Aanmeldingen op de spoeddienst omwille van recreatief druggebruik
Drugs/NPS are commonly used across Europe and Emergency Room admissions with drug/NPS toxicity can result in significant morbidity and mortality. The EMCDDA collect drug indicator data but currently this did not include indicators relating to acute drug toxicity or Emergency Room admissions before the start of Euro-DEN. We have developed a representative minimum dataset that includes parameters to capture the most clinically important aspects of acute drug/NPS toxicity, with basic demographic information and data on drugs/NPS used. The Euro-DEN network uses the minimum dataset to establish the drugs and NPS responsible for Emergency Room admissions across Europe and the clinical patterns of acute toxicity. With these trends and patterns, we will be able to monitor include geographical and seasonal differences in the drugs/NPS used and patterns of acute toxicity; we will also be able to identify patterns of acute toxicity of emerging NPS. This information will be disseminated to a wide range of stakeholders including policy makers, healthcare professionals, academics in the drugs field and drugs workers.
The emergency departments of UZ Gent and ZNA Stuivenberg are the two Belgian centers which are part of the Euro-DEN registration.
In summary, Euro-DEN has developed a novel key indicator to enable real-time monitoring of drug/NPS acute toxicity, the morbidity and mortality associated with this toxicity.
Euro-DEN case definitions
For the purpose of data collection for the Euro-DEN project, the following case definition
will be used:
“An individual who presents to participating acute care facilities with symptoms and/or
signs consistent with acute recreational drug toxicity and/or directly related to
recreational drug use. Patients with a primary diagnosis of isolated ethanol intoxication
will be excluded (although those who co-ingest ethanol and present with recreational
drug toxicity will be included)”.
A recreational drug is defined as “a psychoactive compound that was taken for the
purpose of recreational activities rather than for medical or work purposes or as part of
(deliberate) self-harm”. The types of drugs, agents or activities to be included are:
• Established classified recreational drugs
• New (novel) psychoactive substances
• Plants, fungi or herbal/alternative medicines
• Use of licensed pharmaceutical preparations for recreational use
• Use of industrial and/or domestic products (i.e. solvents, glues, propellants
etc.) for recreational purposes
The recreational drug(s) associated with the presentation will be based on one or a
combination of the following:
i) the patient’s self-reported use;
ii) information retrieved from witnesses;
Euro-DEN data collection SOP v3 10th September 2013 2
iii) the opinion of the physician assessing the patient; and/or
iv) the toxicologist reviewing data entry/case records.
Case inclusion criteria
Any case in which a patient has symptoms and/or signs consistent with acute
recreational drug toxicity and/or directly related to acute recreational drug use should be
included in the data collection.
This will include a patient who presents to the Emergency Room (ER) because of
concerns about an acute episode of drug use, even if the patient has no clinical signs
on examination. The clinical symptoms the patient describes having experienced should
A patient who has been unwell prior to attendance to the ER but is found to have no
clinical signs on examination will also be included. The clinical symptoms and/or signs
the patient was witnessed to have had should be recorded (e.g. seizures in a nightclub).
Case exclusion criteria
A patient who attends the ER with any of the following presentations should be
excluded from the data collection:
• Lone alcohol ingestion or intoxication, including cases involving ‘spiked drinks’ (i.e.
drinks to which it is alleged a substance has been maliciously added) where
patients have no symptoms of acute recreational drug toxicity
• Symptoms and signs consistent with an alternate medical diagnosis and not
related to acute recreational drug toxicity
• Injury related to trauma, unless the trauma is directly related to drug use e.g. as a
result of hallucinations
• Drug or ethanol withdrawal
• Secondary complications of chronic drug use (e.g. infected injection sites,
HIV/HBV/HCV, endocarditis) and no evidence of acute recreational drug toxicity
• Secondary complications of previous acute drug use complications (e.g. previous
stroke secondary to hypertensive intracranial haemorrhage presenting with
• An individual transferred through the ER for care to other areas of the participating
centres (e.g. intensive care, surgery etc.) and not for a primary emergency
For example if a patient attends the ER requiring treatment because s/he has been
physically assaulted but it subsequently found s/he has used recreational drugs, the
patient should not be included in the study as the presenting complaint was not related
to the drug use.
Jaarlijkse bijdrage aan het Europees Drugsrapport van de EMCDDA
Lyphout, C., Yates, C., Margolin, Z. R., Dargan, P. I., Dines, A. M., Heyerdahl, F., ... & Wood, D. M. (2019).
Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data.
European journal of clinical pharmacology, 75(1), 77-85
Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Dargan PI, Euro-DEN Research Group. Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN).. Clin Toxicol (Phila). 2015 Nov;53(9):893-900. doi: 10.3109/15563650.2015.1088157.
Wood DM, Heyerdahl F, Yates CB, Dines AM, Giraudon I, Hovda KE, Dargan PI.
The European Drug Emergencies Network (Euro-DEN).
Clin Toxicol (Phila). 2014 Apr;52(4):239-41. doi: 10.3109/15563650.2014.898771. Epub 2014 Mar 21. No abstract available.
Dines AM, Wood DM, Galicia M, Yates CM, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R; Euro-DEN Research Group, Dargan PI. Presentations to the Emergency Department Following Cannabis use--a Multi-Centre Case Series from Ten European Countries. J Med Toxicol. 2015 Dec;11(4):415-21. doi: 10.1007/s13181-014-0460-x.
Vallersnes OM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DENResearch Group, Dargan PI. Psychosis associated with acute recreational drug toxicity: a European case series. BMC Psychiatry. 2016 Aug 18;16:293. doi: 10.1186/s12888-016-1002-7.
Miró Ò, Galicia M, Dargan P, Dines AM, Giraudon I, Heyerdahl F, Hovda KE, Yates C, Wood DM, Liakoni E, Liechti M, Jürgens G, Pedersen CB, O'Connor N, Markey G, Moughty A, Lee C, O'Donohoe P, Sein Anand J, Puiguriguer J, Homar C, Eyer F, Vallersnes OM, Persett PS, Chevillard L, Mégarbane B, Paasma R, Waring WS, Põld K, Rabe C, Kabata PM. Intoxication by gamma hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse. Toxicol Lett. 2017 Aug 5;277:84-91.
Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Wood DM; Euro-DEN Research Group. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol. 2019 Jan;15(1):4-11. doi: 10.1007/s13181-018-0674-4`
Liakoni E, Yates C, Dines AM, Dargan PI, Heyerdahl F, Hovda KE, Wood DM, Eyer F, Liechti ME; Euro-DEN Plus Research Group. Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical methods in a multicenter European case series. Medicine (Baltimore). 2018 Feb;97(5):e9784.
Miró Ò, Dargan PI, Wood DM, Dines AM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DENPlus Research Group, Galicia M. Epidemiology, clinical features and management of patients presenting to European emergency departments with acute cocaine toxicity: comparison between powder cocaine and crack cocaine cases. Clin Toxicol (Phila). 2019 Aug;57(8):718-726.
Wolfe CE, Wood DM, Dines A, Whatley BP, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI; Euro-DEN Research Group. Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set. Neurotoxicology. 2019 Jul;73:183-187.
Galicia M, Dargan PI, Dines AM, Yates C, Heyerdahl F, Hovda KE, Giraudon I; Euro-DEN Plus Research Group, Wood DM, Mirsó Ò; Euro-DEN Plus Research Group. Clinical relevance of ethanol coingestion in patients with GHB/GBL intoxication. Toxicol Lett. 2019 Jul 10;314:37-42. doi: 10.1016/j.toxlet.2019.07.001.
The Euro-DEN Project: Guidelines on when to call the Emergency Services 112 for unwell recreational drug users
Datum laatste wijziging: 17/08/2019
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