Non-fatal poisoning with illicit drugs in Denmark Henrik Saelan For The Danish Health and Medicines Authority, November 2012 Non-fatal poisoning with illicit drugs in Denmark

The Danish registration system in emergency rooms In Denmark we base our knowledge of non-fatal poisonings on contacts with emergency rooms All emergencies are registered in the National Patient Register All poisonings have a specific action code and cases get a ICD 10 code for the type of poisoning In Denmark we have been publishing these data since 1999 Data are not very specific, the next slides will show the break down we can do

Here we see the development from 1999 in main categories of poisonings

Contacts to hospital after intoxication and poisoning caused by the various illicit drugs in 2011 broken down by different age groups   < 20 years 20-24 years 25-29 years ≥ 30 years Opioids 34 44 37 541 Stimulants 149 187 99 156 Mushrooms and hallucinogens 9 10 7 6 Cannabis 66 39 17 33 Polydrug use and unspecified 59 68 60 259 Total 317 348 220 995

How should we interpret this information We can see it in relation to what we know about experimental use We can se it as something prior to deaths due to poisoning

Used one or several of the illicit drugs other than cannabis Percentage of 16-34 year-olds who have used one or several illicit drugs other than cannabis during the last month, last year and ever in 1994, 2000, 2005, 2008 and 2010. Used one or several of the illicit drugs other than cannabis 1994 (n=1,648) 2000 (n=4,019) 2005 (n=2,470) 2008 (n=1,710) 2010 (n=3,287) Last month 0.1 1.8 1.5 1.4 1.3 Last year (Last month included) 0.6 5.0 4.0 4.9 3.4 Ever 4.2 13.3 16.4 16.0 14.4

Percentage of the 16-34-year-olds who have used amphetamine, cocaine or ecstasy in the last year in 2000, 2005, 2008 and 2010   2000(n=3,980) 2005(n=2,456) 2008(n=1,709) 2010(n=3,260) 16-34 years men women total wome n Amphetamine tried within the past year 5.3 1.4 3.2 3.4 1.2 2.2 3.1 3.6 0.9 2.0 Cocaine tried within the past year 1.0 2.1 5.4 2.9 5.8 1.5 4.7 0.8 2.5 Ecstasy tried within the past year 1.7 1.8 0.2 1.9 0.6 1.1 1.3 0.4

Poisoning deaths among drug users in the year in question grouped by the assumed main cause of death. The numbers in parenthesis are percentages    1991 1997 2004 2005 2006 2007 2008 2009 2010 2011 Heroin/morphine 94 (57) 153(71) 81 (38) 77 (37) 83 (37) 69 (34) 70(36) 75(36) 66(32) 53(24) Methadone & other drug 51 (31) 46 (21) 95 (44) 89 (43) 92 (42) 84 (41) 82(42) 96(47) 89(44) 114(52) Other 9 (12) 17 (8) 38 (18) 40 (20) 52 (25) 43(22) 35(17) 48(24) 51(23) Poisonings total 154 (100) 216 (100) 214 (100) 206 (100) 221 (100) 205 (100) 195 (100) 203 (100) 218 (100) This fits better to emergency rooms. From other studies we know that older high risk drug ursers tend to supplement their methadone with cocain, alcohol and benzodiazepins

Conclusion We think registers covering emergency rooms give supplementary/confirming information on what is going on Data are not very good and likely gives an underestimation of the size of the problem Validating studies are needed The equipment for analyzing blood samples should be as good as possible (preferably gas-chromotography) if new drugs are to be discovered

Thank you for your attention