Retrospective analysis of stimulant abuse cases reported to the Swiss Toxicological Information Centre during 1997-2009.

STUDY AIM: To describe characteristics of stimulant abuse and toxicity.

METHOD: We conducted a retrospective analysis of cases of exposure to cocaine, amphetamines (amphetamine, methamphetamine, and 3,4-methylenedioxymethamphetamine [MDMA]) and methylphenidate reported to the Swiss Toxicological Information Centre between 1997 and 2009.

RESULTS

There were 667 reports for cocaine, 147 for amphetamine, 41 for methamphetamine, 433 for MDMA, and 122 for methylphenidate. Detailed outcome data were available in 546 (39%) of all reported cases. Exposure to amphetamine or MDMA commonly resulted in mild to moderate toxicity, but severe toxicity was seen in approximately 15% of reported cocaine and MDMA exposures with a known medical outcome. Frequently observed clinical signs and symptoms included tachycardia, arterial hypertension, nausea, agitation, and panic. Amphetamine and MDMA exposures were seen in a younger population and were mainly reported at weekends, while cocaine users were older and exposures occurred proportionally more frequently on weekdays. Parenteral drug use and co-use of heroin was more frequent in cocaine users than in those using other stimulants. There has been an increase in reports of non-medical use of methylphenidate in recent years, indicating a need for further studies of abuse of prescription stimulants.

CONCLUSION

Stimulant abuse is associated with major toxicity in approximately 15% of reported cases with a known medical outcome. Amphetamine and MDMA users differed from cocaine users in terms of user characteristics, time of use and medical complications. Non-medical use of prescription stimulants such as methylphenidate needs attention.