Recreational Drug Toxicity Guideline

This guideline describes the basics of assessment and treatment for patients with acute recreational drug toxicity. It also has handy information for discharge planning including Take Home Naloxone and D&A rehab resources. Please be aware that if a patient has needed treatment with naloxone, they should ideally be observed for at least 2hr after the last dose before any potential ED discharge. For those treated with intramuscular naloxone or larger naloxone doses (>1-2mg), consider a slightly longer observation period (3-4hr post naloxone), and anyone requiring a naloxone infusion should not be discharged for at least 4-6hr after the infusion is ceased.

Additionally, SCGH ED has joined the Emerging Drugs Network of Australia (EDNA); a large-scale project aiming to aid in patient care, identify and characterise trends in novel drugs of abuse, and to facilitate early detection of any outbreaks. The primary focus is on cases of unusual / severe toxicity, as well as suspected clusters of recreational overdoses. This initiative is also linked to new government-funded harm minimisation / public health initiatives; with the aim of creating a feedback loop to drug user groups and healthcare staff.

As part of this project, ED doctors have access to mass spectrometry analysis for a wide range of drugs of abuse, performed off-site at the ChemCentre in Bentley. Be aware that the turnaround time for this relatively advanced testing is at least a few days. As such, testing should generally be reserved for cases of severe toxicity (particularly those needing ICU admission), where a turnaround time of a few days may still be clinically useful.

For the samples to be processed, they need to be sent with a dedicated request form to the pathology lab. These forms are located on the flight deck opposite C26 (see photo). In addition, medical staff need to enter some basic information via RedCap.

The forms are located of the flight deck near C26: