National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

Drugs of misuse

Drugs of misuse commonly cause acute toxicity, which can be severe and sometimes fatal. For example, during 2014 two thirds of deaths caused by drug poisoning were associated with drugs of misuse.1 It is therefore not surprising that drugs of misuse form an important component of NPIS activity, by both telephone enquiries and TOXBASE accesses. An important recent development has been the increasing number of telephone enquiries and TOXBASE accesses related to new drugs of misuse, now termed new psychoactive substances (NPS)2 and dealing with these is a particular challenge. There is often little information available about their pharmacology and toxicology, while the use of many different brand names for NPS-containing products makes it more difficult to identify the specific chemicals involved in episodes of toxicity. The top 10 substances by number of telephone enquiries and TOXBASE accesses are shown in Tables 1a and 1b, respectively.

 

Table 1a. Top 10 telephone enquiries relating to drugs of misuse.

* Recreational use only

**Synthetic Cannabinoid Receptor Agonists

 

 

Table 1b. Top 10 TOXBASE accesses relating to drugs of misuse.

* Recreational use only

**Synthetic Cannabinoid Receptor Agonists

 

During this reporting year there were 1,613 NPIS telephone enquiries relating to 385 different substances or products, accounting for 3.4% of all NPIS telephone enquiries. In comparison there were 1,722 telephone enquiries about 286 substances made during 2014/15. The trends over the last 14 years are shown in Figures 1 and 2. The mean age of patients in these enquiries was 28 years old and 70.5% were male, in keeping with other drug of misuse demographic data and NPIS reports for previous years.

 

 

Figure 1. Annual telephone enquiries to NPIS regarding selected class A drugs (2002-2015/16)

 

 

 

 

Figure 2. Annual telephone enquiries to NPIS regarding other selected drugs of misuse

(2002-2015/16)

 

 

 

During 2015/16 there were also 67,228 TOXBASE accesses to 839 different substance or product pages, representing 4.0% of TOXBASE activity overall. This compares to 69,537 accesses to 598 different substances during the previous year. The trends over the last 14 years are shown in Figures 3 and 4. This TOXBASE data is likely to under-represent the total accesses associated with drug misuse as it excludes pharmaceutical substances that may be taken for misuse purposes. For example, there were 48,204 TOXBASE accesses to information about medicinal drugs that may be subject to misuse, including benzodiazepines, drugs used in ADHD and opioids. It is not possible to determine if toxicity caused by these drugs resulted from misuse, self-harm or medication errors.

 

Figure 3. Annual TOXBASE accesses regarding selected class A drugs (2002-2015/16)

 

 

 

Figure 4. Annual TOXBASE accesses regarding other selected drugs of misuse (2002-2015/16)

 

 

The large number of different drugs, each with a variety of street names, and the vast number of different branded products means that it continues to be a significant challenge for NPIS and healthcare professionals to remain up to date with drugs of misuse. Using intelligence from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the UK Focal Point, the Advisory Council on the Misuse of Drugs (ACMD), other sources and literature, NPIS added 78 new drugs of misuse and a further 257 synonym pages to TOXBASE over the reporting period. Because the exact chemical involved is often unknown, NPIS has continued to promote the recognition of the toxicological syndrome (toxidrome) as the most appropriate guide to clinical management.

 


Synthetic cannabinoid receptor agonists

Branded products, such as 'Black Mamba', 'Vertex' or 'Sweet Leaf' were the most common reason for health professionals to contact NPIS by telephone in regards to drugs of misuse (Table 2). Analytical data published by other sources, such as WEDINOS, suggest that the great majority of these contain synthetic cannabinoid receptor agonists (SCRAs).

 

Enquiries relating to branded products fell compared with the previous year, but there has been a marked increase in those enquiry numbers where the health professional suspected exposure to a SCRA. In only eight of the 108 telephone enquiries (7.4%) the caller reported the specific chemical involved, meaning in most cases the caller had recognised that a SCRA of some type was involved.

 

Overall, these drugs currently dominate NPIS activity relating to drugs of misuse – both telephone enquiries and TOXBASE accesses - reflecting the substantial problem they are posing to UK healthcare professionals.

 

Table 2. Top five branded products involved in telephone enquiries and TOXBASE accesses.

 


Stimulants

NPIS activity related to established stimulant drugs such as cocaine, MDMA and amphetamine remained high and was relatively unchanged compared with the previous year. For example, MDMA, cocaine and amphetamine were the three most common drugs of misuse accessed on TOXBASE (Table 1). The synthetic cathinone mephedrone persists in the top 10 for telephone enquiries and TOXBASE accesses, but activity by both means reduced this year by around 30% compared to 2014/15. Drugs used in the treatment of ADHD continued to be an important component of the NPIS workload, with 3,759 accesses to the TOXBASE entry for methylphenidate during the year, a 14% increase compared with 2014/15, although telephone enquiries relating to misuse were relatively infrequent.


Opioids

Opioids, particularly heroin and methadone, continue to dominate mortality data for drugs of misuse. NPIS telephone enquiries for heroin increased by 5% and TOXBASE accesses by 7.8% compared with the previous year. In contrast, there were reductions in telephone and TOXBASE activity relating to methadone.


Future developments

On 26 May 2016, the Psychoactive Substances Act was introduced in the UK. As a consequence, the production, supply, possession with intent to supply, import or export of any non-exempted psychoactive substance are offences and carry a custodial sentence of up to seven years4. This act aims to reduce the availability of novel psychoactive substances, sometimes previously referred to as 'legal highs'4. The impact of the Act on NPIS-activity relating to drugs of misuse and NPS in particular will be monitored and published in the NPIS annual report for 2016/17.


References

  1. Office for National Statistics UK. Accessed at:
    www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/
    deathsrelatedtodrugpoisoninginenglandandwales/2015-09-03
  2. NPIS annual report 2014/15
  3. Wedinos. Accessed at: www.wedinos.org/db/samples/
  4. www.gov.uk/government/news/trade-in-so-called-legal-highs-now-illegal

Information from the NPIS Annual Report 2015/16.

 

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