Substance abuse patient characteristics: a scene from an emergency department near the Hong Kong Shenzhen border

Transcription

1 Hong Kong Journal of Emergency Medicine Substance abuse patient characteristics: a scene from an emergency department near the Hong Kong Shenzhen border WC Yuen, WF Tang, CH Chung Objective: Drug abuse is an escalating problem in Hong Kong, especially among teenagers and young adults. A study was conducted in order to obtain the characteristics of drug abusers presenting to the Accident & Emergency department of North District Hospital, which is located in the New Territories near the Hong Kong Shenzhen border. Design: Prospective study. Setting: Accident and Emergency department of a public general hospital. Patients: Drug abusers presenting to the Accident and Emergency department in a six-month period. Main outcome measures: Epidemiological data including demographic data, types of drug taken, place of drug abuse and magnitude of cross-border drug abuse were collected and analyzed. Results: The sex distribution was male 59 and female 13 (ratio=4.5:1). The mean age was 29.2 (range 14 to 67 years). Of interest, 29.2% abused drugs at home; 29.2% abused drugs in parties such as karaoke, rave and disco; 68% abused drugs in Hong Kong; 32% abused drugs in China and 6.9% claimed themselves first-time drug abusers. The commonest drug taken was ecstasy (40.3%) the majority (55%) in China and the rest (45%) in Hong Kong. For organic solvent abusers, 57.1% were below 18 years of age. One patient died, resulting in a mortality rate of 1.4%. Conclusion: Ecstasy was the commonest drug abused on both sides of the "border". The majority of substance abusers were teenagers or young adult males. This study confirmed the significant magnitude of psychotropic substance abuse problem among the young population in the North District, indicating the urgent need for clinical and social intervention. (Hong Kong j.emerg.med. 2001;8: ) Keywords: China, ecstasy, emergency services, Hong Kong, hospital, substance-related disorders Introduction According to the information from the Central Registry of Drug Abuse (CRDA), there is a rising trend of ecstasy (3,4-methylenedioxymethamphetamine or MDMA) and a downward trend of heroin abuse. 1 There was also an increase in the number of abusers of methamphetamine, ketamine and cannabis. Reported abusers of ecstasy rose from 275 in the Correspondence to: Yuen Wan Chit, RN, BN, PgDNE(HK) North District Hospital, Accident &Emergency Department, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong wanchit@citmail3.com Tang Wai Fong, RN, BN Chung Chin Hung, FRCS(Glasg), FHKAM(Surgery), FHKAM(Emergency Medicine) second half of 1999 to 1,065 in the first half of 2000, while at the same time abusers of ketamine rose from 21 to 453, and that of cannabis from 660 to Young adults enjoy using stimulants or hallucinogens in rave parties. 3-5 Some of them even cross the border to the Mainland in order to obtain cheaper drugs. 6,7 The Government of the Hong Kong Special Administrative Region is closely monitoring the situation of Hong Kong people travelling to the Mainland to take drugs. 7 The purpose of this study was to obtain prospectively the epidemiological characteristics of drug abusers presenting to the Accident & Emergency (A&E) Department of North District Hospital, a public general hospital situated in the New Territories near the Hong Kong Shenzhen border. By recognising the local pattern of substance abuse, emergency physicians would be better prepared to manage the manifestations and toxicity of the substances involved. 4

2 Yuen et al./substance abuse patient characteristics 197 Methods During a six-month period from 22nd August 2000 to 21st February 2001, patients presenting to the A&E department with history of substance abuse were recruited into the study. A standardised questionnaire was used for each patient. The nursing staff completed the form by interviewing the patient. The data collected included personal particulars, substances abused, place of abuse, education level, employment and marital status. Clinical information including chief complaints, triage category, specialty and outcome were also retrieved from the A&E records. Seventy-two questionnaires were collected in total. Due to practical reasons such as patients who are confused, some information could not be gathered at the emergency department and the missing data were later retrieved from the hospital records, including patient outcomes. The data were analysed using the Statistical Package for Social Science, Windows version Chi Square test was used to test the hypotheses and a probability level of p<0.05 was regarded as statistically significant. Results Demographic characteristics A total of 72 subjects were recruited at the A&E Department of North District Hospital. According to the discharge summaries from the hospital computerised clinical management information system, another 36 cases were diagnosed as drug abuse after admission. Therefore, the identification rate or patient response rate at the A&E department was 67% (a total of 108 cases). The mean age of the 72 respondents was 29.2, (median 26, range 14 to 67) as shown in Figure 1. There were 59 males (81.9%) with mean age of There were 13 (18.1%) females with mean age of Among the 35 responding to education level, 24 (68.6%) attained at least Form 3 level. Two were students and both were aged 14. Of the 36 responding to employment status, 21 (58.3%) were unemployed. Of the 37 responding to marital status, 30 (81.1%) were single. Location of substance abuse The majority of patients (68%) took drugs in No. of patients 10 Sex M F Figure 1. Age and sex distribution of substance abusers.

3 198 Hong Kong j. emerg. med. Vol. 8(4) Oct 2001 Hong Kong while the remainder (32%) took them in China. Among them, ecstasy was the most commonly abused substance. Of the 29 ecstasy abusers, 16 (55%) took them in China and 13 (45%) in Hong Kong. Analysis showed that ecstasy was positively associated with cross-border drug abusers (chi-square test p=0.001). Nature of substance abused The most commonly abused substance in this study was ecstasy 40.3% (29 out of 72). Eleven took heroin (15.3 %), 2 in China and 9 in Hong Kong. Another eleven took benzodiazepines, again 2 in China and 9 in Hong Kong. All the seven cases of organic solvent abuse (9.7%) occurred in Hong Kong. The commonly abused substances in this study are shown in Table 1. However, 25% claimed that they took more than one drug and 25% took alcohol simultaneously. Occasion of substances abuse Twenty-one respondents (29.2%) abused drugs at karaoke, rave parties or discos. Ecstasy was significantly associated with the above party activities in comparison with other drugs (chi-square test p=0.005). Twenty-one patients took the drugs at home. (Table 2) In this study, there was no case of ecstasy abuse in street or park. Table 1. Nature of substance abused. Drug name No. of cases Percentage Ecstasy % Benzodiazepine % Heroin % Organic solvent 7 9.7% Ketamine 5 6.9% Cannabis 3 4.2% Cocaine 2 2.8% Cough mixture 2 2.8% Unknown 2 2.8% Total % First time abuser Among the 72 respondents, 5 (6.9%) of them were first time substance abusers with 3 of them taking the drugs in parties and 2 took them in friend's house. One first time abuser took ecstasy in China. The other four first time abusers took drugs in Hong Kong two ecstasy, one ketamine and one cannabis. Age in relation to substance abused Heroin and benzodiazepine abusers were statistically significantly older than the rest of the respondents (ANOVA p<0.001). The mean age of benzodiazepine abusers was (median 40, range 23-61) while the mean age of heroin abusers was (median 35, range 27-67). The use of organic solvent was significantly associated with young age. (Table 3) Among the seven organic solvent abusers, four (57.1%) were below 18 years old (chi-square test p<0.001). Presentation Collapse and decreased level of consciousness were the commonest presenting symptoms (22.2%). Dizziness occurred in 15.3%. Other common symptoms included headache and insomnia. (Figure 2) Their triage categories are shown in Table 4. Outcomes Forty patients (55.6%) were admitted into North District Hospital and two (2.8%) were admitted to a psychiatric hospital. Thirty-four patients (47.2%) were admitted into medical ward, 3 (4.2%) into surgical ward, 2 (2.8%) into paediatric ward and 1 (1.4%) into intensive care unit. Nine patients (12.5%) discharged themselves against medical advice, 2 (2.8%) were found to have disappeared and 19 (26.4%) were discharged home. One patient (1.4%) died after admission a 20-year-old male patient who had taken ecstasy with alcohol in China. Table 2. Location of substance abuse. Friend's house Home Street Park Unknown Party Total Ecstasy Others Total

4 Yuen et al./substance abuse patient characteristics 199 Table 3. Age in relation to substance abused. Drug name Mean age Number Benzodiazepine Heroin Cocaine Cough mixture Ecstasy Ketamine Unknown Cannabis Organic solvents Total Discussion The findings in general concurred with the data from the Central Registry of Drug Abuse, 1-3,8 especially with regard to the small proportion of the population involved, sex and age distribution, unemployment and student status. However, in contrast, ecstasy had taken over heroin as the most commonly abused substance in the North District. This confirmed the rising trend of psychotropic substance abuse, especially among the younger population in the New Territories. 3 Ecstasy was originally synthesized in Germany as an appetite 40 Percentage Emotional disturbanc Ches t pain Palp itation Abrasion Abdominal pain Inju r y Incontin ence Loc al inf ec tion Skin rash Suic id e idea Sob Headache T/A 10 0 Collapse & LOC Dizz iness Ins omnia Fever Multiple pain Figure 2. Presenting symptoms. C hie f of compla ints Sob=Shortness of breath; T/A=Traffic accident; LOC=Loss of consciousness Table 4. Triage categorisation. Triage category Admitted & died Admitted Not admitted Total I II III IV V Total

5 200 Hong Kong j. emerg. med. Vol. 8(4) Oct 2001 suppressant in ,9 Through the 1990s, ecstasy abuse escalated. It became widely used by "raver" in the United Kingdom and this trend has spread to the United States. 4,10 The trend is increasing exponentially. Ecstasy was usually taken in a convivial manner in fun atmosphere. Drug abusers at rave parties tend to be young people seeking experimentation, excitement, pleasure, pressure relief or sociability, 5 often by taking multiple drugs and alcohol. Party venues, discos and amusement games centres are black spots for illegal drug sale. 11 According to police statistics, juvenile drug offences soared by 77% in the year 2000, as increasing numbers of teenagers took drugs at parties. 5,11 The study also reflected that ecstasy was the most common drug for cross-border abusers who required medical treatment. As the Mainland is a popular holiday destination for Hong Kong people during holiday periods, there are concerns with recent reports that young people go to Shenzhen to abuse psychotropic substances and bring them back to Hong Kong. 2,6,11 Among the first time abusers, ecstasy was also the most commonly abused drug. Although abusers may think ecstasy harmless, they can produce a wide range of unwanted effects including death. Serious adverse effects of abusing ecstasy include persistent confusion, depression, anxiety, paranoia, muscle tension, involuntary teeth clenching and blurred vision. Recent research findings also link ecstasy use to long-term brain damage that leads to memory loss and motor disturbances. 2,3 When used with alcohol or other substances, it is even more dangerous. In addition, "club drugs" are often adulterated or impure. In our study, one patient died after substance abuse with ecstasy and alcohol, shortly after his transfer from mainland China. Heroin and benzodiazepines are used in older age groups, while organic solvent abuse is also common among the teenagers. Another area of concern is that a high proportion of substance abusers are educated. Anti-drug campaign by multi-disciplinary task force including government departments, voluntary organisations, social workers, clinicians and law enforcement agents should target along these directions. Limitation The accuracy of the result depended on the cooperation of respondents and the completeness of data entry in the questionnaire by hospital staff. Factors such as reluctance or inability to respond and unreliable information from the respondents might affect the result of this study. Conclusion This study confirmed the rising trend of psychotropic substance abuse, especially ecstasy and organic solvents, among the young population in the North District. Emergency physicians should familiarise themselves with their clinical presentation, toxicity and complications in order to better manage them. Efforts should be made to keep rave parties, discos and karaoke free from drugs. Cross-border cooperation with Chinese officials in law enforcement is needed to halt the escalating trend of psychotropic drug abuse among the youths. Acknowledgement We are grateful to all staff of the A &E Department of North District Hospital for collecting the data. Special thanks are given to Ms. Helen Leung, Dr. CP Ng, Dr. Axel Siu and Dr. Ludwig Tsoi for their advice and assistance. References 1. The Government of the Hong Kong Special Administrative Region Narcotics Division, Central Registry of Drug Abuse (CRDA). Selected Drug Abuse Statistics (1994 September 2000). gov.hk/nd/stat/index.htm 2. HK Special Administrative Region Government. Abuse of "Ecstasy" and Ketamine Proved Fatal. [Press release] Sep Yuen ECP. The common drugs of abuse in Hong Kong. Hong Kong J Emerg Med 2001;8(2): Graema KA. New drugs of abuse. Emerg Med Clin North Am 2000;18(4):

6 Yuen et al./substance abuse patient characteristics Hong Kong Focus: HKMA to target drug abuse. Medical Tribune 2001 Feb: Apple Daily Oct 25:A The Government of the Hong Kong Special Administrative Region. Enhanced Hong Kong Mainland co-operation in combating cross-boundary drug crimes. [Press release] Jan Hong Kong Annual Report Drug Abuse and Trafficking 2000 Sep hkar99/eng/10/10_14_content.htm 9. Rattray M. Ecstasy: towards an understanding of biochemical basis of the actions of MDMA. Essays Biochem 1991;26: Schwartz RH, Miller NS. MDMA (ecstasy) and rave - A review. Paediatrics 1997;100(4): Hong Kong Special Administrative Region Government. Legislative Council Question 1: Drug addiction and abuse of psychotropic substances. [Press release] Mar 29.