ArticleJournal of medical toxicology : official journal of the American College of Medical Toxicology2023
Characterization of Nonfatal Opioid, Cocaine, Methamphetamine, and Polydrug Exposure and Clinical Presentations Reported to the Toxicology Investigators Consortium Core Registry, January 2010-December 2021.
Article in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 12 citations in OpenAlex.
- Social, Economic, and health risks among people who use Methamphetamine: Comparing three patterns of opioid Co-Use.Addictive behaviors reports · 2026Article
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- Characterizing patterns of opioid and stimulant use by route and associations with non-fatal overdose and xylazine use in people who have injected drugs from Baltimore, MD, 2023-2024.Drug and alcohol dependence reports · 2026Article
- Infectious disease complications associated with opioid use disorder at a southern county hospital: a retrospective chart review.BMC infectious diseases · 2026Article
- Ketamine enhancement of dexmedetomidine attenuation of methamphetamine-induced agitation in rats.Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques · 2026Article
- Transcranial magnetic stimulation in cocaine use disorder and the risk of seizure: a review of the evidence.Frontiers in psychiatry · 2026Review
- Trends in Nonfatal Fentanyl Exposures Involving Stimulants in the United States, 2015-2023.American journal of preventive medicine · 2025Article
- Definitive urine drug testing in emergency medicine: Recreational and psychiatric drug findings.Journal of mass spectrometry and advances in the clinical lab · 2025Article
- Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties.The International journal on drug policy · 2025Article
- Naloxone Administration and Survival in Overdoses Involving Opioids and Stimulants: An Analysis of Law Enforcement Data from 63 Pennsylvania Counties.medRxiv : the preprint server for health sciences · 2024Article
- Longitudinal patterns of use of stimulants and opioids in the AIDS linked to the IntraVenous experience cohort, 2005-2019.The International journal on drug policy · 2024Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTo characterize and compare opioid-only, cocaine-only, methamphetamine-only, opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure and to examine clinical presentations, leading to a better understanding of overdose effects involving these drug exposures.
methodsWe examined drug exposures in the Toxicology Investigators Consortium (ToxIC) Core Registry from January 2010 to December 2021, a case registry of patients presenting to participating healthcare sites that receive a medical toxicology consultation. Demographic and clinical presentations of opioid-only, cocaine-only, methamphetamine-only, and opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure consultations were described; differences between single and polydrug exposure subgroups were calculated to determine statistical significance. Clinical presentations associated with exposures were evaluated through calculated adjusted relative risk.
resultsA total of 3,883 consultations involved opioids, cocaine, methamphetamine, opioid-and-cocaine exposure, or opioid-and-methamphetamine exposure. Opioid-only (n = 2,268, 58.4%) and methamphetamine-only (n = 712, 18.3%) comprised most consultations. There were significant differences in clinical presentations between exposure subgroups. Opioid-and-cocaine exposure consultations were 8.15 times as likely to present with a sympathomimetic toxidrome than opioid-only. Conversely, opioid-and-cocaine exposure and opioid-and-methamphetamine exposure were 0.32 and 0.42 times as likely to present with a sympathomimetic toxidrome compared to cocaine-only and methamphetamine-only consultations, respectively. Opioid-and-cocaine exposure was 0.67 and opioid-and-methamphetamine exposure was 0.74 times as likely to present with respiratory depression compared to opioid-only consultations. Similarly, opioid-and-cocaine exposure was 0.71 and opioid-and-methamphetamine exposure was 0.78 times as likely to present with CNS depression compared to opioid-only consultations.
conclusionsUsed in combination, opioids and stimulants may mask typical clinical presentations of one another, misattributing incorrect drugs to overdose in both clinical treatment and public health surveillance.
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