Among over 50,000 emergency department visits in Basel, Switzerland, 210 were related to recreational drug toxicity, with cannabis detected in 33% of cases, making it the most commonly identified substance.
Read this if you want to understand how often cannabis contributes to emergency department visits compared to other recreational drugs.
Cannabis detected in 33% of drug-related ER cases, the most of any substance
What the researchers found
Over one year at a Swiss university hospital, researchers systematically tracked every emergency department visit related to recreational drug toxicity. Of 50,624 total ER visits, 210 (0.4%) were directly drug-related.
Cannabis was the most commonly detected substance at 33%, followed by cocaine at 27% and opioids at 19%. The typical patient was male (73%) with a mean age of 33 years.
The most frequent symptoms across all drug presentations were tachycardia (28%), anxiety (23%), nausea/vomiting (18%), and agitation (17%). Severe complications included two deaths, two heart attacks, 13 seizure cases, and 6 psychosis cases. Most patients (76%) were discharged home, while 10% required intensive care.
Notably, despite widespread concern about novel psychoactive substances (NPS), only 2 of 210 cases involved NPS, suggesting classic drugs remain far more clinically significant.
Why it matters
This study provides a reality check on drug-related emergency presentations. While NPS receive enormous media attention, cannabis and cocaine remain responsible for the vast majority of acute drug toxicity cases in clinical practice.
The numbers in context
210 drug-related cases out of 50,624 ER visits (0.4%). Cannabis: 33% of analytically confirmed cases. Cocaine: 27%. Opioids: 19%. Mean age: 33 years. 73% male. 76% discharged home. 10% ICU admission. Only 2 NPS cases.
How the study worked
Prospective case series of all emergency department presentations at the University Hospital of Basel, Switzerland, from October 2014 to September 2015 with acute toxicity from recreational drug use. Analytical confirmation using immunoassays and LC-MS/MS capable of detecting novel psychoactive substances.
What this study cannot tell us
Single center in one Swiss city. Self-reported drug use may be inaccurate. Not all patients received analytical confirmation. Cannabis detection may overrepresent its role in toxicity due to its long detection window. Polysubstance use was common.
How to read the evidence
Systematic prospective data collection with analytical confirmation. Strong methodology for a single-center study.
When this study was published
Published in 2016 using 2014-2015 data. Drug use patterns and NPS availability have continued to evolve.
The bigger picture
This systematic data collection provides a snapshot of real-world drug toxicity patterns in a Western European city. The dominance of cannabis among detected substances likely reflects its high prevalence of use rather than exceptional toxicity, as most cannabis-related presentations were of moderate severity.
Questions still open
- What proportion of cannabis-related ER visits are due to anxiety/panic versus actual toxicity? Would these patterns differ in countries with legal cannabis? How do synthetic cannabinoid emergency presentations compare in countries where they are more prevalent?
Common questions
How common are cannabis-related emergency visits?
Are synthetic cannabinoids causing a lot of emergencies?
Read the original research
Presentations due to acute toxicity of psychoactive substances in an urban emergency department in Switzerland: a case series.
BMC pharmacology & toxicology, 17(1), 25
Citation
Liakoni, Evangelia; Dolder, Patrick C; Rentsch, Katharina M; Liechti, Matthias E. (2016). Presentations due to acute toxicity of psychoactive substances in an urban emergency department in Switzerland: a case series.. BMC pharmacology & toxicology, 17(1), 25. https://doi.org/10.1186/s40360-016-0068-7
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