Characteristics of Drug Abusers

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Background: The impact of the COVID-19 pandemic on the trends, characteristics and management of acute toxicity related to drug abuse in Hong Kong is not clear.

Aims: To characterise the trends and patterns of acute toxicity related to methamphetamine, cocaine, cannabis, heroin and ketamine abuse presenting to emergency departments in Hong Kong during the COVID-19 pandemic.

Method: We conducted a retrospective study of all consecutive patients reported to the Hong Kong Poison Information Centre by public emergency departments in Hong Kong between 23 January 2017 and 22 January 2023 for acute toxicity related to the above-mentioned drugs. We studied the trends and patterns of acute toxicity using Poisson regression, interrupted time series analysis and multivariable logistic regression.

Results: We analyzed 1,453 episodes. Acute toxicities involving methamphetamine, cannabis and heroin increased shortly after the beginning of the pandemic but then decreased faster than the pre-pandemic period. Acute toxicities involving ketamine increased and followed a similar trend as before the pandemic. As for cocaine, no significant changes in the number and trend of acute toxicities were observed during the pandemic. Overall, closure of social and recreational venues during the pandemic had a limited impact on acute drug toxicities. Several significant changes in the patterns of acute toxicity and clinical presentations are noteworthy.

Conclusion: The pandemic has had multiple impacts on local patterns of drug abuse and associated toxicities. The findings of this study call for continued vigilance against drug use and related acute toxicity during and in the aftermath of the COVID-19 pandemic.

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Background: Cannabis abuse has been prevalent among youth recently, and the situation is noteworthy.

Aims: To explore the risk factors of cannabis abuse among youths in Hong Kong and discuss strategies for preventing cannabis abuse among youth.

Method: This exploratory study is based on the experiences of service users at the Youth Crime Prevention Centre of the Hong Kong Federation of Youth Groups and the opinions of social workers and relevant stakeholders. The study uses qualitative methods to collect data from various sources between March 2022 and February 2023, exploring the risk factors of cannabis abuse among youth and discussing strategies for preventing cannabis abuse through individual interviews and focus groups. The study adopts the General Strain Theory and the Differential Association Theory as its theoretical foundation.

Results: This study found that youth cannabis users generally come from families with discord or frequent conflicts, and they tend to have a low sense of achievement and low self-esteem. They all know friends who use cannabis, and when these young people experience negative emotions due to stress in their lives, they often adopt a self-reliant attitude, rarely seeking help from others, and are influenced by their peers to mistakenly believe that cannabis can alleviate their emotions, leading to the occurrence of addictive behaviors such as cannabis use.

Conclusion: This exploratory study, has enriched our knowledge of cannabis use among youth and inspired us in future social planning to prevent cannabis use among youth. Preventing cannabis use among youth requires a variety of techniques, including enhancing young people’s awareness of the dangers of cannabis, enhancing support for youth in facing life stress and emotional distress, enhancing the positive peer influence among good friends, strengthening family and social support for youth, using big data analysis and artificial intelligence to strengthen drug abuse prevention education, and formulating anti-cannabis use education policies for youth at different stages of their growth.

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Background: Methamphetamine, cocaine and cannabis are popular recreational drugs in Hong Kong. There is a lack of local studies on the trends, patterns, harms and burden of their abuse in emergency departments (EDs).

Aims: To characterise the trends, patterns and burdens of acute toxicity related to methamphetamine, cocaine and cannabis abuse presenting to local EDs and to analyse the factors associated with end-organ toxicity and drug-related ED reattendance.

Method: We reviewed 1 629 episodes of acute toxicity that involved 1 348 patients reported to the Hong Kong Poison Information Centre from 2010 to 2019. We studied the trend of acute toxicity using a negative binominal model. Univariate analysis, followed by multivariable logistic regression analysis, were conducted to identify independent predictors for end-organ toxicity. Cox regression analysis was performed to identify factors associated with drug-related ED revisits.

Results: During the study period, a rising trend of acute toxicity of these drugs was not observed. Polysubstance abuse predominated. Most patients were triaged as urgent in the ED with prominently neurological and cardiovascular symptoms. Many patients had hypokalaemia (a low potassium level), rhabdomyolysis (breakdown of muscle tissue), acute kidney injury and disorganised behaviours. In total, 18 patients died and 96 required intensive care. Patients with a triage temperature > 39°C, a heart rate >120 beats/minute, profused sweating, agitation, sluggish or non-reactive pupils, a triage ranking of a higher acuity, concurrent use of cough mixture/pills or other medications and associated injury were more likely to develop end-organ toxicity. Methamphetamine abuse and the need for urgent psychiatric consultation were significantly associated with a higher risk of ED reattendance, whereas a major effect of acute toxicity was associated with a lower risk of reattendance.

Conclusion: This study extended our current understanding of acute toxicity related to methamphetamine, cocaine and cannabis abuse in Hong Kong. Methamphetamine remains a major public health burden and threat to physical and mental health. More resources should continue to be channelled to educate young people about the harms of methamphetamine and to prevent its use. There is a need to bring drug services from different agencies to the patients while they are still in hospital to ensure maximum engagement so as to motivate drug abusers to quit drugs.

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Background: This is a hospital-based study to investigate the characteristics of drug abusers requiring medical care through Accident and Emergency (A&E) Department attendance.

Aims: To identify and understand the drug abusers in-depth so as to characterise and improve the subsequent downstream clinical pathway of drug abuses as well as to guide the development of a new model of medico-social collaborative interventions for drug abuses in future.

Method: Using big data methods, the project team analysed 8 423 patients on their medical conditions, patterns of A&E attendances and hospitalisations and compared how healthcare resources were used by patients with and without substance abuse.

Results: Among the patients who attended A&E, the substances most frequently used were opioids, followed by ketamine, barbiturate/hypnotics, amphetamines and cocaine. Opioids and ketamine are the two main substances that contribute to patients with substance abuse returning to hospital.

Conclusion: The public healthcare system in Hong Kong can be stretched by excessive A&E and hospital visits. To reduce the burden on public healthcare resources and prevent unnecessary hospital visits, early intervention is needed to help patients with substance abuse get the treatment and care they need.

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