Drugs of Abuse: New drugs or old ones? Epidemiological survey of acute intoxications in florence in the last five years

Objective: the aim of our study was to review the distribution and clinical significance of drugs of abuse acute poisonings among the patients admitted to the Toxicology Unit of Careggi Florence Hospital, from January 2006 to August 2010. Case series: the total number of acute xenobiotics intoxications was 5,876. Among them, 3,514 patients (59.8%) were drugs of abuse acute poisonings including alcohol, opiates, cocaine, benzodiazepines and psychostimulant/hallucinogenic substances with an incidence rate of 324 cases/year per 100,000 persons. Interestingly, the frequency distribution of drugs of abuse acute intoxications was as follows: 3,206 (91%) for alcohol; 137 (3.9 %) for opiate overdoses, 78 (2.2%) for cocaine intoxications, 42 (1.2%) for recreational benzodiazepine overdoses, 28 (0.8%) for psychostimulants/hallucinogens and 22 (0.6%) for cannabinoid abuse. Although average hospitalization period was rather short (>60% released into 48 hours) and no deaths were observed, drugs of abuse acute poisonings presented difficult clinical management showing the patients an altered mental state (29.8%), multiple medical emergencies (9.1%) and an altered GCS (8.7% with a GCS<15 in the last year). Although acute alcohol poisoning was more frequent then psychostimulant/hallucinogen and THC intoxications, the medical complications in this group of patients were highly represented (13 over 50 patients, 26%). The incidence of medical complications in acute cocaine, opiate and alcohol intoxications was 38.5%, 19.7% and 7.9%, respectively. Conclusions: New synthetic recreational drugs are described in the last years. However, alcohol, opiates and cocaine are still the most important drugs of abuse causing acute poisonings and requiring medical intervention. Once hospitalized, psychostimulant/hallucinogen and THC poisonings show a high incidence of medical complications.