Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Nov 23;10(1):157.
doi: 10.1186/s13613-020-00762-9.

Management of pharmaceutical and recreational drug poisoning

Bruno Mégarbane  1 , Mathieu Oberlin  2 , Jean-Claude Alvarez  3 , Frederic Balen  4 , Sébastien Beaune  5 , Régis Bédry  6 , Anthony Chauvin  7 , Isabelle Claudet  8 , Vincent Danel  9 , Guillaume Debaty  10 , Arnaud Delahaye  11 , Nicolas Deye  12 , Jean-Michel Gaulier  13 , Francis Grossenbacher  14 , Philippe Hantson  15 , Frédéric Jacobs  16 , Karim Jaffal  17 , Magali Labadie  18 , Laurence Labat  19 , Jérôme Langrand  20 , Frédéric Lapostolle  21 , Philippe Le Conte  22 , Maxime Maignan  23 , Patrick Nisse  24 , Philippe Sauder  25 , Christine Tournoud  26 , Dominique Vodovar  20 , Sebastian Voicu  17 , Pierre-Géraud Claret  27 , Charles Cerf  28
Affiliations
Review

Management of pharmaceutical and recreational drug poisoning

Bruno Mégarbane et al. Ann Intensive Care. .

Abstract

Background: Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis.

Methods: A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology.

Results: The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature.

Conclusions: The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

Keywords: Antidote; Guidelines; Intoxication; Pharmaceutical drug; Poisoning; Recreational drug.

PubMed Disclaimer

Conflict of interest statement

Frédéric Lapostolle declares conflicts of interest with AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, Medtronic, Merck-Serono, Mundipharma, Novartis, Pfizer, Serb and Teleflex. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Examples of new psychoactive substances (NPS) mimicking the psychoactive effects of "traditional" molecules
Fig. 2
Fig. 2
The Drugs Wheel, a new model for substance awareness (UK version 2.0.7 dated 08/09/2018—www.thedrugswheel.com)
See this image and copyright information in PMC

Similar articles

  • Targeted temperature management in the ICU: Guidelines from a French expert panel.
    Cariou A, Payen JF, Asehnoune K, Audibert G, Botte A, Brissaud O, Debaty G, Deltour S, Deye N, Engrand N, Francony G, Legriel S, Levy B, Meyer P, Orban JC, Renolleau S, Vigué B, de Saint Blanquat L, Mathien C, Velly L; Société de réanimation de langue française (SRLF); Société française d’anesthésie et de réanimation (SFAR); Association de neuro-anesthésie réanimation de langue française (ANARLF); Groupe francophone de réanimation et urgences pédiatriques (GFRUP); Société française de médecine d’urgence (SFMU); Société française neuro-vasculaire (SFNV). Cariou A, et al. Anaesth Crit Care Pain Med. 2018 Oct;37(5):481-491. doi: 10.1016/j.accpm.2017.06.003. Epub 2017 Jul 5. Anaesth Crit Care Pain Med. 2018. PMID: 28688998
  • Intrahospital transport of critically ill patients (excluding newborns) recommendations of the Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU).
    Quenot JP, Milési C, Cravoisy A, Capellier G, Mimoz O, Fourcade O, Gueugniaud PY. Quenot JP, et al. Ann Intensive Care. 2012 Feb 3;2(1):1. doi: 10.1186/2110-5820-2-1. Ann Intensive Care. 2012. PMID: 22304940 Free PMC article.
  • Targeted temperature management in the ICU: guidelines from a French expert panel.
    Cariou A, Payen JF, Asehnoune K, Audibert G, Botte A, Brissaud O, Debaty G, Deltour S, Deye N, Engrand N, Francony G, Legriel S, Levy B, Meyer P, Orban JC, Renolleau S, Vigue B, De Saint Blanquat L, Mathien C, Velly L; Société de Réanimation de Langue Française (SRLF) and the Société Française d’Anesthésie et de Réanimation (SFAR) In conjunction with the Association de Neuro Anesthésie Réanimation de Langue Française (ANARLF), the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), the Société Française de Médecine d’Urgence (SFMU), and the Société Française Neuro-Vasculaire (SFNV). Cariou A, et al. Ann Intensive Care. 2017 Dec;7(1):70. doi: 10.1186/s13613-017-0294-1. Epub 2017 Jun 19. Ann Intensive Care. 2017. PMID: 28631089 Free PMC article. Review.
  • Early management of severe pelvic injury (first 24 hours).
    Incagnoli P, Puidupin A, Ausset S, Beregi JP, Bessereau J, Bobbia X, Brun J, Brunel E, Buléon C, Choukroun J, Combes X, David JS, Desfemmes FR, Garrigue D, Hanouz JL, Plénier I, Rongieras F, Vivien B, Gauss T, Harrois A, Bouzat P, Kipnis E. Incagnoli P, et al. Anaesth Crit Care Pain Med. 2019 Apr;38(2):199-207. doi: 10.1016/j.accpm.2018.12.003. Epub 2018 Dec 21. Anaesth Crit Care Pain Med. 2019. PMID: 30579941 Review.
  • Early management of severe abdominal trauma.
    Bouzat P, Valdenaire G, Gauss T, Charbit J, Arvieux C, Balandraud P, Bobbia X, David JS, Frandon J, Garrigue D, Long JA, Pottecher J, Prunet B, Simonnet B, Tazarourte K, Trésallet C, Vaux J, Viglino D, Villoing B, Zieleskiewicz L, Gil-Jardiné C, Weiss E. Bouzat P, et al. Anaesth Crit Care Pain Med. 2020 Apr;39(2):269-277. doi: 10.1016/j.accpm.2019.12.001. Epub 2019 Dec 13. Anaesth Crit Care Pain Med. 2020. PMID: 31843714
See all similar articles

Cited by

See all "Cited by" articles

References

    1. Studnek JR, Thestrup L, Blackwell T, Bagwell B. Utilization of prehospital dispatch protocols to identify low-acuity patients. Prehosp Emerg Care. 2012;16:204–209. doi: 10.3109/10903127.2011.640415. - DOI - PubMed
    1. Ebrahimi K, Vaisi Raigani AA, Jalali R, Rezaei M. Determining and comparing predictive and intensity value of severity scores—“sequential organ failure assessment score”, “acute physiology and chronic health evaluation 4”, and “poisoning severity score”—in short-term clinical outcome of patients with poisoning in an ICU. Indian J Crit Care Med. 2018;22:415–421. doi: 10.4103/ijccm.IJCCM_238_17. - DOI - PMC - PubMed
    1. Grmec Š, Gašparovic V. Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality. Crit Care. 2001;5:19–23. doi: 10.1186/cc973. - DOI - PMC - PubMed
    1. Chan B, Gaudry P, Grattan-Smith TM, McNeil R. The use of Glasgow Coma Scale in poisoning. J Emerg Med. 1993;11:579–582. doi: 10.1016/0736-4679(93)90312-U. - DOI - PubMed
    1. Maignan M, Richard A, Debaty G, Pommier P, Viglino D, Loizzo F, Timsit J-F, Hanna J, Carpentier F, Danel V. Intentional drug poisoning care in a physician-manned emergency medical service. Prehosp Emerg Care. 2015;19:224–231. doi: 10.3109/10903127.2014.964890. - DOI - PubMed

LinkOut - more resources