Dr. Emilio Salgado: “You can no longer be totally sure that a person doesn’t use cocaine”
The Hospital Clínic Barcelona has a Clinical Toxicology Unit that is over 40 years old. It is part of the Accident & Emergency Department. This Department currently deals with 50% more cases of intoxication than in 2019. In addition to an increase in the most common intoxications, new profiles are being treated, along with new substances of abuse. This requires crosscutting collaboration with other hospital services.
Doctor of Medicine from the University of Barcelona. Associate Professor of Clinical Toxicology in the Faculty of Medicine and Health Sciences at the UB. Member of the IDIBAPS 'Emergencies: processes and pathologies' research group. Elected member of the Board of Governors of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT).
Currently, 50% more cases are treated in the A&E Department (Villarroel Centre) than in 2019. In 2019, 2,080 cases were treated and we shall end this year with 2,500 cases of intoxicated patients treated in the A&E Department. The phenomenon of intoxication is a growing health problem.
Barcelona is a very powerful area in terms of the consumption of substances of abuse, just like Amsterdam, London and New York… Obviously, we are facing a globalization in the consumption of substances of abuse. Barcelona is a hotspot, far more than people might think.
It should be borne in mind that cocaine is the second most widely used illicit substance in our area, second only to alcohol, and the first substance that can make people end up in the A&E Department.
"We have detected a marked increase in cases of adolescent girls consuming large quantities of paracetamol in order to commit suicide".
We have detected a marked increase in cases of adolescent girls consuming large quantities of paracetamol in order to commit suicide. The pandemic has changed the behaviour in this type of practice. We are worried about these cases and many of them, if they are not treated early enough, can lead to severe and even fatal intoxications.
In 2021, 62% of the intoxications treated in the A&E Department were caused by the use of substances of abuse (61% of which involved ethanol, 29% cocaine, and 20% amphetamine derivatives). Around 30% of the intoxications treated were caused by drugs (mostly for suicide purposes), and a small number were caused by domestic chemical agents, smoke from fires, and poisoning from plants or animals (mushrooms, snake bites, etc.).
With conventional measures. Ninety-five percent of the intoxications treated in the A&E Department can only be stabilized through supportive treatment (monitoring, serotherapy, etc.). Generally, most substances are eliminated and the patient gradually returns to normality. The rate of medical admissions for intoxication that we see in A&E is low, around 5%, half of them in the ICU.
This phenomenon has been quite complicated in terms of its handling by the media. It started in France and Great Britain in October 2021 and spread across Europe from north to south. The first cases were treated at the Hospital Clínic at the start of May this year: they were young people, French or British, who came for treatment as a result of attacks in nightclubs, something that was already occurring in their places of origin. When discussing this at the start of July with the main European professionals in Clinical Toxicology, meeting at the EAPCCT's Board of Governors, it was noted that these attacks by needle spiking were a growing phenomenon. However, in none of the cases recorded so far had any substance been detected that raised suspicions of the presence of a toxic substance related to these assaults.
Personally, I think that the information was not checked properly… people began by stating that these attacks were related to chemical submission phenomena, when this had not been proven until then. Social media reported the phenomenon and the media helped spread the fear of being a victim of intoxication, without a clear, concise and reassuring message about this being sent out by the health authorities.
"It was an explosive phenomenon marked by disinformation and fear."
There was no sign of the involvement of any toxic substance related to chemical submission in any of the 73 cases of needle spiking treated at the Hospital Clínic A&E Department between May and 31 October. Twenty-three percent of the victims were men. Moreover, in 39% of the cases, on physical examination no evidence of any injury suggestive of needle spiking was found. It was an explosive phenomenon marked by disinformation and fear.
In 33% of the cases treated, the victim stated that they had consumed an undetermined amount of alcohol voluntarily. This was later confirmed in the analyses carried out in the A&E Department. It should also be borne in mind that when someone is attacked, they may respond by hyperventilating, feeling dizzy, anxious, etc. In the Hospital Clínic A&E Department, as a referral centre for Care of Victims of Sexual Violence in the city of Barcelona, each month real cases of "chemical submission" are treated, and these were different.
The consumption of certain substances is part of human nature. Of course, the social paralysis brought about by the pandemic and the consequences from a psychological point of view, especially among adolescents, have been extraordinary. So, once this nightmarish sensation has passed it is, to a certain extent, understandable that people want to experience what they have been unable to experience for two years and believe that, with the consumption of alcohol in particular, they can feel this new sensation they have been longing for. The need for consumption has certainly always been there.
"We are seeing a change in the alcohol consumption pattern. The young peopole adopt a ‘binge’ drinking pattern."
We are seeing a change in the alcohol consumption pattern. Part of the population, especially those under 30 years of age and in recreational contexts, consumes large quantities of alcohol in the shortest time possible. In other words, they adopt a ‘binge’ drinking pattern. This used to be more typical in European countries outside of the Mediterranean area, but it has been spreading to our part of the world in recent years.
The consumption of cocaine is skyrocketing in our geographical area. According to drug seizure statistics and wastewater analysis, Barcelona is one of the cities with the highest cocaine consumption in the world. You can no longer be totally sure that a person doesn’t use cocaine.
The context depends on the purpose that the consumer seeks with their consumption: to escape, to party, to interact more easily with others, to have group sexual relations, to increase work performance. It should be clear that, in the short term, the drug that causes most deaths is cocaine, without a doubt, and the drug that causes most harm from a chronic point of view is alcohol.
Yes, we are proud of it. Great masters have passed through here: Dr. Pere Muné, Dr. Santiago Nogué…. My healthcare work involves consultations and the study of patients who are treated in the A&E Department for intoxication, as well as looking after the Clinical Toxicology Outpatient Clinic, where patients suspected of suffering from some type of chronic intoxication are treated on an outpatient basis. I also provide consultancy services for the management of intoxicated patients who are admitted to hospital. Special mention should also be made of the support by the Toxicology Laboratory, which, with its extraordinary work, diagnoses the most complex cases of intoxication analytically, helping to detect new substances of abuse, in order to act as a “Toxicovigilance” centre within the national network of Toxicology Units. Finally, we also play an active role in research and teaching.
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