Hospitalized cocaine detoxification patients in Paris, France: Increased patient levels and changing population characteristics since 2011

Abstract

Aim of the study

The past twenty years have seen a rise in cocaine-related statistics in France, including cocaine use in the general population, emergency ward presentations of acute cocaine intoxication, cocaine use disorders related outpatient appointments and cocaine-related deaths. This study's objectives were to describe trends in patients’ admission for specific cocaine detoxification as well as changes in patients’ characteristics in the Assistance publique–Hôpitaux de Paris (AP–HP) hospitals group located in Paris region, France.

Methods

We reviewed the international classification of diseases 10^th edition (ICD-10) discharge codes of the AP–HP hospitals group between 2011 and 2021. In addition, medical reports of the largest addiction medicine ward were also analysed for changes across the years 2009, 2014, 2019 and 2022.

Results

The regional database showed an almost 3-fold increase in cocaine-related disorders discharge codes between 2011 and 2019. This occurred due to a rise in hospital stays for cocaine dependence or cocaine acute intoxication prior to the fall in levels of inpatient stays associated with the coronavirus disease 2019 (COVID-19) pandemic. The in-depth analysis of inpatients’ stays in the specialized addiction medicine ward also showed an increase in admissions for cocaine detoxification programs, with a prevalence of 1.19% in 2009 to 15.73% in 2022 (P = 1.44 × 10⁻²⁰). Inpatient characteristics showed significant changes, especially in 2022, namely: more daily users, less intravenous administration and less comorbid illicit substances use disorders, with heightened levels of cured hepatitis C patients (P < 0.05). Inpatient prescriptions were primarily dopaminergic antagonists with sedatives properties (cyamemazine, loxapine and chlorpromazine), dopamine-receptors partial agonist (aripiprazole) and serotonin reuptake inhibitors.

Conclusion

The referral to hospital care for cocaine detoxification has increased in Paris region since 2011, coupled with changes in inpatients’ characteristics. This trend has significant implications for the management of inpatient hospital services.