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

 

NPIS telephone enquiry numbers and the volume of TOXBASE accesses (including those made via the TOXBASE app) give an indirect indication of the drugs of misuse most commonly encountered by health professionals. The data can be used to follow trends with time, including the emergence of new substances, 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 PHE, 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).

 


Methods

 

Telephone enquiries are included in this analysis if the exposure is to a substance with no other purpose than drug misuse, or when the exposure has been classified as ‘recreational’ by the SPI receiving the call, irrespective of the substance involved and including medicinal drugs. This has the advantage that substances not previously recognised as being involved in misuse can be identified.
The intent of the exposure is not available when using TOXBASE access data. For example, looking at TOXBASE access data relating to diazepam would not allow insight into whether the access related to an exposure that was for recreational drug misuse, self-harm or therapeutic error. For this reason accesses to TOXBASE pages that relate to licensed medications are omitted from cumulative data. There are two exceptions, methylphenidate and methadone, which are included because these are under specific surveillance.

 


Overall activity

 

During the 2018/19 reporting year there were 1,220 telephone enquiries meeting the misuse criteria described above, a 2.0% decrease compared to 2017/18. These enquiries related to 396 different substances or products and accounted for 3.0% of all telephone enquiries. There were also 66,227 TOXBASE accesses relating to 1,055 different substances or products, accounting for 3.1% of all TOXBASE online accesses; similar numbers to last year. There were also 9,818 accesses to the TOXBASE app, an 11.4% increase compared to 2017/18, relating to 682 different products and substances.

 

 


Substances involved

 

The top 10 substances of misuse involved in telephone enquiries, TOXBASE online accesses and TOXBASE app accesses are shown in Table 1a. As in previous years, cocaine, cannabis and MDMA were most commonly involved in telephone enquiries and cocaine, MDMA and heroin in TOXBASE online accesses

 

The top ten substances involved in telephone enquiries and TOXBASE accesses are shown in Table 1.

 

Table 1. Top 10 drugs/substances of misuse involved in telephone enquiries, TOXBASE online accesses and TOXBASE app accesses

 

Compared with last year, ketamine activity increased via TOXBASE online (28.9 %), via the app (by 49.4%) and by telephone enquiries (34.3%). Ketamine was the 12th most common drug of misuse for telephone enquiries in 2018/19.


TOXBASE app use data identified two cathinones whose activity has increased substantially in this period, specifically NEiH or 2-(ethylamino-4-methyl-1-phenyl-pentan-1-one) increased by 350.0% and N-propylnorpentedrone or 1-phenyl-2-(propylamino)pentan-1-one increased by 672.7%. Each was first identified in the EU by the EMCDDA in 2018. There were, however, no telephone enquiries received involving either substance.


The emergence of novel fentanyl derivatives has been an important public health concern in recent years. This year there were no telephone enquiries about novel fentanyls to NPIS but 71 TOXBASE accesses to 16 different fentanyl derivatives. However it may be difficult for clinicians to identify these substances clinically from other opiate toxicity presentations and under-recognition is likely, especially if users are unaware of their presence in drug products they have purchased, e.g. heroin powder or counterfeit pharmaceuticals.


Synthetic cannabinoid receptor agonists (SCRA), and products likely to contain SCRA, continue to be the commonest new psychoactive substance group for which the NPIS has provided advice.


Trends with time

 

In our previous annual report we compared NPIS telephone enquiry numbers and TOXBASE accesses for four consecutive financial years to assess the impact of the Psychoactive Substances Act (PSA), enacted in May 2016. 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. These data were used by the Home Office in their evaluation of the PSA. Reductions in telephone enquiry activity for common New Psychoactive Substances (NPS) in the first two years after the PSA came into force have continued in 2018/19, including for mephedrone, synthetic cannabinoid receptor agonists and branded NPS products. A similar pattern is seen for TOXBASE accesses, the exception being an increase in accesses about NPS products. The trend of increases in telephone and TOXBASE activity relating to some common conventional drugs of misuse including cocaine, heroin and cannabis have also continued this year, although there have been modest reductions for MDMA (Table 2).

 

Table 2. Overall NPIS drug of misuse activity and for selected drugs 2014/15 to 2018/19

 

Ten year trends in activity for Class A, B and C drugs of misuse are shown in Figures 1a to 1d. These are expressed as a percentage of total activity, because there have been changes in overall telephone and TOXBASE activity relating to all substances over this period, with increasing use of TOXBASE and declining frequency of telephone enquiries. These data show recent increases in the proportion of overall telephone enquiry activity relating to cocaine, heroin and cannabis, but these are not accompanied by substantial increases in TOXBASE activity for these substances when measured in this way. There have been substantial reductions in telephone and TOXBASE activity relating to mephedrone over several years and more recent reductions for synthetic cannabinoid receptor agonists. There have been modest year on year increases in the proportion of telephone and TOXBASE activity related to ketamine.

 

 

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 2018/19.

 

| 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 |