The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department

Smith, Jennifer L.; Soderstrom, Jessamine; Dawson, Andrew; Alfred, Sam; Greene, Shaun L; Isoardi, Katherine Z; McCutcheon, David; Oosthuizen, Francois J.; Ezard, Nadine; Burcham, Jonathon; Fatovich, Daniel M

doi:10.1111/1742-6723.13839

Cited by 19 publications

(23 citation statements)

References 11 publications

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“…After reviewing this cluster of deaths from 2016 to 2017, the Coroners Court of Victoria (2021) recommended the urgent implementation of both a DCS and an early warning network. In response, the Victorian Government began releasing public drug alerts and now funds part of the Emerging Drugs Network of Australia (Smith et al , 2022). Despite these welcome advances, there is still no public access to substance analysis.…”

Section: Discussionmentioning

confidence: 99%

Community-led guerrilla drug checking in response to deaths from adulterated MDMA in Victoria, Australia

Barratt

Bright

Blackwell³

2022

DHS

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Purpose Following deaths and hospitalisations in Melbourne, Victoria, Australia, related to the unwitting consumption of a combination of 25C-NBOMe and 4-FA, a community-led unauthorised drug checking service was rapidly established at a subsequent music festival. We aim to demonstrate the value of community-led drug checking, even when conducted in less-than-ideal conditions, by describing this service and reporting on its outcomes. Design/methodology/approach In all, 131 samples were tested with between 1 and 4 (M = 2.24 and SD = 0.61) reagents (Mandelin, Marquis, Mecke and Simons), and behavioural intentions of service users were reported. Findings People whose results indicated that the drug tested was what they expected, or was a drug familiar to them, were more likely to report an intention to take the drug compared to those whose results indicated that the drug was not what they had expected. For example, in 11 cases where the expected substance was not identified and novel substances including 2 C-X (including the NBOMe series), methylone, mephedrone, PMA and MXE were indicated, most reported an intention to discard (8/11). Practical implications The guerrilla service appeared to dissuade some people from consuming substances with higher risk profiles. It was also quick to identify substances of concern consistent with the NBOMe/4-FA combination for broader community action. The authors urge governments in Australia and elsewhere to reconsider their opposition to drug checking services, given their utility as vital health services during times of volatile drug market shifts. Originality/value While these data are five years old, it has only been in the past year that the Coroners Court of Victoria finalised their report on the deaths associated with this drug outbreak, providing context for the rapid peer response.

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Section: Discussionmentioning

confidence: 99%

Community-led guerrilla drug checking in response to deaths from adulterated MDMA in Victoria, Australia

Barratt

Bright

Blackwell³

2022

DHS

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“…A number of studies, nationally [26,27] and internationally [28][29][30], have reported the benefits of analytically confirmed drug data from ED populations to enable detection of specific compounds and their associated toxicity. A key advantage for frontline clinicians is improved access to timely and objective clinical and toxicological information [31]; a recognised gap in current clinical practice and medical curricula [7,8].…”

Section: Discussionmentioning

confidence: 99%

‘Trial by fire’: An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department

Smith

McCutcheon

Weber

et al. 2022

Drug and Alcohol Review

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Introduction:The often unknown nature of acute drug intoxication, especially with illicit drugs and emerging novel psychoactive substances, can present a significant challenge for emergency clinicians. Less experienced clinicians are particularly vulnerable to the diagnostic dilemmas of complex toxicology emergencies. We sought to better understand the confidence of junior doctors in assessing and managing toxicological emergencies across two emergency departments in Perth, Australia. Methods: An online survey was conducted between August 2020 and February 2021. Self-rated confidence was measured on a five-point Likert Scale across 10 statements. Two open-ended questions were included to capture perceived barriers and facilitators impacting clinical confidence. Quantitative data were analysed using descriptive methods and Fisher's exact test. Free-text responses were analysed using content analysis.Results: A total of 104 surveys were completed (19.2% interns, 40.4% resident medical officers and 40.4% registrars). Self-rated confidence varied across statements and by staff type. The lowest confidence rating was for managing a patient who had overdosed from an unknown substance (31.7%) and the highest rating for referring a patient to psychiatry following deliberate self-poisoning (86.6%). Confidence increased with greater clinical experience for all statements. Qualitative analysis revealed perceptions of clinical preparedness, complexity of patients and a safe and supportive culture as key factors impacting confidence.Discussion and Conclusions: Overcoming perceived deficits in knowledge and clinical experience were key to building confidence. Our findings highlight the need for improved access to toxicology-specific curricula and training, and strategies to ensure adequate supervision from senior clinicians.

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“…Drug-use is generally self-reported in clinical, community, and research settings. For example, hospital data is coded on clinical observations and inferences about the drugs involved and systems are generally insensitive to capturing novel and emerging substances of concern (52). Under-reporting of substance use in acute settings may underestimate the burden of drug-related harms, impacting capacity for planning and provision of best-practice policies, prevention, and care (1,28,33,34).…”

Section: Alert Dissemination Andmentioning

confidence: 99%

“…Under-reporting of substance use in acute settings may underestimate the burden of drug-related harms, impacting capacity for planning and provision of best-practice policies, prevention, and care (1,28,33,34). When blood samples are routinely collected in severe or unusual toxicity presentations, toxicosurveillance can screen for substances and ndings can be translated into timely and appropriate clinical responses and/or used to inform EWS and public health risk communications (16,52,79). For example, in Victoria, EDNAV reported in 2021, that 90% of 320 acute presentations screened for illegal, pharmaceutical, and novel substances, one or more substances unknown to the clinical team at time of management were detected.…”

Section: Alert Dissemination Andmentioning

confidence: 99%

“…Other Governments have also issued public drug warnings arising from local systems (21,45,50). Efforts to establish national monitoring and reporting systems have commenced (51,52). While theoretically feasible, coordination of data across Australia's federated system is challenged by time-delays and inconsistent reporting across jurisdictions and requires su cient resourcing and ongoing funding to operate effectively (25).…”

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confidence: 99%

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Co-Designing High-Risk Drug Alerts for Health and Community Service Practitioners

Brien

Volpe

Grigg

et al. 2022

Preprint

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Background Alerts about drug market changes (e.g., drug strength, purity, adulterations, or other trends) may be useful to assist health and community workers to anticipate, prevent and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community settings in Victoria, Australia. Methods We used an iterative, parallel mixed methods participatory design to co-produce drug alert prototypes with practitioners and managers working across alcohol and other drugs and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and presented for testing of utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to identify key barriers and facilitators to successful alert design. Results Timely and reliable alerts about high-risk single substances were important to nearly all practitioners (98%) yet many reported insufficient access to timely information about drug markets and emerging threat (64%). Alerts were useful for increasing exposure to drug market intelligence; facilitating risk communication; and improving capacity for effective responses. Alerts must be ‘shareable’ across a range of settings to meet the needs of diverse professional and public audiences. Practitioners and managers considered themselves ‘conduits’ for information sharing. To maximize engagement and impact, alerts must be attention-grabbing and easily recognisable; available on multiple platforms; published in printable and electronic formats in varying levels of detail; and disseminated using appropriate notification mechanisms. Three clinical drug alert prototypes (SMS prompt, summary flier, and detailed PDF) were developed and considered acceptable and useful for a range of audiences and settings. Discussion Adequate planning and resourcing for effective drug alert design and evaluation arising from jurisdictional and national early warning systems is imperative to their utility. Such systems need to have access to reliable multidisciplinary drug market intelligence for rapid assessment and verification of risk to report timely and effective risk communications. Systems that offer close to real-time detection of adulterants/contaminants (e.g., drug checking services) are best-placed to provide rapid, evidence-based drug market intelligence to inform preventive and responsive action.

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The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department

Cited by 19 publications

References 11 publications

Community-led guerrilla drug checking in response to deaths from adulterated MDMA in Victoria, Australia

Community-led guerrilla drug checking in response to deaths from adulterated MDMA in Victoria, Australia

‘Trial by fire’: An online survey exploring confidence of junior doctors in managing toxicology presentations to the emergency department

Co-Designing High-Risk Drug Alerts for Health and Community Service Practitioners

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