Acute poisoning with psychoactive substances in the 1990-2000 period of socioeconomic transition and crisis in Plovdiv region, Bulgaria.

The "opening" of the post-totalitarian societies of Eastern Europe increased the illegal spread of psychoactive substances (PAS) in the past decade. We studied psychoactive substance acute poisoning (PAS AP) - types of toxic agents involved, incidence rates, and their changes - as indirect indicators of the characteristics, magnitude and development of the problem in Bulgaria during the 1990-2000 period of socioeconomic transition and crisis after collapse of communism. The study analyzed retrospectively the caseload of all 571 PAS acute poisonings that occurred in the territory: 417 men (73%) and 154 women (27%); mean age 24.07 y (range 10-75). The number of all AP and PAS AP showed a marked increase during the last 3 years of the studied period, especially in 2000. The average PAS AP incidence rate for 1998-2000 (13.50/100,000) compared to the mean value for the preceding period 1990-1997 (5.76/100,000) showed a 2.34 fold increase. Acute alcohol intoxication was 62.7%, of all PAS AP; the opioid 15.2% (heroin 11.0%, other opioids 4.2%); prescribed and over the counter drugs 12.6%; inhalants 1.1%; cannabis 1.1%; and cocaine 0.7%. Amphetamine (or amphetamine-like), hallucinogens and phencyclidine (or phencyclidine-like) AP were not encountered. The average percentage of alcohol AP for 1998-2000 compared to the preceding 1990-1997 dropped from 78.12% to 44.72% (1.75 fold), while that of opioids rose from 6.59% to 26.47% (4.02 fold), and that of the other drugs group from 12.22% to 21.78% (1.78 fold increase). The new non-alcoholic PAS AP (heroin, cocaine, inhalants and cannabis AP, as Indirect indicators of narcotic exposure) showed a rapid increase. The data showed they are expanding and catching up with alcohol as a new cause of substance-related problems, thus becoming one of the important health and social problems of post-totalitarian society.