Royal Adelaide Hospital
Emergency Department
Designer Drug Early Warning System
12-month Technical Report
DASSA Research Monograph No. 19
Research Series
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EXECUTIVE SUMMARY
This technical report presents findings from the Designer Drug Early Warning System [D2EWS]
Arising jointly from recommendations of the SA Drugs Summit in 2003 and research interests of the Royal Adelaide Hospital Emergency Department (RAH ED), this project monitors the incidence and clinical effects of intoxicating substances in patients presenting clinically intoxicated to the RAH ED. Initially envisioned to focus principally on psychostimulant use in young ecstasy and related drug users, the project’s unique design and methodology has allowed identification of patterns of use across the full spectrum of drugs of abuse and has done so in three broad groups of users: Illicit Drug Users (defined here as excessive or non-sanctioned use of both licit and illicit substances, including alcohol, across the spectrum of use from occasional to regular to dependent), drug users intending deliberate Self-Harm, and the victims of Drink Spiking.
D2EWS is a clinically based, prospective monitoring system, in which blood analysis of intoxicated patients provides precise identification of the intoxicating substances as well as the levels of these drugs in the patients’ blood. This information is then able to be correlated with the patients’ clinical and demographic details to provide a unique data-set.
The project confirms that alcohol remains the major cause of intoxication leading to attendance at the RAH ED, followed by benzodiazepines, cannabis, amphetamines and opioids. The incidence of psycho-stimulant use is shown to have increased dramatically in the 3 years since pre-study estimates were made, and the use of benzodiazepines among Illicit Drug Users is much higher than previously thought. Other drugs, such as gamma-hydroxy butyrate (GHB), ketamine and lysergic acid diethylamide (LSD), although less frequently detected, are shown to be of major concern given the younger average age of users and the associated clinical harms. Of concern too, is data suggesting significant rates of diversion of prescription medication for Illicit Drug Use, and the substantial proportion of patients with established psychiatric illness.
Multiple drug use by individuals is a major feature of the project’s data with nearly 60% testing positive to more than one drug, and almost 20% to 3 or more drugs. This problem has been shown to extend across all drug groups, all ages, and all three presentation categories.
Such data from the D2EWS project adds to the body of knowledge of the populations that are at most risk of harm from illicit and other drug use. It shows that different categories of presentations to the ED have different patterns of drug use, different demographic details and levels of risk-taking. Further, it is envisaged that analysis of the clinical features associated with the precise quantification of drug levels may allow refining of the emergency management of these patients.
In addition to adding significantly to the understanding of drug use generally in our community, information from D2EWS has allowed early identification and notification of emerging drug issues to both health and police agencies. For example, following an increase in heroin-related presentations to the RAH ED in September 2005, a Drug Alert was published which, in addition to providing advanced notice to the other metropolitan Emergency Departments (EDs), also provided important information to the South Australian Police Force (SAPOL). Similarly, following reports of several LSD-related attendances to the RAH ED in early 2005 the project began monitoring for this drug. This required the development of new blood testing techniques by the project collaborators at Forensic Sciences of SA. A series of cases were subsequently detected and a specific Drug Alert was published.
The project is a unique collaboration between the RAH ED Research Group, which designed and manages the project, clinical staff of the RAH ED, Forensic Sciences of South Australia (FSSA), which performs all drug analyses, and the Drug and Alcohol Services of South Australia (DASSA), which provides expert advice and sourced funding for the project.
