Inspired by patient cases from her intercalated Urgent & Emergency Care BSc, Year Four Student Doctor Tess Blandamer has just had her practice review into drink and injection spiking published by the Emergency Medicine Journal (EMJ).
“As part of my intercalated degree last year I spent nine months in the Emergency Department (ED) of Southmead Hospital, a large major trauma centre in Bristol. With the rapid increase in drink spiking and new phenomenon of injection spiking, patients were presenting to the ED almost daily having been drink or injection spiked.
To my complete shock, I found the majority of patients were being turned away at triage, with no drug testing, no psychological support, and no clear onward referral pathway.
As a woman in my early 20s, the demographic most at risk of spiking, I felt particularly distressed at the lack of care these patients were receiving. Furthermore, there were huge, positive social media movements to raise awareness of spiking and encourage people to attend ED should they be affected, with some even promising testing, which was out of step with what I was seeing on the ground.
Dr Roberts, an Emergency Medicine Registrar and Trainee Emergency Research Network Fellow for North Bristol NHS Trust approached me about doing a research project in this area, as he had also noticed the poor management of these patients.
To be honest, before he asked it hadn’t really crossed my mind that I, with little experience of research/projects, could do something to change patient care. However, I quickly realised the potential to make a real difference and jumped at the opportunity.
The article really gained momentum when the following week I discovered a friend of a friend had sadly been injection spiked and was happy to share her story as a clinical case.
Dr Birse, another Registrar in the ED, had identified the same issue and was creating a drink and injection spiking guideline and patient information leaflets for the department as part of a quality improvement project. He kindly agreed to let us use his material as supplements to strengthen the recommendations of the review.
There were two other consultants involved, Consultant Toxicologist Dr Dear and Consultant Psychologist Dr Roberts, both of whom accepted the invitation to contribute on their respective subjects. My supervisor, Professor Carlton, is an experienced academic who helped with many technicalities of the article.
The practice review
Essentially, a practice review discusses management of a particular symptom or disease by systematically synthesising evidence. The aim is to update developments in the field, recommend practice changes and discuss controversies, all of which I hope our review meets. For the EMJ, at least one of the co-authors has to be an ‘expert in the field’, which were the consultants for our paper.
Our work found there was a distinct lack of data, research, and evidence in all areas of drink and injection spiking.
Prevalence data is scarce due to under-reporting by victims and lack of confirmatory testing in potential cases, however a 2022 UK Home Affairs Committee report stating 11% of women and 6% of men (in a survey of 1693 adults) had been a victim of spiking.
Since 2000, there have only been three published studies that have included results of drug testing in patients presenting for spiking at EDs and no published studies into injection spiking. Lastly and, in my opinion, most surprising and concerning, there is only one UK guidance on drink and drug spiking by the National Poisons Information Service which is scarce in detail and only advises testing ‘if clinically indicated’, without further clarification.
Our article explores drugs likely to be commonly used for both drink and injection spiking and discusses the significant psychological sequalae spiking can have for victims. We debate the evidence and arguments for/against testing for drugs of spiking in EDs and how this may be achieved.
It became clear that there is urgent need for more research on drink and injection spiking to inform evidence-based investigative and treatment pathways. In the meantime, our example guideline sets out an approach that addresses issues such as psychological sequalae and blood borne virus risk, which we believe is the bare minimum we should be doing for these patients.
EMJ publication
As the review is focused on the management of patients presenting to the ED, our aim was always to be published in the EMJ. Therefore, I always referred to the EMJ practice review guidelines, which set out limits on the word count, number of references and figures, to ensure it met the requirements for publication.
The review was rejected twice, the first time with major changes and the second time with minor ones. Although I felt a little disheartened by the first rejection, I am grateful to the other co-authors for supporting me to continue pursuing publication, assuring me it was a normal part of the publication process for most articles. Overall, it was a long and challenging process and a steep but highly rewarding learning curve.
I’d really like to encourage any student currently placed in an ED to approach their supervisor or consultants to ask if they currently have a drink and injection spiking guideline and patient information leaflets.
If not, you could use the examples available within the article to indicate what these changes may look like. With permission, you could even implement the guidance as a quality improvement project or audit, with the aim of both improving patient care and achieving publication yourself.
Regarding pursuing publications in general, my advice would be to seek as many opportunities as possible. That said, it’s much easier when you are genuinely interested and passionate about the subject, so try to find something you like.
Lastly, if you see something that you think could be done better for patients, I would really encourage you to have a think about writing some sort of article or guideline, even if you have no experience - it’s an opportunity to make a real difference to patient care.”
Discover more
- Go to ‘Drink and injection spiking: how to approach an increase in presentations?’ on the EMJ website (link). To access, click Log in > Via institution > UK Access Management Federation > University of Liverpool, and log in using the University of Liverpool portal. The example guideline and the patient information leaflets can be found at the bottom of the article.
- For further information on drink spiking, see the Drink Aware website (link), and the advice available by the School of Medicine (link) and Liverpool Guild of Students (link) on protecting yourself and others against spiking.
- If you or someone you know has been personally affected by spiking, you can contact the School’s Wellbeing Team (link), Guild Advice Service (link) and Merseyside Police (link).