Objectives Patients with alcohol use disorder (AUD) and liver cirrhosis benefit from stopping alcohol intake. Baclofen has been trialled for AUD in cirrhosis and appears to be effective. However, in patients without cirrhosis acamprosate is safer and more efficacious. Acamprosate is rarely used in cirrhosis due to safety concerns: the only published report was for 24 h in a controlled setting. Our centre uses both medications off-label in cirrhotic patients. We performed an audit to pragmatically compare the safety of acamprosate to baclofen in these patients. Methods The electronic records of patients prescribed acamprosate or baclofen between 01/04/17 and 31/03/20 were retrospectively reviewed. Adverse events and abstinence at last follow-up were compared by Student's t-test, Mann-Whitney U or chi-square test. Confounding variables were evaluated by logistic regression. Results In total 48 cirrhotic patients taking acamprosate (median 84 days, range 2-524); 44 baclofen (247 days, 8-910) met inclusion criteria. At baseline, 41% had Childs-Pugh B or C cirrhosis. More patients taking baclofen had an unplanned hospital admission or attendance (23 vs 13; P = 0.013) and the mean number per patient was higher (1.6 vs 0.6; P = 0.032). Subgroup analysis revealed increased admissions in actively drinking patients prescribed baclofen to achieve abstinence (mean 2.4 vs 0.6; P = 0.020); acamprosate use was associated with a reduced chance of admission or attendance (OR, 0.284; 0.095-0.854; P = 0.025) independent of treatment length. No difference in efficacy was observed. Conclusions In patients with cirrhosis, acamprosate was associated with fewer unplanned admissions than baclofen, hence may be safer despite historical concerns.

BackgroundNovel psychoactive substances (NPS) are a growing public health concern. We aimed to identify the acute neurological consequences of NPS. MethodWe performed a retrospective case-note review of patients who presented to the emergency department after taking NPS. ResultsWe identified 237 admissions from 190 patients, mostly young men. There were high rates of psychiatric comorbidity (43%), unemployment (39%), homelessness (24%) and incarceration (17%). Most reported use of synthetic cannabinoids (SC; 91%). Some took synthetic cathinones (SCath; 7%) or nitrous oxide (NOS; 2%). SC caused impaired consciousness (61%) and seizures (16%). SCath users presented with psychiatric disturbance or seizures (55%). Most patients were managed conservatively (67%) and a small proportion (14%) were referred to drug or psychology services. ConclusionsNPS users represent a vulnerable group in society. Certain clinical features may suggest the type of NPS used. Most patients require supportive management and onward referral to drug addiction services is recommended.

BackgroundNew psychoactive substances (NPS) are of global concern accounting for increasing deaths in the UK. We conducted a retrospective analysis of patients attending Leeds Teaching Hospitals NHS Trust with NPS abuse during 2016–2017 and report neurological presentations and outcomes.MethodsWe identified 227 records of NPS attendances through electronic searches using Symphony electronic software. Demographic and clinical data were obtained from case-note review.ResultsAverage age was 34, 82% were male. Two thirds were unemployed, 17% prisoners, 9% students and 4% prison workers. ‘Spice’ accounted for the majority of presentations (90%). 4-methyl methcathinone (‘MCAT’) accounted for 8% of presentations. The remainder reported nitrous oxide (NOS) use. In the spice subgroup, 52% had low GCS, 20% had seizures. Ventilatory support was required in two cases (1%). In the MCAT subgroup, average GCS was 14 and 20% of patients presented with seizure. Psychiatric disturbance was higher in MCAT group (30%). Most patients (62%) were observed in the emergency department and then discharged. Only 3% were referred to the drug and alcohol team.ConclusionsSpice accounted for the majority of NPS presentations. Unemployed single men were particularly at risk. Low GCS and seizures were the commonest presentations, with most requiring observation only.