NPS (New Psychoactive Substances)

Substance [1, 2]

  NPS (New Psychoactive Substance).

        * so-called ‘legal highs’

* synthetic, such as designer drug.

* structural easily modified.

* difficult to detect by traditional urine test.

* novel and diverse appearance and package.

* not controlled by the 1961 Single Convention on Narcotic Drugs, or the 1971 Convention on Psychotropic Substances, posing a public threat.

 

History told by Patient (46%), Family (39%), EMT (22%), Friend (15%), Police (11%) [2]

 

 

Common name or Trade name [1, 2]

  管制一級

      Desomorphine (Krokodial) 鱷魚

  管制二級

      PCP-based. (Angel dust)

      MDPV(浴鹽)

      GHB (液態快樂丸), 神仙水

             MDMA 快樂丸、搖頭丸.

      PMMA (happy粉) 

      25B-NBOMe (毒郵票)

  管制三級

      Mephedrone (Meow Meow)喵喵

      bk-MDMA (Methylone)卡西酮

            ketamine (K仔、Special K或K)

Nimetazepam(一粒眠)

  管制四級

      5MeO DiPT (火狐狸), Tryptamine類.

 

  Mixed type (6—12種)以Ketamine為based + Cathinone, MDPV 等.混10種很常見

 

 

Involving system [1]

    * Cardiovascular: HTN, tachycardia.

* Urologic: cystitis, bladder atrophy

* GI: cramping pain

* Mental: executive dysfunction, defected memory

* Psychosis

    * addiction.

 

 

Presentation [2]

-          Respiratory rate< 10 /min, and > 16/min (88%)

-          Tachycardia + bradycardia (59%)

-          SBP >140 mmHg, <90 mmHg (32%)

-          BT (<35 degrees Celsius, > 38 degrees Celsius) 12%

-          low oxygen saturation < 90% (5%)

 

 

Antidote and Treatment [3]

-          no antidote

-          evaluation of blood morphology, coagulation parameters, biochemistry screening  

-          Symptomatic treatment of patients, fluid therapy and sedation if irritable/ aggressive behavior 

-          Management the complication, trauma, infection and so on.

 

Disposition [2]

 

  急診暫留 (52%)

Admission (16%)

ICU (14%)

Transfer (2.2%)

OHCA (0.6%)

IHCA (0.3%)

 

 

REFERENCES

 

1.      Morning meeting, July 24, 2020. Emergency Department, MacKay Memorial Hospital, Taipei, Taiwan.

 

2.      藥物濫用個案醫療救護訓練. 台灣急診醫學會. 亞東紀念醫院July 20, 2020.

 

3.      Jalali R, Dmochowska P, Godlewska I, et al. Designers Drugs-A New Challenge to Emergency Departments-An Observational Study in Poland. Medicina (Kaunas). 2020;56(7):E354. Published 2020 Jul 17. doi:10.3390/medicina56070354

 

~~ Aug 4, 2020 by Yu-Jang Su