David M Wood

King's College London, Londinium, England, United Kingdom

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Publications (99)250.05 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to establish a management protocol for body stuffers presenting to the emergency department. This is a retrospective observational case series of patients presenting to the emergency department of a large inner-city hospital as 'body stuffers' during the period between 1 January 2006 and 31 October 2011, irrespective of the type of drug ingested. We reviewed demographic data, ingestion characteristics, clinical progress and outcome. A total of 126 patients were included in the study, with a mean age of 31±8.10 years (range 15-58 years), among whom 106 were male (84%). Drugs ingested were as follows: heroin (n=61, 48%), cocaine (n=58, 46%), other drugs (n=20, 16%) and unknown (n=10, 8%). Of the patients, 23 (18%) ingested more than one drug. At presentation, 96 had features of drug toxicity. The presence of depressant drug toxidrome was more commonly observed among heroin users, but stimulant drug toxidromes were seen across all groups. Of the patients, 12 developed changes in clinical state, with a mean time to development of symptoms of 2 h 50 min±1 h 39 min (range from 1 h 0 min to 5 h 36 min). Abdominal radiography showed the presence of foreign bodies in 8% of the tests performed, and packets were recovered from one patient who underwent gut decontamination. Patients developed new or worsening features of drug toxicity within 6 h of presentation. Toxidromes observed are often not drug/class specific, and treatment including gut decontamination and radiography do not aid in expediting discharge. We propose an observation period of 6 h from the time of admission as the time required if the patient is asymptomatic or there is resolution of presenting signs and symptoms.
    European Journal of Emergency Medicine 05/2015; DOI:10.1097/MEJ.0000000000000277 · 1.50 Impact Factor
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    ABSTRACT: The international boundaries to medical education are becoming less marked as new technologies such as multiuser videoconferencing are developed and become more accessible to help bridge the communication gaps. The Global Educational Toxicology Uniting Project (GETUP) is aimed at connecting clinicians in countries with established clinical toxicology services to clinicians in countries without clinical toxicologists around the globe. Centers that manage or consult on toxicology cases were registered through the American College of Medical Toxicology website via Survey Monkey®. Data was analyzed retrospectively from February 2014 to January 2015. Google hangouts® was used as the main conferencing software, but some sites preferred the use of Skype®. Registration data included contact details and toxicology background and qualifications. Thirty sites in 19 different countries in Australasia, Europe, Africa, and America were registered. Twenty-eight (93 %) sites were located in a major urban center, one (3.5 %) site in a major rural center and one (3.5 %) a private practice. Expectations of GETUP included sharing toxicology cases and education (30, 100 % of sites), assistance with toxicology management guidelines (2, 7 %), assistance with providing a toxicology teaching curriculum in languages other than English (2, 7 %), and managing toxicology presentations in resource-poor settings, international collaboration, and toxicovigilance (2 sites, 7 %). Twenty-two conferences were performed during the first 12 months with a mean of 3 cases per conference. GETUP has connected countries and clinical units with and without toxicology services and will provide a platform to improve international collaboration in clinical toxicology.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 05/2015; DOI:10.1007/s13181-015-0479-7
  • Clinical Toxicology 04/2015; 53(5):1-2. DOI:10.3109/15563650.2015.1033062 · 3.12 Impact Factor
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    ABSTRACT: 4-Methyl-5-(4-methylphenyl)-4,5-dihydrooxazol-2-amine (4,4'-dimethylaminorex (4,4'-DMAR)) is a derivative of the controlled substances aminorex and 4-methylaminorex marketed as a potential novel psychoactive substance. This paper brings together the published scientific and 'grey' literature to understand 4,4'-DMAR as a novel psychoactive substance. Searches of the published scientific and 'grey' literature, using the keywords '4-methyl-euphoria', '4-methyl-U4Euh', '4-M-4-MAR', '4,4-dimethylaminorex', '4,4'-DMAR', 'para-methyl-4-aminorex' and 'Serotoni', were undertaken to identify information on the availability, prevalence of use and desired/unwanted effects of 4,4'-DMAR. No studies have reported the prevalence of use of 4,4'-DMAR. Internet snapshot studies in April and May 2014 showed availability of 4,4'-DMAR from one and two Internet suppliers respectively. Price decreased with increasing purchase amounts from €12/g for a 1-g purchase to €2.20/g for a 100-g purchase in April 2014. Internet discussion fora suggest that the desired and unwanted effects of 4,4'-DMAR are similar to those seen with other sympathomimetic drugs such as 3,4-methylenedioxy-methamphetamine and mephedrone, although the duration of unwanted effects and 'comedown' appear to be longer. Unwanted effects were reported at doses of 5-200 mg, which overlaps with the reported doses (10-200 mg) associated with desired effects. 4,4'-DMAR has been detected, along with other drugs, in 27 deaths in Europe; the contribution of the 4,4'-DMAR in these deaths has not been established. Currently, there appears to limited availability of 4,4'-DMAR; therefore, use is likely to be low. Its desired and unwanted effects appear similar to other sympathomimetic recreational drugs such as methylenedioxy-methamphetamine or mephedrone. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 03/2015; 30(3). DOI:10.1002/hup.2472 · 1.85 Impact Factor
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    ABSTRACT: Analysis of anonymous pooled urine samples from street urinals has been used to demonstrated time-trends in the detection of classical recreational drugs and novel psychoactive substances (NPS). This study aimed to expand this to undertake a geographical trend analysis of classical recreational drugs/NPS across the UK. Samples of anonymous pooled urine were collected from street urinals that had been in place for one night in April 2014 in nine cities across the UK. Collected samples were then analysed for the presence of recreational drugs, novel psychoactive substances and anabolic steroids using high performance liquid chromatography coupled to high-resolution accurate mass full-scan mass spectrometry (HRAM LCMS) and gas chromatograpy coupled to electron impact ionisation mass spectrometry operating in selected ion monitoring and full scan modes (EI-GCMS) Results: Nine classical recreational drugs, nine NPS and four anabolic steroids were detected across the nine cities; the range of detection was from 1 in Leeds to 14 in London. The most common classical drugs were cocaine (9 cities) and MDMA (8 cities); the most common NPS was 4-methylmethcathinone (5 cities). In addition there was variation in the detection of NPS, with methylhexaneamine detected only in Bristol and London, piperazines (TFMPP and 1-benzylpiperazine) and pentedrone only detected in Birmingham and the cathinone methylone only detected in London. There is variability in the detection of classical recreational drugs, NPS and anabolic steroids across the UK, likely reflecting variation in their use. This technique can be used to supplement drug use surveys to determine geographical and time trends in the use of these substances. This is important to ensure appropriate targeting of drug-related interventions. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    QJM: monthly journal of the Association of Physicians 03/2015; DOI:10.1093/qjmed/hcv058 · 2.46 Impact Factor
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    ABSTRACT: Cannabis is the most commonly used illicit drug in Europe, and is generally regarded as having low acute toxicity. We present the findings of the first 6 months of data collection from the Euro-DEN project on presentations related to cannabis use to further understand the acute toxicity related to the use of cannabis. Data was extracted on clinical features, treatment and outcome from the Euro-DEN minimum dataset for all cases of acute recreational drug toxicity reported 1st October 2013 to 31st March 2014 for all cannabis-related presentations. Of 2198 presentations reported by 14 of the 16 Euro-DEN centres, 356 (16.2 %) involved cannabis either alone or together with other drugs/alcohol. There were 36 that involved lone use of cannabis (1.6 % of all presentations). Of the 35 non-fatal lone cannabis presentations, the most commonly reported features were neuro-behavioural (agitation/aggression 8 (22.9 %), psychosis 7 (20.0 %), anxiety 7 (20.0 %)) and vomiting 6 (17.1 %). Most patients (25, 71.4 %) received no treatment and 30 (85.7 %) were discharged/self-discharged from the ED. There was one fatality amongst these lone-cannabis cases: an 18-year-old male collapsed with an asystolic cardiac arrest whilst smoking cannabis and suffered hypoxic brain injury related to prolonged cardiac arrest. THC was detected in a urine sample taken at ED arrival; no other drugs were detected. Lone acute cannabis toxicity was typically associated with neuro-behavioural symptoms and vomiting. Although uncommon, severe toxicity including cardiovascular toxicity and death may be under-recognised, and it is important that Emergency Physicians are aware of this.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 02/2015; DOI:10.1007/s13181-014-0460-x
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    ABSTRACT: Abstract Introduction. The 25X-NBOMe series are N-2-methoxybenzyl analogues of the respective 2C-X substituted phenethylamine and include 25B-N(BOMe)2, 25B-NBOMe, 25C-NBOMe, 25D-NBOMe, 25E-NBOMe, 25G-NBOMe, 25H-NBOMe, 25I-NBOMe, 25N-NBOMe and 25iP-NBOMe. There are reports of their use as novel psychoactive substances and associated acute toxicity from Europe, the United States and elsewhere over the last five years. This review will discuss the epidemiology of use and pattern of acute toxicity associated with use of these compounds. Methods. A PubMed search was performed using the search terms 'NBOMe', '25B-N(BOMe)2', '25B-NBOMe', '25C-NBOMe', '25D-NBOMe', '25E-NBOMe', '25G-NBOMe', '25H-NBOMe', '25I-NBOMe', '25N-NBOMe' and '25iP-NBOMe' covering the years 1966-2014. In addition, abstracts from the 2010-2014 congresses of the European Association of Poisons Centres and Clinical Toxicologists and the 2010-2013 North American Congress of Clinical Toxicology were reviewed using these search terms. Further information was obtained from the European Information System and Database on New Drugs co-ordinated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Prevalence of use. There are no national or international surveys collecting data on the prevalence of use of NBOMe drugs. The only information on prevalence of use is from two sub-population surveys of individuals who frequent nightclubs. Of 22,289 respondents of the 2013 Global Drugs Survey, 582 (2.6%) had previously used an NBOMe; the most commonly used NBOMe was 25I-NBOMe (442 respondents, 2.0% of whole cohort and 75.9% of those who had used an NBOMe). In a survey of 397 clubbers in London nightclubs in 2013, 11.8% had heard of the NBOMe drugs (compared with 96.0% for mephedrone), and 4.8% had ever used an NBOMe (compared with 76.6% for mephedrone). Acute toxicity. There were 29 published cases in the literature of acute toxicity associated with the use of an NBOMe: 25I-NBOMe - 23 cases; 25B-NBOMe - 3 cases; 25C-NBOMe - 3 cases. Commonly reported features include tachycardia (96.6%), hypertension (62.0%), agitation/aggression (48.2%), seizures (37.9%) and hyperthermia (27.6%). Five patients were reported to have developed acute kidney injury. There were an additional 25 reports of acute toxicity related to the use of 25I-NBOMe reported to the EMCDDA. The pattern of toxicity in these cases is similar to that seen in the published cases. NBOMe-related deaths. 25I-NBOMe has been detected in eight fatalities; in one of these, 25C-NBOMe was also detected. The role of the NBOMe drugs in these deaths has not been determined in all cases. Conclusions. Currently, there is evidence suggesting limited use of the NBOMe class of drugs as novel psychoactive substances compared with that of classical recreational drugs and other novel psychoactive substances such as mephedrone.
    Clinical Toxicology 02/2015; 53(2):85-92. DOI:10.3109/15563650.2015.1004179 · 3.12 Impact Factor
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    ABSTRACT: Background. Intravenous lipid emulsion (ILE) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are being used together or in close succession in the management of circulatory failure secondary to cardiotoxic drug poisoning. There have been reports of mechanical problems, including fat emulsion agglutination, clogging, increased blood clot formation and even cracking of parts of the machine, in patients concurrently receiving VA-ECMO and ILE as part of parenteral nutrition. Objective. To ascertain the adverse effects associated with the combined use of ILE and ECMO in the poisoned patient. Methods. PubMed and OVID (1966 to 9 June 2014) and EMBASE (1947 to 9 June 2014) were searched to identify publications relating to studies and/or case reports where ILE had been used at the same time when VA-ECMO was used - 7 were identified. In addition, the abstracts published between 2006 and 2013 inclusive of those from the North American Congress of Clinical Toxicology and the congresses of the European Association of Poisons Centres and Clinical Toxicologists were searched to identify additional cases and 2 were found. Finally all cases posted on lipidrescue.org were reviewed to determine if they related to the use of ILE with VA-ECMO and no new cases were identified. In vitro study. An in vitro study involving the continuous infusion of 20% ILE at 3 mL/h for 24 h demonstrated layering (separation of intact fat emulsion from blood) and agglutination (clumping resulting in little or no flow of fat emulsion through the circuit) in all circuits within 30 min of starting the fat emulsion infusion. Clinical studies. An observational study based in 42 centres that regularly used 'fat emulsion' during VA-ECMO treatment reported cracking of stopcocks (the valve which restricts flow in the VA-ECMO tubing) (n = 10, 23.8%); fat emulsion agglutination (n = 11, 26.2%); clogging and associated malfunction of the membrane oxygenator (n = 2, 4.8%); and increased blood clot formation in the circuits (n = 2, 4.8%). In a prospective observational study of 9 neonates on VA-ECMO receiving intravenous nutrition, layering and agglutination were seen in four sets of VA-ECMO tubing and blood clots were found in seven circuits. Nine case reports were identified where ILE was used with VA-ECMO for the management of circulatory failure/instability secondary to cardiotoxic drug poisoning. In two of these case reports, the authors specifically stated that ILE did not cause any mechanical complications with the VA-ECMO; the other seven reports made no comment as to whether there were any complications or not. Conclusions. There is in vitro and clinical evidence that the combined use of ILE and extracorporeal membrane oxygenation may be associated with fat deposition in the VA-ECMO circuits and increased blood clot formation. Clinicians managing poisoned patients with both of these novel treatment modalities should be aware of these potential complications.
    Clinical Toxicology 01/2015; 53(3):1-6. DOI:10.3109/15563650.2015.1004582 · 3.12 Impact Factor
  • Drug Testing and Analysis 01/2015; 7(5). DOI:10.1002/dta.1764 · 2.82 Impact Factor
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    ABSTRACT: Gamma-hydroxybutyric acid (GHB) is a well-known illicit club and date-rape drug. Dried blood spot (DBS) sampling is a promising alternative for classical venous sampling in cases of (suspected) GHB intoxication since it allows rapid sampling, which is of interest for the extensively metabolized GHB. However, there is limited data if -and how- capillary DBS concentrations correlate with venous concentrations. We conducted a comparative study in 50 patients with suspected GHB intoxication, to determine and to correlate GHB concentrations in venous DBS (vDBS) and capillary DBS (cDBS). This is the first study that evaluates in a large cohort the correlation between capillary and venous concentrations of an illicit drug in real-life samples. Of the 50 paired samples, 7 were excluded: the vDBS concentration was below the LLOQ of 2 µg/mL in 3 cases and 4 samples were excluded after visual inspection of the DBS. Bland-Altman analysis revealed a mean % difference of -2.8% between cDBS and vDBS concentrations, with the zero value included in the 95% confidence interval of the mean difference in GHB concentration. A paired sample t-test confirmed this observation (p = 0.17). Also the requirement for incurred sample reproducibility was fulfilled: for more than two-thirds of the samples the concentrations obtained in cDBS and those in vDBS were within 20% of their mean. Since equivalent concentrations were observed in cDBS and vDBS, blood obtained by fingerprick can be considered a valid alternative for venous blood for GHB determination. Copyright © 2015 John Wiley & Sons, Ltd.
    Drug Testing and Analysis 01/2015; DOI:10.1002/dta.1760 · 2.82 Impact Factor
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    ABSTRACT: The aim of this study was to design an information leaflet for patients with paracetamol overdose based on Medicines and Healthcare products Regulatory Agency guidance and to assess its readability. A two-sided one page information leaflet was designed for patients being discharged from hospital after a paracetamol overdose. Patients presenting with an acute paracetamol overdose, irrespective of whether they were treated or not, were recruited to read the leaflet and then answer a brief structured questionnaire based on the leaflet. The readability of the information leaflet was assessed using the Flesch reading ease score. Thirty patients (15 male, 12 female, 3 not recorded; mean age 38 ± 13.0 years) were recruited, wherein 100% of patients reported the language used was understandable, 96.6% knew which symptoms would require urgent medical review after discharge and 100% of patients knew the liver was affected by paracetamol. The Flesch reading ease score was 67.6 (out of a maximum of 100), equivalent to a UK reading age of 10–11years old. Our information leaflet for all patients being discharged after paracetamol overdose was well received by patients, provided them with the required knowledge and had an appropriate reading age based on UK literacy rates. We would recommend that this leaflet could be used as a template on a national level, localized to individual hospitals, to improve patient knowledge of paracetamol toxicity, and facilitate early medical review in the event of deterioration following discharge from the hospital.
    12/2014; 2(6). DOI:10.1002/prp2.75
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    ABSTRACT: Introduction. 1-Cyclohexyl-4-(1,2-diphenylethyl)piperazine (MT-45) is a novel psychoactive substance available over the Internet. MT-45 is an opioid-like compound. This study provides an overview of availability, use and desired and unwanted effects of MT-45 through triangulation of available data sources. Methods. Searches of the published scientific literature and 'grey' information sources, using the keywords 'MT 45', 'MT-45' and '1-cyclohexyl-4-(1,2-diphenylethyl)piperazine' were undertaken in June 2014 to identify information on the availability, prevalence of use and desired/unwanted effects of MT-45. In addition an Internet snapshot survey in English was undertaken in May 2014 to determine the availability and cost of MT-45. Results. In June 2014 we were unable to identify any studies reporting the prevalence of use of MT-45. The Internet snapshot study identified 17 Internet sites selling MT-45. Information on price was available from 9 sites, with the mean price of MT-45 decreased with increasing purchase amounts from US$57.60 ± 19.37 per gram for a 1-g purchase to US$3.36 ± 1.83 per gram for a 1-kg purchase. We identified one published scientific paper reporting on the acute harms in nine cases of analytically confirmed MT-45 toxicity, one US government report relating to two MT-45-related deaths and 20 user reports on Internet discussion forums relating to the use of MT-45. All these suggest that the desired and unwanted effects of MT-45 are similar to those seen with other opioids, and that the opioid-like unwanted effects may be reversed with the opioid antagonist naloxone. There were user reports of MT-45 being used in heroin withdrawal and of 'withdrawal symptoms' after use, suggesting that long-term use may be associated with dependency as seen with other opioids. Conclusions. Combining published scientific literature and 'grey' information sources, we have demonstrated that MT-45 has opioid-like desired and unwanted effects. Whilst the information is limited at the moment, it has the potential to have similar dependence liability to other opioids.
    Clinical Toxicology 11/2014; DOI:10.3109/15563650.2014.983239 · 3.12 Impact Factor
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    ABSTRACT: Background: Acute recreational drug toxicity is a common cause of emergency department (ED) presentations. There is limited published information on the perception, knowledge and experiences of these patients with regards to seeking medical care. Methods: Thirty-one participants with acute recreational drug toxicity completed a two-page questionnaire survey to gather information on previous health services used in relation to drug use, knowledge of sources of information on drugs, how their admission may influence their future use of drugs and their experience with their current hospital stay. Results: This was the first presentation to hospital with acute recreational drug toxicity in 20 (62.5% of respondents) participants. For 19 (59.4%), this admission would lead to stopping or reducing the use of recreational drugs/noel psychoactive substances (NPS). Seventeen (53.1%) of them utilised the Internet as a source of information on recreational drugs. Mean satisfaction score in relation to current attendance of 84.8 (range 46–100) and 29 (91%) would return to this hospital for treatment for future recreational drug problems. Conclusion: Contact with healthcare staff in an emergency setting may be the only access to healthcare services; it is important that this opportunity is utilised to inform individuals about the harms associated with using recreational drugs/NPS and sources of help/advice if required.
    Journal of Substance Use 11/2014; DOI:10.3109/14659891.2014.980863 · 0.48 Impact Factor
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    ABSTRACT: Background. The number of new (novel) psychoactive substances (NPS) available in the illegal market is increasing; however, current monitoring of the drug situation in Europe focuses mainly on classical drugs of abuse, with limited emphasis on clinical presentation in the emergency department (ED). The European Drug Emergencies Network (Euro-DEN) is a European Commission-funded project that aims to improve the knowledge of acute drug toxicity of both classical recreational drugs and NPS. As a baseline for this project, we performed a study to establish which data are currently being collected and reported in Europe on ED presentations with acute toxicity related to NPS and classical drugs of abuse. Methods. We used a three-pronged approach to identify any systematic collection of data on NPS toxicity in Europe by i) performing a literature search, ii) utilising an online survey of the European Monitoring Centre for Drugs and Drug Addiction Re seau Europe en d'Information sur les Drogues et les Toxicomanies national focal points and iii) exploiting the knowledge and resources of the Euro-DEN network members. Results. The literature search revealed 21 papers appropriate for assessment, but only one described a systematic collection of clinical data on NPS. Twenty-seven of thirty countries responded to the online survey. More than half of all the countries (52%) did not perform any registration at all of such data, 37% collected systematic clinical data on NPS at a national level, while 44% collected data on classical drugs. A few examples for good practice of systematic collection of clinical data on ED presentations due to acute toxicity were identified. Conclusion. The systematic collection of data on ED presentation of toxicity related to NPS and classical drugs in Europe is scarce; the existing collection is limited to single centres, single countries, groups of patients or not focused on novel drugs; the collection of data is highly variable between the different countries. Euro-DEN, a European Commission funded project, aims at closing some of these gaps.
    Clinical Toxicology 10/2014; 52(10):1-8. DOI:10.3109/15563650.2014.976792 · 3.12 Impact Factor
  • Hisham Nizar, Paul I Dargan, David M Wood
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    ABSTRACT: 4,4'-Dimethylaminorex is a stimulant novel psychoactive substance (NPS) first detected in Europe in November 2012. It is a derivative of 4-methylaminorex, a substance controlled under Schedule 1 of the 1971 United Nations Convention on Psychotropic Substances. There is currently no information on the availability or cost of these substances from Internet suppliers. An Internet snapshot study was undertaken in English using established European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) methodology to determine the availability of 4-methylaminorex and 4,4'-dimethylaminorex in April 2014. Twenty Internet sites selling 4-methylaminorex were identified, 18 selling in US dollars and two in GB Pound Sterling. Fourteen (70 %) Internet sites had a minimum purchase amount of ≥10 g (compared to user doses of 10-25 mg). For the 18 suppliers selling in US$, 9 quoted a fixed price per gram irrespective of the amount ordered and 11 had a reducing price per gram with increasing purchase quantity (US$30.8 ± 34.2/g for 1 g purchase to US$15.2 ± 20.3/g for 1 kg purchase). Only one Internet site selling 4,4'-dimethylaminorex was identified, selling in Euros. The minimum purchase quantity was 500 mg. The price per gram reduced from 36.08/g for a 500 mg purchase to 2.20/g for a 100 g purchase. This Internet snapshot demonstrated that there was a greater availability from Internet suppliers of products advertised as 4-methylaminorex than 4,4'-dimethylaminorex, despite the 4-methylaminorex being an internationally controlled substance. Whilst this may reflect misunderstanding by suppliers, it has the potential to put those purchasing at risk of contravening border control and/or local law enforcement legislation. The use of methodology such as Internet snapshot surveys is of increasing interest to clinical/medical toxicologists in their understanding of the supply, availability and cost of novel psychoactive substances.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 08/2014; 11(1). DOI:10.1007/s13181-014-0425-0
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  • David M Wood, Wui Ling Chan, Paul I Dargan
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    ABSTRACT: Over the last decade, there has been a reduction of organ donation from intracranial haemorrhage-, stroke- and blunt trauma-related deaths in the USA. There has been a corresponding increase in the use of drug-intoxicated patients as organ donors from 2.1 % in 2003 to 6.8 % in 2013.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 07/2014; 10(4). DOI:10.1007/s13181-014-0413-4
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    British Journal of Clinical Pharmacology 07/2014; 78(1):190-1. DOI:10.1111/bcp.12277 · 3.69 Impact Factor
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    ABSTRACT: Methiopropamine use in Europe has been detected since January 2011, but there is limited information on its acute toxicity. Here, we describe a case of analytically confirmed methiopropamine acute toxicity. A 27-year-old woman with no previous medical history was brought to the emergency department with palpitations, chest tightness, anxiety, nausea, vomiting and visual hallucinations following the use of a 'Quicksilver'. Toxicological analysis of her urine collected at presentation to the ED detected methiopropamine at a concentration of 400 ng/mL. Other drugs were also detected but at a much lower concentration. This is the first ever case report of analytically confirmed acute toxicity related to methiopropamine use. It confirms the potential for significant acute toxicity with cardiovascular, gastrointestinal and psychotic symptoms thus providing further information to help with managing these patients and allow legislative authorities to consider the need for its control.
    Journal of medical toxicology: official journal of the American College of Medical Toxicology 04/2014; 10(3). DOI:10.1007/s13181-014-0399-y
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    ABSTRACT: In September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in management of paracetamol poisoning: use of a single '100mg/L' nomogram treatment line; ceasing risk assessment; treating all staggered/uncertain ingestions; increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions, and costs of paracetamol poisoning. Prospectively collected data from adult patients presenting to 3 large UK hospitals from 3 Sept 2011 to 3 Sept 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90,000 patients/annum with paracetamol overdose. There were increases in the numbers:- presenting to hospital (before 1703, after 1854; increase 8.9%[95%CI 1.9-16.2] p=0.011); admitted (1060/1703 [62.2%] vs 1285/1854 [69.3%]; increase: 7.1% [4.0-10.2], p<0.001); and proportion treated (626/1703 [36.8%] vs 926/1854 [50.0%]; increase: 13.2% [10.0-16.4] p<0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15min 87/323[26.9%], 60min 145/514[28.2%]; increase: 1.3%[-4.9-7.5] p=0.682). Across the UK the estimated cost impact is £8.3M (6.4M to 10.2M) annually, with a cost-per-life saved of £17.4 M (95% CI 13.4 to 21.5 M). The changes introduced by the CHM in September 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost-benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in assessment of poisoning.
    British Journal of Clinical Pharmacology 03/2014; 78(3). DOI:10.1111/bcp.12362 · 3.69 Impact Factor

Publication Stats

1k Citations
250.05 Total Impact Points

Institutions

  • 2011–2015
    • King's College London
      • Drug Control Centre
      Londinium, England, United Kingdom
  • 2007–2015
    • Guy's and St Thomas' NHS Foundation Trust
      • Department of Clinical Toxicology
      Londinium, England, United Kingdom
    • St. George's University
      گرینیدا، میسیسیپی, Mississippi, United States
  • 2013
    • Lancaster University
      • Department of Applied Social Science
      Lancaster, England, United Kingdom
  • 2011–2013
    • ICL
      Londinium, England, United Kingdom
  • 2010–2011
    • Public Health England
      Londinium, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2008
    • University of London
      Londinium, England, United Kingdom
  • 2004–2008
    • St George's, University of London
      • Medical School
      Londinium, England, United Kingdom