Recreational drug use and the emerging challenges of psychoactive substances in Malta : a case series

Abstract

Introduction: Recreational drug-related hospital admissions, excluding alcohol, appeared to be relatively constant in Mater Dei Hospital (MDH), Malta’s sole public, acute general hospital. While ‘classical’ recreational drugs such as cocaine, heroin and Methylenedioxymethamphetamine (MDMA) were always seen as the main culprits, intoxications secondary to novel psychoactive substances (NPS) have recently emerged in MDH. The aim of this study was to determine the challenges of recreational drug intoxication, including NPS, in MDH.

Methods: All the MDH admissions secondary to recreational drug intoxication between 2010 and 2015 were investigated. MDH clinical performance unit (CPU), hospital data files, hospital discharge letters and the hospital database software system were utilised for data collection. Intoxications associated with self-harm, trauma and lone alcohol ingestions were excluded.

Results: 286 patients were admitted to MDH with recreational drug intoxication between 2010-2015, with a peak of 71 patients in 2015. 78.3% were males and the median age was 26 years. While 79% of the admissions were Maltese nationals, there was a surge in foreigner admissions, from 11.8% between 2010-2012 to 28.3% between 2013-2015 (p<0.001). Admissions occurred mostly in spring and summer, on Saturday or Sunday, and at night. 52.4% of admissions were acutely confused. Ethanol co-ingestion (40.9%) and polydrug use (39.9%) were common in these admissions. 16% needed admission to critical care. 91.3% admissions were secondary to ‘Classical’ recreational drugs, mostly heroin and cocaine. In 2015, 36.6% of admissions were secondary to NPS, mostly synthetic cannabinoids (SCRA). SCRA admissions were associated with severe sympathomimetic and neuropsychiatric features. An SCRA toxidrome mnemonic (MEET_SCRA) is proposed from the most common features of lone intoxications.

Conclusion: Recreational drugs were associated with significant hospital burden, with NPS representing a new threat to MDH and Maltese public health. The toxidrome mnemonic MEET_SCRA could potentially aid in the identification of SCRA intoxications.