{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T14:32:06Z","timestamp":1793197926643,"version":"4.5.0"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004752","name":"State Government of Victoria","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004752","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study is to characterise the analytical toxicology findings and clinical features of fatal cases recorded in the Emerging Drugs Network of Australia\u2014Victoria (EDNAV) clinical registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>EDNAV is a state\u2010wide toxicosurveillance system capturing de\u2010identified demographic, clinical and analytical data from ED presentations with illicit drug\u2010related toxicity. Venous blood samples are screened for illicit, pharmaceutical and novel psychoactive substances (NPS) using liquid chromatography\u2013quadrupole time\u2010of\u2010flight mass spectrometry. We conducted a retrospective observational case series of fatal registry cases recorded between September 2020 and December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010six fatal cases were identified (0.9% of 5026 EDNAV cases). Most patients were male (89%) with a median age of 33\u2009years. Out\u2010of\u2010hospital cardiac arrest occurred in 67% of cases. Polysubstance exposure predominated (91%), with a median of three substances detected per case. Mixed stimulant\u2013sedative patterns were most common (64%), followed by opioid\u2013benzodiazepine (19%) and stimulant\u2010only (7%). The most frequent individual detections were methamphetamine (54%), heroin (52%), diazepam (37%), cocaine (20%) and MDMA (17%). NPS accounted for 7.8% of detections, were never identified in isolation and were predominantly novel benzodiazepines (80%). Hypoxic brain injury was the most common terminal complication (72%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fatal cases were characterised by near\u2010universal polysubstance detections, with methamphetamine and heroin the most frequent individual detections. Most deaths occurred out of hospital, with many patients presenting with irreversible hypoxic brain injury. NPS were rare and co\u2010occurred with traditional illicit substances. Community\u2010based interventions including bystander resuscitation, early emergency service activation and take\u2010home\u2010naloxone represent the highest\u2010yield strategies to reduce mortality from illicit substance use in Victoria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70347","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:15:45Z","timestamp":1788999345000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Toxicological and Clinical Characteristics of Fatal Cases in the Emerging Drugs Network of Australia\u2014Victoria (\n                    <scp>EDNAV<\/scp>\n                    ) Clinical Registry 2020\u20132025"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3238-5613","authenticated-orcid":false,"given":"James","family":"White","sequence":"first","affiliation":[{"name":"Victorian Poisons Information Centre Austin Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9225-7127","authenticated-orcid":false,"given":"Sarah J.","family":"Hampton","sequence":"additional","affiliation":[{"name":"Victorian Poisons Information Centre Austin Health  Melbourne Australia"},{"name":"Department of Emergency Medicine Austin Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7423-2467","authenticated-orcid":false,"given":"Shaun","family":"Greene","sequence":"additional","affiliation":[{"name":"Victorian Poisons Information Centre Austin Health  Melbourne Australia"},{"name":"Department of Emergency Medicine Austin Health  Melbourne Australia"},{"name":"Department of Critical Care University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Mortality Trends \u2013 Deaths of Despair","author":"Australian Institute of Health and Welfare","year":"2024"},{"key":"e_1_2_12_3_1","volume-title":"Victorian Fatal Overdoses Reach 10\u2010Year High","author":"Coroners Court of Victoria","year":"2025"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.70112"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.70202"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.14059"},{"key":"e_1_2_12_7_1","volume-title":"Reportable Deaths [Internet]","author":"Coroners Court of Victoria","year":"2024"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkz049"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.272"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7432a1"},{"key":"e_1_2_12_11_1","volume-title":"Victorian Overdose Deaths 2015\u20132024","author":"Coroners Court of Victoria","year":"2025"},{"key":"e_1_2_12_12_1","volume-title":"Australia's Annual Overdose Report 2024","author":"Penington Institute","year":"2024"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2022.2137524"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.70104"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70347","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1742-6723.70347","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70347","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:35:50Z","timestamp":1793194550000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.70347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/1742-6723.70347"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.70347","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"value":"1742-6731","type":"print"},{"value":"1742-6723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"assertion":[{"value":"2026-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70347"}}