Cardiovascular effects associated with acute recreational drug toxicity presentations to the emergency department: a European drug emergencies network (Euro-DEN plus) study

W J van den Busken; Alison M Dines; Florian Eyer; Fridtjof Heyerdahl; Knut Erik Hovda; Matthias E Liechti; Òscar Miró; Odd Martin Vallersnes; David M Wood; Chris Yates; Paul I Dargan; (on behalf of the Euro-DEN Plus Research Group); F M J Gresnigt; Euro-DEN Plus Research Group

doi:10.1080/15563650.2026.2669671

Cardiovascular effects associated with acute recreational drug toxicity presentations to the emergency department: a European drug emergencies network (Euro-DEN plus) study

Clin Toxicol (Phila). 2026 Jun 23:1-9. doi: 10.1080/15563650.2026.2669671. Online ahead of print.

Authors

W J van den Busken¹, Alison M Dines², Florian Eyer³, Fridtjof Heyerdahl^{4

5}, Knut Erik Hovda^{5

6}, Matthias E Liechti⁷, Òscar Miró⁸, Odd Martin Vallersnes^{9

10}, David M Wood^{2

11}, Chris Yates¹², Paul I Dargan^{2

11}; (on behalf of the Euro-DEN Plus Research Group); F M J Gresnigt^{1

13}; Euro-DEN Plus Research Group

Collaborators

Euro-DEN Plus Research Group:
Monia Aloise, Jacek Anand, Kurt Anseeuw, Robertas Badaras, George Bailey, Marcin Bitel, Jeffrey Bonnici, Miran Brvar, Carl Byrne, Blazena Caganova, Feriyde Calýskan, Alessandro Ceschi, Laurence Daveloose, Miguel Galicia, Birgit Andrea Gartner, Ketevan Gorozia, Damjan Grenc, Erato Antoniou Hini, Laura Hondebrink, Gesche Jürgens, Soso Kutubidze, Gabija Laubner, Evangelia Liakoni, Viesturs Liguts, Cathelijne Lyphout, Bruno Mégarbane, Adrian Moughty, Gabriela Viorela Nitescu, Roberta Noseda, Niall O'Connor, Raido Paasma, Juan Ortega Perez, Marius Perminas, Per Sverre Persett, Kristiina Põld, Erik Puchon, Jordi Puiguriguer, Julia Radenkova-Saeva, Jan Rulisek, Perla Sader, Caroline Samer, Yasmin Schmid, Irene Scholz, Roberts Stašinskis, Jonas Surkus, Irma van den Hengel-Koot, Federico Vigorita, Severin B Vogt, William Stephen Waring, Ioanna Yiasemi, Sergej Zacharov, Tobias Zellner

Affiliations

¹ Emergency Department OLVG Hospital, Amsterdam, the Netherlands.
² Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
³ Department of Clinical Toxicology, TUM University Hospital, Tecuhnical University of Munich, Germany.
⁴ Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ The Norwegian CBRNe Centre of Medicine, Oslo University Hospital, Oslo, Norway.
⁷ Clinical Pharmacology and Toxicology, University Hospital and University of Basel, Basel, Switzerland.
⁸ Emergency Department, Hospital Clínic, University of Barcelona, Catalonia, Spain.
⁹ Department of General Practice, University of Oslo, Oslo, Norway.
¹⁰ Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
¹¹ Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK.
¹² Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain.
¹³ Dutch Poison Information Center (DPIC), UMC Utrecht, University Utrecht, Utrecht, GA, the Netherlands.

PMID: 42334445
DOI: 10.1080/15563650.2026.2669671

Abstract

Introduction: Recreational drugs affect the cardiovascular system through distinct mechanisms; however, data regarding their cardiovascular impact in the emergency department setting is limited. This study aimed to assess the incidence of cardiovascular effects following recreational drug use in presentations to the emergency department, identify the main drug groups involved, and compare cases with and without cardiovascular effects.

Methods: Data were extracted from the European Drug Emergency Network (Euro-DEN Plus) dataset from October 2013 to December 2021. Recreational drugs were categorised into ten main drug groups: opioids, cocaine, crack cocaine, cannabis, 3,4-methylenedioxymethamfetamine, amfetamine-type stimulants, gamma-hydroxybutyrate and gamma-butyrolactone, hallucinogens, benzodiazepines, and ketamine.

Results: Among 59,571 presentations, 13,905 (23.3%) involved cardiovascular effects. Cocaine (OR 3.19, 95% CI 2.99-3.39) and 3,4 methylenedioxymethamphetamine (OR 1.18, 95% CI 1.13-1.23) showed the strongest associations with cardiovascular features, including chest pain, palpitations, hypertension, and arrhythmias. Opioids (OR 0.35, 95% CI 0.31-0.38) and benzodiazepines (OR 0.38, 95% CI 0.32-0.44) were associated with less frequent cardiovascular features. Patients with cardiovascular features exhibited higher median values for temperature, heart rate, blood pressure, and respiratory rate (p <0.001). Cardiovascular features were associated with an increased risk of intubation (OR 1.91, 95% CI 1.70-2.15), critical care admission (OR 2.18, 95% CI 2.00-2.38), and mortality (OR 15.8, 95% CI 7.36-33.9).

Discussion: Cardiovascular effects were common in acute recreational drug toxicity. Cocaine and amfetamine-type stimulants increased the risk of chest pain and arrhythmias, with chest pain being a key indicator of acute coronary syndrome. Cardiovascular effects were more frequently observed with cocaine than with crack cocaine. Cannabis was positively associated with palpitations but not arrhythmias. Gamma-hydroxybutyrate and gamma-butyrolactone, opioids, and benzodiazepines were linked to hypotension. The presence of cardiovascular effects was associated with worse outcomes, underscoring the need for thorough cardiac assessment.

Conclusions: Cardiovascular effects were present in almost a quarter of emergency department presentations with acute recreational drug toxicity, particularly involving cocaine and 3,4 methylenedioxymethamphetamine.

Keywords: 3,4 methylenedioxymethamphetamine; acute drug toxicity; amfetamine; amfetamine (amphetamine); amphetamine; cardiovascular; cocaine; lysergide (lyseric acid diethylamide); midamafetamine (3,4 methylenedioxymethamphetamine; midomafetamine; psilocybine (psilocybin).