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

Introduction

 

Enquiries relating to drugs of misuse form an important component of the work of the NPIS. Telephone enquiry numbers and volume of TOXBASE accesses give an indirect indication of the drugs of misuse most commonly encountered by health professionals and the data can be used to follow trends with time and to characterise features of toxicity reported for different substances. These data can be of value in assessing toxicity relating to drugs of misuse and are shared periodically with responsible agencies including Public Health England, the Advisory Council on the Misuse of Drugs (ACMD), the UK Focal Point (UK FP) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

 


Overall activity

 

In 2017/18 there were 1,245 NPIS telephone enquiries relating to drugs of misuse, which is a 2.9% increase compared to 2016/17. These enquiries related to 333 different substances or products and accounted for 3.0% of all NPIS telephone enquiries. There were also 63,373 TOXBASE accesses relating to 994 different substances or products and accounting for 3.2% of all TOXBASE accesses. The top ten substances involved in telephone enquiries and TOXBASE accesses are shown in Tables 1a and 1b.

 

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

 

 

 

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

 

 

 


Substances involved

 

The top 10 substances of misuse involved in telephone enquiries, TOXBASE accesses are shown in Table 1a and 1b. As in previous years, cocaine, MDMA and cannabis were most commonly involved in telephone enquiries and cocaine, MDMA and heroin in TOXBASE accesses. Two medications, codeine (including co-codamol) and pregabalin, have appeared in the top 10 telephone enquiries related to drug misuse for the first time.

 

NPIS activity related to new psychoactive substances (NPS), sometimes previously referred to erroneously as ‘legal highs’, has in recent years primarily involved synthetic cannabinoid receptor agonists (SCRA) and branded products. The latter encompass NPS sold in branded packaging with names such as ‘Black Mamba’, ‘Clockwork Orange’, ‘Annihilation’, ‘Exodus’ and many others. Recently, the majority of these branded products have included a herbal base designed for smoking and are found to contain SCRA when analysed, although the specific SCRA included in any particular product may vary with time and location.

 

For some NPS products, there may be no information on content and some may contain mixtures of substances, occasionally including controlled drugs. Because of the large numbers of different products and substances involved, telephone enquiries and TOXBASE accesses to these are reported as a single, separate group.


Trends with time

 

It is important to monitor trend in telephone enquiry and TOXBASE data for drugs of misuse to better understand the impact of public health measures, including changes in legislation. An important recent change is the Psychoactive Substances Act (PSA) enacted on 26 May 2016. This legislation applies to any psychoactive substance if the substance is likely to be used for its psychoactive effects and regardless of its potential for harm. Specific exemptions include nicotine, alcohol, caffeine and licensed medicinal products. Offences include supply or offer to supply, production, importation or exportation, as well as possession within a custodial institution.

 

To assess the impact of the PSA, NPIS telephone enquiry numbers and TOXBASE accesses were compared for four consecutive financial years. The first two years were before the enactment of the PSA, while the second two years included enquiries and accesses that were almost all made after the PSA came into force, with the exception of those made between 1 April and 26 May 2016. Enquiries and accesses relating to commonly encountered NPS are presented, together with data for some common conventional drugs of misuse. It is important to include the latter group because of the concern that legislation affecting NPS might result in increased use of conventional drugs that were already controlled.

 

Telephone and TOXBASE access data both show reductions for common NPS in the two years since the PSA came into force. These include mephedrone, synthetic cannabinoid receptor agonists and branded NPS products. Of note, enquiries relating to mephedrone and branded products fell between 2014/15 and 2015/16, before the PSA came into force, although larger reductions were seen subsequently.

Conversely, there have been increases in telephone and TOXBASE activity relating to some common conventional drugs of misuse including cocaine, MDMA (‘ecstasy’) and cannabis. Overall, however, telephone enquiries and (to a lesser extent) TOXBASE accesses relating to all drugs of misuse (NPS and conventional) have fallen in the last two years (Table 2a).

 

 

Table 2a. Overall NPIS drug of misuse activity and for selected drugs for two years before and two years after the Psychoactive Substances Act, 2016

 

 

 

 

Ten year trends in activity for Class A, B and C drugs of misuse are shown in Figures 1a to 1d. Because there have been changes in overall telephone and TOXBASE activity relating to all substances, with increasing use of TOXBASE and declining frequency of telephone enquiries, these data are normalised by expressing as a percentage of total activity. These data show recent increases in the proportion of overall telephone enquiry activity relating to cocaine, MDMA and heroin but these are not accompanied by increases in TOXBASE activity for these substances when measured in this way. These figures illustrate the longer term substantial reductions seen in activity relating to mephedrone and more recent reductions for SCRAs.

 

 

Figure 1a. Telephone enquiries for legal class A by year

 

 

Figure 1b. TOXBASE accesses for legal class A by year

 

 

 

 

Figure 1c. Telephone enquiries for legal class B and C by year

 

Figure 1d. TOXBASE accesses for legal class B and C by year

 


Information from the NPIS Annual Report 2017/18.

 

| Reserach we undertake | Antidotes | Button batteries | Carbon monoxide | Cyanide | 2,4-dinitrophenol | Drugs of misuse | Electronic cigarettes | Glycols and methanol |Household products | Iron poisoning | Lead exposure | NSAIDs | Oral anticoagulants | Pesticides | Snake bite |