). The area is a usual open drug scene with opioid users 1200 >3 million Poisoned patients are seen by the Emergency Medicine Physicians on a 24/7 day-basis. Specialists on-call from the Paris Poison Centre and the medical and toxicological intensive care unit are consulted for specific or severe cases, respectively.
Germany Munich 48.1,11.6 Munich Department of Clinical Toxicology, Klinikum rechts der Isar, School of Medicine,Technical University Munich. Specialist department in a tertiary teaching hospital City of Munichand the surrondings Area of ~ 665 km2, the hospital is ~ 2 km from a party scene, an open consumption scene is near the main and eastern railway station, both ~<3 km. Users prefer sympathomimetics (NPS, cocaine, amphetamines, etc.). Among opioids, heroin does not play a dominant role, rather fentanyl and methadone. Cannabinoids and pregabalin are in the foreground. ChemSex, due to the proximity of a gay neighborhood). 1161 (28 in department: 5 in a fully equipped ICU, 13 in a high dependency unit and 10 in a general ward In the city and district of Munich: about 1.9 million Poisoned patients are admitted directly and treated separately from the general medical ER at the department of Clinical Toxicology Provides a toxicological laboratory service and the Munich´s Poison Control Center with about 44,000 inquiries per year
Italy Monza 45.6,9.3 Monza Emergency Department – Ospedale San Gerardo Emergency Room in teaching hospital North-eastern region of Milan Monza is a quiet, wealthy medium-sized city with no special problems about drugs, although wealth may contribute to the use of recreational drugs. The type of users is very different: heroin users, recreational stimulant users, party goers with cannabis most used. 600 500,000 These patients are seen by ER medical staff and the consultant toxicologist is on-call by telephone from Poison Control Centre Poison Control Centre : CAV/CNIT (Centro Antiveleni – Centro Nazionale di Informazione Tossicologica) of Pavia.
Italy Rozzano 45.4,9.2 Rozzano Humanitas Research Hospital, via Manzoni 56, 20089 ER in teaching hospital South Milan Lombardy Outskirts south of Milan, near night clubs and discos. Several patients with psychiatric problems and substance abuse who do not usually belong to our ER because they do not have psychiatry 780. (565 National Health Service,215 private healthcare) 178 764 (Rozzano and neighboring municipalities) Toxicology patients are seen by ER medical staff and the consultant toxicologist is on-call by telephone from Poison Control Centre CAV/CNIT Poison Control Centre CAV/CNIT (Centro Antiveleni – Centro Nazionale di Informazione Tossicologica) of Pavia H24.
Latvia Riga 56.9,24.1 Riga Riga East Clinical University Hospital, Riga              
Lithuania Kaunas 54.9, 23.8 Kaunus Hospital of Lithuanian University of Health Sciences ER in university hospital Quiet area of the city with no safe consumption rooms nor night life settings   2000 NA - not only a regional hospital; in some areas of medicine, it is national. Treated by ER clinicians and referred to medical wards or ICU if required  
Lithuania Vilnius 54.7,25.3 Vilnius Toxicology Centre, Republic Vilnius University Hospital ED in university hospital City of Vilnius No particular characteristic and the hospital is the main emergency hospital in Vilnius 657 500000 Patients are seen by the Clinical Toxicology doctor in the ER 24/7. 1000 patients per year are hospitalized in the toxicology centre. This is a clinical department which consists of 6 ICU beds and 15 general ward beds. Alongside is a psychiatry ward with 17 beds.
Malta Msida 35.9,14.5 Msida Emergency Department, Mater Dei Hospital The sole public, general, teaching hospital in Malta Malta A nearly whole country catchment area. Malta is the smallest national capital in the EU. A tourist destination with its warm climate with numerous recreational areas. Most common recreational overdoses are cocaine (crack on the rise), cannabis, synthetic cannabinoids, and heroin. Party goers presentations tend to be highest from April-Sept with another small peak in November 1000 516000 There is no formal toxicological service, with poisoned patients being treated in the Emergency Department, intensive care, paediatric wards or general medical wards.  
Norway Oslo OAEOC 59.9,10.7 Oslo OAEOC Oslo Accident and Emergency Outpatient Clinic (OAEOC) Main casualty clinic in Oslo. Primary care emergency institution City of Oslo Located in the city centre, close to both main nightlife areas, safe consumption room, and open opioid addict scene. Main patient groups: ethanol (both binge drinking and chronic high alcohol consumption), injecting opioid and amphetamine users, and club scene drug users. 15 beds for short time observation (max 6 hours) of recreational drug/ethanol toxicity patients. 18 beds in general 24-hour observation unit. 700000 Poisoned patients are treated at the Emergency General Practice Department, mostly by registrar/resident-level general practitioners. 15% of poisoned patients presenting are referred on to another hospital In Norway patients cannot present directly to hospitals, but have to be assessed in primary care or by the ambulance service first.
Norway Oslo OUH 59.9,10.7 Oslo OUH Department of Acute Medicine, Oslo University Hospital (OUH) Emergency hospital with local, regional and national responsibility of a variety of assignments The most severe poisoned patients in the region. OUH is the region`s trauma hospital and consists of several acute specialities. All kind of people elder than 18 years are attending. People below 18y attend to a child-Hospital also located in the OUH-area. After stabilization, patients are sometimes continued to local hospitals. The area around centre is a settlement area where people live and work and in connection to several travelling possibilities: bus, tram and subways. Type of people using drugs: young people attending to private parties and from the city night-life, and people in all ages using drugs in combining also because of addiction. Young and elder heroin users, GHB users, recreational stimulant users, party goers etc. In the medical clinic:~ 200 beds. In our Department of Acute Medicine, the intensive care unit has 10 beds and the Observational unit has 17 beds for observational use for several medical needs. Most severely poisoned patients from a catchment area of approximately 3 million people. The Department consists of an observational unit of 17 beds with a medical intensive care unit of 12 beds and it hosts the Norwegian CBRNe Centre of Medicine. All five Clinical consultants for the National Poisons Control Centre are also employed at the same department.
Poland Gdansk 54.4,18.6 Gdansk Pomeranian Centre of Clinical Toxicology (PCT) and Department of Clinical Toxicology Medical University of Gdansk Specialist toxicology hospital Centre of Gdansk but patients are from 25 hospitals in the Pomeranian province and~12 in Warmian-Masurian and Kuyavian-Pomeranian provinces of north Poland. The cities of Gdansk, Gdynia and Sopot (Triplecity) form a large port with numerous night clubs and a large academic centre (about 100, 000 people). 17 in PCT, including 7 intensive care beds Combined population in 3 regions covered:~. 5,8 million Staff specialises in internal diseases, clinical toxicology and emergency medicine. PCT serves as a Poison Control Centre and Toxicological Information Centre. Toxicology reference hospital - operates 24/7. Only cases with serious toxicity are admitted.
Ireland Drogheda 53.7,-6.4 Drogheda Emergency Department, Our Lady of Lourdes Hospital ED in general hospital North East of the Republic of Ireland. Mixed urban and rural population Large rural town population of 41,000 (2016). Large catchment area. Drugs ingested in context of parties and nightclubs primarily. Main drug groups are heroin, cocaine and stimulants. 340 350,000 Patients treated in the ED and admitted to hospital or discharged as appropriate  
Ireland Dublin 53.3,-6.3 Dublin Emergency Department, The Mater Misericordiae University Hospital . Teaching hospital ED in teaching hospital North inner city serving a domiciled population   600 185000 Initial management of toxicological emergencies is in the ED with admission under general medicine or critical care if required.  
Romania Bucharest 44.4,26.1 Bucharest Pediatric Poisoning Centre, Emergency Clinical Hospital for Children “Grigore Alexandrescu” Reference toxicology unit for children in Romania within a teaching hospital City of Bucharest and four counties around Teenagers and young people using especially cannabis and recreational drugs, in clubs, private parties, street, school or universities 440 5m The patients are managed by the six paediatricians and 24 nurses working here. Patients under 18 years old with acute overdoses are admitted to the centre. 25 beds in the unit
Slovakia Bratislava 48.2,17.1 Bratislava National Toxicological Information Centre, University Hospital (NTIC) Teaching hospital. Largest medical facility in Slovakia   The common public area of the capital of Slovakia, city of Bratislava 2500 500000 NTIC, is a national clinical toxicology service providing advice and information to the health care providers, the general public, and other national organizations. NTIC has about 6500 toxicological consultations per year. NTIC operates on a 24/7 - basis
Slovenia Ljubljana 46.1,14.5 Ljubljana Medical emergency unit and Centre for Clinical Toxicology, University Medical Centre Emergency Department in teaching hospital Central Ljubljana Urban area with discos/dance clubs + a couple of squatter areas and an outpatient methadone clinic with a bustling drug using and trading community. Stimulant drugs more common than heroin and opioids.A high use of cannabis and GHB. 2100 300 000 residents. Serves as a tertiary reference hospital for ~ 1.3 million people. Patients in the ER are seen by internists, with consultant toxicologist on-call. Centre for Clinical Toxicology has 6 monitored beds and 15 beds in a general ward. Excluding infectious disease, paediatric, surgical, neurological and psychiatric emergencies. Psychiatric evaluation and treatment is provided by a detached Psychiatric clinic. Toxicology Laboratory of the Institute of Forensic Medicine performs toxicological analyses.
Spain Barcelona 41.4,2.2 Barcelona Emergency Area, Clinical Toxicology Unit, Hospital Clinic ED in teaching hospital Central Barcelona Centre of the city, with many nightlife venues around. Many of our patients are recreational drug users and also participants in chemsex sessions. 600 550000 Patients are treated in the emergency area, intensive care or general medical wards.  
Spain Palma de Mallorca 39.6,2.9 Mallorca Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases Teaching hospital Leading tourist destination - large migrant population of tourists and seasonal workers especially during summer months, with over 8 million foreign tourists each year. Near a) shelter for low/no income people where intravenous heroin and cocaine are used, along with other drugs. b) an area of pubs & clubs used all year round but especially in the summer and c) beach area with large influx of visitors in the summer and in both these areas MDMA, cocaine, cannabis and synthetic cannabinoids or other new drugs are used 750 Primary hospital for a resident population of about 400,000 and as a reference hospital for over a million people The ER treats poisoned patients on arrival; poisoned patients are reviewed by a member of the Clinical Toxicology Unit when on-duty or during office hours. No formal reference consultant is on-call for toxicology
Switzerland Basel 47.6,7.6 Basel Division of Clinical Pharmacology and Toxicology University Hospital Primary care and referral centre North-western Switzerland Several safe consumption rooms in Basel, opioid abuse often, recreational stimulant users, no open drug scene in Basel. 780 1000000 Patients seen by the emergency physician with the clinical pharmacologist & toxicologist on-call when specialised advice is needed.  
Switzerland Bern 46.9,7.5 Bern Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital Primary care facility (walk-in patients) and tertiary referral centre for hospitals in the greater Bern area City of Bern and greater Bern area A small city and there are some local night clubs and a drug treatment facility in the vicinity. 1230 2 millions Poisoned patients are seen by the emergency physicians with clinical pharmacologists and toxicologists on-call when specialised advice is needed. Patients ≥16 years of age)
Switzerland Lugano 46.0,8.95 Lugano Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale Specialized clinical pharmacology and toxicology unit providing consultancy to and collecting data from EDs of a network of 4 public academic teaching hospitals in Southern Switzerland. Urban and rural areas. ER located near open drug scene and night life settings; commonly seen in ER are mostly recreational stimulant users. 1000 Almost 350 000 people. Serves as referral centre for Southern Switzerland. Management of poisoned patients involves the emergency physician, supported by the consultant clinical pharmacologist and toxicologist when needed. If required, management continues in medicine or critical care wards.
Switzerland Geneva 46.2,6.1 Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4 ED in university hospital Canton of Geneva   1920 499,480    
The Netherlands Utrecht 52.1,5.1 Utrecht University Medical Center (UMC) ER in university hospital Not located near open drug scene or safe consumptions rooms. Outside the city center of Utrecht though close (~10 km). However, the city center also has a hospital with an ED. The hospital is located within Utrecht Science park. There are student housing facilities on the park and one restaurant, but other than that there is little to do and it is surrounded by grass-lands. The type of people are mostly recreational stimulant users and partygoers 1100 Unknown. We are an academic/ university hospital, so patients can come from the whole Netherlands to the UMCU (17.4 million inhabitants). These patients are seen in the ED by specialists on call from acute internal medicine or intensive care. The Dutch National Poisons Information Center is located within the UMC Utrecht
The Netherlands Amsterdam 52.4,4.9 Amsterdam Emergency department, OLVG Hospital ED in teaching hospital Central Amsterdam OLVG is a city centre hospital in Amsterdam. Many of the drug related patients are national or international tourists. Drug use is mostly related to social events, although people with chronic use are also seen. 400 1 million Toxicology patients are mostly seen (under supervision) by emergency physicians. In case of severe toxicity, intensive care medicine, internal medicine, the hospital pharmacist and a clinical toxicologist will be involved.
Türkiye Izmir 38.4,27.1 Izmir İzmir Medical Sciences University, Tepecik Training and Research Hospital ED in teaching hospital City of Izmir Deprived area with low income and education attainment households where whole families may use and deal drugs, usually synthetic cannabinoids 600 350,000 These patients are seen by the emergency medicine specialty program residents and their instructors. Patients seen 24 hours/7 days in the ER, and consulted on in intensive care or general medical wards.
United Kingdom London 51.5,-0.1 London STH Clinical Toxicology Service, Guy’s & St Thomas’ (STH) NHS Foundation Trust ED in teaching hospital Central and south east London with a number of small and large night time economy venues nearby, particularly those catering for men who have sex with men (MSM, “gay”). Recreational/NPS toxicity presentations are mostly commonly from those night-time economy venues, as well as privately held “chemsex parties” and private residences. Additionally, presentations are from street homeless and hostel dwellers. 1100 1,6 million Patients are seen by the Clinical Toxicology service during office hours in the ER, intensive care or general medical wards and out of hours a consultant toxicologist is on-call.  
United Kingdom London 51.4,-0.0 London KCH Emergency Department, King’s College Hospital (KCH) NHS Foundation Trust ED in teaching hospital. No formal toxicology service but strong links with the service at GSTT London. South east London. It has a diverse socioeconomic resident population. Recreational drug/NPS toxicity presentations are most commonly from local night-time economy venues, privately held “chemsex parties”, private residences, hostels and those who are street homeless. 900 1 million    
United Kingdom York 54.0,-1.1 York York Teaching Hospital NHS Foundation Trust ED in teaching hospital Semi-rural population, living in or near York and North Yorkshire   700 800000 Patients are managed initially within the Emergency Room and, if needed, may be admitted to the Acute Medical Unit or critical care areas under the care of a General Physician. Support from a local liaison psychiatry team.
United Kingdom London STMW 51.5,-0.2 London STMW St Mary's Hospital, Imperial College Healthcare NHS Trust ER in teaching hospital and inner-city major trauma centre. Central west and northwest London High numbers of stimulant recreational drug users, patients using drugs for chemsex and high rates of homelessness in the local area. 495 2 million    


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