Data collection on acute drug toxicity using the Euro-DEN plus model in countries bordering the European Union

Background

The Euro-DEN Plus project has been collecting data on acute illicit drug/NPS related harm in Europe for over 10-years using a sentinel centre model – these data are reported in the European Drug Report and the EMCDDA Statistical Bulletin. There is a paucity of data on acute harms and other key indicators relating to illicit drug/NPS use and prescription medicine misuse in ENP and Western Balkan countries (hereafter ENP). The Euro-DEN Plus project has been collaborating with EMCDDA under the auspices of the EU4MD-II and IPA8 projects to develop similar data collection in ENP countries. The aim of this study is to determine the feasibility of data collection on acute drug toxicity in sentinel centres in ENP countries using a focused Euro-DEN data collection tool.

Methods

Sentinel centres were recruited from ENP-South countries and the Western Balkans with the aim of collecting up to 6-months of data on acute drug toxicity presentations to each centre from July to December 2023. Local ethical approval was in place in each centre. The Euro-DEN Plus dataset was streamlined to focus on demographics, the drug(s) involved in the presentation, day of presentation, discharge destination from the Emergency Department and length of hospital stay. Data were collected in MS excel and returned to the lead centre in London for collation.

Results

Data were collected on 876 presentations to 11 centres in seven countries (Algeria, Israel, Lebanon, Palestine (5 centres), Tunisia, North Macedonia and Serbia). The majority (709, 89.9%) of presentations were in males and the median (IQR) range was 32 (35-39 years). Illicit drugs were most commonly involved (963, 55.3% of all drugs reported ), followed by (misuse) of prescription medicines (714, 41.0%) and new psychoactive substances (NPS: 41, 2.4%). The top five drugs involved in the presentations were cannabis, cocaine, amphetamine, heroin and benzodiazepines. Whilst the majority of presentations were discharged from the emergency department (379, 43.3% medically discharged and 117, 13.4% self-discharged), and most (652, 91.4%) had a length of hospital stay of less than 24 hours, a notable proportion required critical care (148, 16.9%) or psychiatric admission (95, 10.8%) and 40 (4.6%) died in hospital. 

Conclusions

Data using the Euro-DEN Plus methodology provide valuable insight into local drug use and patterns of harm associated with this use in ENP-South and Western Balkan countries. This is important given the paucity of data on other key indicators of drug use from these countries, triangulation of these data with other emerging datasets will improve the monitoring and preparedness in relation to the public health implications of drug use in these countries, and better inform targeted policy making and public health initiatives.