ASSIST: A Surveillance Study of Illicit Substance Toxicity

NCT ID: NCT05329142

Last Updated: 2022-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

1000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-08-19

Study Completion Date

2023-08-19

Brief Summary

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There is a drug-related death crisis in Scotland. This study aims to collaborate with Public Health Scotland in order to assess the feasibility of introducing a surveillance system to the Emergency Department to highlight illicit drug-related attendances. This will utilise both clinical data and toxiclogical analysis of anonymised samples. The data will inform of prevalence, trend data and utcome of ED patients attending with acute illict drug toxicity.

Detailed Description

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The purpose of this research is to establish the introduction of a robust toxicology surveillance system in the Emergency Department (ED) in order to inform public health interests. The study will explore the feasibility of reporting characteristics and causative agents of patients attending hospital as an emergency due illicit substance use. The term illicit substance used during this study encompasses any substance which is not prescribed to the individual and is a controlled drug as per the Misuse of Drugs act 1971 and Misuse of Drugs Regulations 2001.

The study will look at standard care clinical data from all individuals attending the Emergency Department due to acute illicit drug toxicity. Surplus blood samples will be anonymised and analysed for toxicological profiling.

The study will allow identification of emerging drug trends and will be shared contemporaneously with Public Health Scotland and inform the Scottish Government of current incidences to inform public health measures to tackle the drugs death crisis.

Conditions

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Overdose, Drug Drug Use Drug Abuse Drug Toxicity Drug Effect Illicit Drug Use Illicit Drug Overdose Illicit Drug Intoxication

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Stage 1: Usual Care clinical data:

The patient will firstly be identified as having attended the ED due to acute illicit drug toxicity and must fit the inclusion and exclusion criteria. The research team will complete the electronic Case Report Form (eCRF), which will include defined data.

No interventions assigned to this group

Stage 2: Surplus sampling Mass Spectrometry

The research team will select patients with acute moderate / severe toxicity, which will be defined as those requiring at least one of:

* Patient admitted to hospital due to acute illicit drug toxicity
* Pre-hospital cardio/pulmonary resuscitation
* Any part of patient's ED care was in the Resuscitation area of the ED
* Patient died in the ED or within 72 hours

A surplus sample of the standard of care SST sample from this group will be analysed by way of Mass Spectrometry.

Surplus sample toxicology analysis

Intervention Type DIAGNOSTIC_TEST

Anonymised surplus blood sample will be analysed for drugs and their metabolites by way of Mass Spectrometry and LGC Group, Cambridge.

Interventions

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Surplus sample toxicology analysis

Anonymised surplus blood sample will be analysed for drugs and their metabolites by way of Mass Spectrometry and LGC Group, Cambridge.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Age \>16
* Patient attending QEUH ED directly relating to acute illicit drug use
* Patients with reported acute illicit drug use toxicity who are unwell before they are seen in the Emergency Department but appear well in the ED should also be included

Exclusion Criteria

* Condition more likely due to cause other than acute illicit drug use
* Condition due to withdrawal of drugs / alcohol
* Condition primarily related to alcohol use and no evidence of acute illicit drug use
* Attendance is due to complication of previous drug use - i.e., BBV / infected injection site (without acute drug toxicity)
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Public Health Scotland

UNKNOWN

Sponsor Role collaborator

NHS Greater Glasgow and Clyde

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David J Lowe, MBChB BMSc FRCEM

Role: PRINCIPAL_INVESTIGATOR

NHS GGC R&I Non Commerical (Sponsor) Research Coordinator

Locations

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Queen Elizabeth University Hospital, NHS GGC

Glasgow, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Lisa C Dunlop, MBChB, BSc FRCEM

Role: CONTACT

0141 452 2930/1

David J Lowe, MBChB BMSc FRCEM

Role: CONTACT

01414522840

Facility Contacts

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Lisa C Dunlop, MBChB, BSc, FRCEM

Role: primary

0141 452 2930/1

David J Lowe, MBChB BMSc FRCEM

Role: backup

01414522840

References

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UK Public General Acts. Misuse of Drugs Act 1972 Schedule 2. Available from legislation.gov.uk. Accessed 25/02/2022

Reference Type BACKGROUND

The Misuse if Drugs Regulations 2001, Dangerous Drugs. Available from legislation.giv.uk. Accessed 25/02/2022.

Reference Type BACKGROUND

EMCDDA. European Drug Report, trends and Developments 2021. Available from https://www.emcdda.europa.eu/system/files/publications/13838/TDAT21001ENN.pdf accessed 14/02/2022

Reference Type BACKGROUND

National Records of Scotland. Drug-related deaths in Scotland in 2020, published 30/07/21. Available from https://www.nrscotland.gov.uk. Accessed 14/02/2022.

Reference Type BACKGROUND

Public Health Scotland, Drug-related Hospital Statistics, Scotland 2019 - 2020. Published 15/06/2021. Available from https://publichealthscotland.scot/. Accessed 14/02/2022

Reference Type BACKGROUND

Scottish Government. Evidence-Based Strategies for Preventing Drug-Related Deaths in Scotland, Our Emergency Response. January 2020. Available from https://www.gov.scot/. Accessed 10/02/2021

Reference Type BACKGROUND

Di Rico R, Nambiar D, Stoove M, Dietze P. Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs. BMC Health Serv Res. 2018 Dec 5;18(1):945. doi: 10.1186/s12913-018-3756-8.

Reference Type BACKGROUND
PMID: 30518362 (View on PubMed)

EMCDDA. Drug-related deaths and mortality in Europe. Update from EMCDDA expert network July 2019. Available from https://www.emcdda.europa.eu. Accessed 09/02/2020

Reference Type BACKGROUND

European Monitoring Centre for Drugs and Drug Addiction. (2016) Health responses to new psychoactive substances. Available from http://www.emcdda.europa.eu/system/files/publications/2812/TD0216555ENN.pdf. Accessed 15/02/2022

Reference Type BACKGROUND

European Monitoring Centre for Drugs and Drug Addiction (2021), European Drug Report 2021: Trends and Developments, Publications Office of the European Union, Luxembourg.

Reference Type BACKGROUND

Office for National Statistics. Drug misuse in England and Wales: year ending March 2020 09/12/2020. Accessed 16/02/2022

Reference Type BACKGROUND

Deaths mentioning a new psychoactive substance by broad age-group, England and Wales, 2011 to 2015 registrations. 18 January 2017. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/06556deathsmentioninganewpsychoactivesubstancebybroadagegroupenglandandwales2011to2015registrations. Accessed 19/12/2018

Reference Type BACKGROUND

Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. "Zombie" Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York. N Engl J Med. 2017 Jan 19;376(3):235-242. doi: 10.1056/NEJMoa1610300. Epub 2016 Dec 14.

Reference Type BACKGROUND
PMID: 27973993 (View on PubMed)

Seywright A, Torrance HJ, Wylie FM, McKeown DA, Lowe DJ, Stevenson R. Analysis and clinical findings of cases positive for the novel synthetic cannabinoid receptor agonist MDMB-CHMICA. Clin Toxicol (Phila). 2016 Sep;54(8):632-7. doi: 10.1080/15563650.2016.1186805. Epub 2016 May 23.

Reference Type BACKGROUND
PMID: 27213960 (View on PubMed)

Hikin L, Smith PR, Ringland E, Hudson S, Morley SR. Multiple fatalities in the North of England associated with synthetic fentanyl analogue exposure: Detection and quantitation a case series from early 2017. Forensic Sci Int. 2018 Jan;282:179-183. doi: 10.1016/j.forsciint.2017.11.036. Epub 2017 Nov 29.

Reference Type BACKGROUND
PMID: 29216524 (View on PubMed)

Dunlop LC, Craik V, Jarvie N, Hudson S, Walters M, Dear JW, Lowe DJ. Clinical characterisation of the novel benzodiazepine bromazolam-data from the ASSIST (A Surveillance Study of Illicit Substance Toxicity) study. Clin Toxicol (Phila). 2025 Jul 28:1-11. doi: 10.1080/15563650.2025.2524078. Online ahead of print.

Reference Type DERIVED
PMID: 40719187 (View on PubMed)

Other Identifiers

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GN21AE239

Identifier Type: -

Identifier Source: org_study_id

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