New Psychoactive Substances in the UK – analysing the adverse health consequences
Upcoming SlideShare
Loading in...5
×
 

New Psychoactive Substances in the UK – analysing the adverse health consequences

on

  • 637 views

Presentation by John Corkery (University of Hertfordshire, UK) on the occasion of the EESC hearing on New Psychoactive Substances (Brussels, 27 November 2013)

Presentation by John Corkery (University of Hertfordshire, UK) on the occasion of the EESC hearing on New Psychoactive Substances (Brussels, 27 November 2013)

Statistics

Views

Total Views
637
Views on SlideShare
590
Embed Views
47

Actions

Likes
0
Downloads
8
Comments
0

2 Embeds 47

http://www.eesc.europa.eu 46
http://ibogafy.com 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • This presentation focuses on this particular deficit, briefly outlining the key types of morbidity and mortality associated with the use of khat. Other speakers will now doubt comment further on some of these aspects. <br /> It is based on two peer-reviewed papers by the National Programme on Substance Abuse Deaths (np-SAD). These have provoked some comments, which have been answered elsewhere (Drugs, Education, prevention & Policy and need not be rehearsed here. <br /> However, we need to make it clear that the papers were aimed at raising awareness of these issues, to provide an overview of what (little) is known and the need for epidemiological research in these areas. <br />
  • As we have heard, during the past 20 years or so, more has become known about the properties of khat, its pharmacology, physiological and psychological effects on humans. <br /> Khat consumption has adverse health consequences including myocardial infarction, liver failure, depression, psychoses, and dependence. <br /> However, its reputation of social and recreational use in traditional contexts has hindered the dissemination of knowledge about its detrimental effects in terms of morbidity and mortality. <br />
  • As we have heard, during the past 20 years or so, more has become known about the properties of khat, its pharmacology, physiological and psychological effects on humans. <br /> Khat consumption has adverse health consequences including myocardial infarction, liver failure, depression, psychoses, and dependence. <br /> However, its reputation of social and recreational use in traditional contexts has hindered the dissemination of knowledge about its detrimental effects in terms of morbidity and mortality. <br />

New Psychoactive Substances in the UK – analysing the adverse health consequences New Psychoactive Substances in the UK – analysing the adverse health consequences Presentation Transcript

  • New Psychoactive Substances: Proposal for a regulation COM (2013) 619 Public Hearing at European Economic and Social Committee, 99 rue Belliard, 1040 Brussels, 27 November 2013 New Psychoactive Substances (NPS) in the UK – analysing the adverse health consequences John M. Corkery International Centre for Drug Policy 1
  • Overview Epidemiological sources on adverse health consequences Methodological issues and what is needed Deaths – recent trends from np-SAD data, characteristics of deaths of users of new recreational drugs Emerging drugs Contact details International Centre for Drug Policy 2
  • Epidemiological sources on adverse health consequences Presentations for treatment: General Practitioners, Drug Services, Specialist treatment services e.g. Club Drug Clinics. Those realising they have an issue of dependence, psychiatric issues (psychoses, paranoia), or risky behaviours (injecting mephedrone) Acute health issues – overdoses/intoxications/poisoning: Call-outs to paramedic/emergency services, admissions to Emergency Departments, Intensive Care Units, in-patient wards. These can lead to calls to National Poisons Information Units, and toxicological databases (Toxbase) by health professionals, forensic clinicians, clinical toxicologists, etc. Direct drug-induced deaths: overdoses (accidental or intentional); suicides (induced by psychiatric conditions including depression, anxiety, psychoses, caused/triggered by NPS); accidents resulting from impaired judgement – traffic accidents, falls from heights, drowning, etc. International Centre for Drug Policy 3 View slide
  • Methodological issues & what is needed Regular data and information are needed from all of these types of sources to understand the characteristics of those using and suffering adverse health consequences, as well as trends in NPS used and how they are used. We need to understand what are the effects of NPS and how they are brought about, and the characteristics of those suffering them. Problems: little if any research or literature (including animal studies) on physiological, pharmacological, and toxicological properties/effects of NPS. Case-studies and anecdotal reports help a little, but do not provide all the information needed to assess their potential health impacts, and to develop appropriate responses, interventions, treatments, etc. Where information might be generated, it is often not collected. If it is collected, this is often not done in a standardised way. Furthermore, often is not possible to collate this even at regional (sub-national) level. International Centre for Drug Policy 4 View slide
  • Methodological issues & what is needed Inadequate resources at local level to identify opportunities to collect data and to conduct collection on a regular and systematic basis. Lack of agreed protocols/instruments for data collection. Legal/ethical problems about sharing data between agencies – patient confidentiality, data protection legislation. This has been overcome in some small areas with memoranda of understanding; but then issue of sharing these data at higher levels. Mainly a problem with ‘health’ data, but also problem sharing names etc between those investigating drug deaths (coroners, pathologists, toxicologists) and those monitoring them, thereby not helping the latter with case identification and follow-up. Insufficient resources (including financial) for those investigating NPS characteristics – neurobiologists, pharmacologists, toxicologists, etc; and those monitoring adverse health consequences – locally & nationally. Often based on ‘good will’; perhaps need statutory or mandatory authority to collect and report data to nominated specialist centres. International Centre for Drug Policy 5
  • Characteristics of UK NPS deaths Main findings from work done a couple of years ago: • Gender – even split for Aminoindanes, ATS,to lesser extent for Methcathinones, rest typically male – as we would expect • Age – mean age ranges from 18.5 to 38.5 years, lower than typical np-SAD case (mid-40s) • Ethnicity – where known, mostly White - typical of np-SAD • Employment and living arrangements similar to np-SAD cases • Addiction – most had a history of previous drug use; higher than most np-SAD cases • Place of death – More than half in residential premises, but significant proportions in hospital International Centre for Drug Policy 6
  • Characteristics of UK NPS deaths Main findings: • Manner of death – most attributed to accidents or drug abuse, but for methcathinones (typically mephedrone) large number of suicides/open verdicts • Reflected in underlying cause – mostly accidental poisonings but many traumatic deaths, especially hangings for mephedrone • The mean number of PM drugs ranges from 1-9, but typically 3 or 4 • This is in line with findings for other UK stimulant deaths, reflecting polysubstance use • From the research we have recently published on mephedrone and other NPS, we know that NPS can kill of their own accord International Centre for Drug Policy 7
  • Trends in UK NPS deaths 2009 onwards 38 NPS (excluding piperazines) were mentioned in the PM toxicology of cases notified between September 2009 and April 2013, 35 of which were also implicated in the causing or contributing to deaths. There was one additional death where the drug implicated was not in the PM toxicology. These substances can be grouped in the following way: Aminoindanes (2) Amphetamine-type substances (ATS) (6) Benzofurans (3) Dietary supplement (1) Indoles (1) Methoxetamine Methcathinones (12) Natural products (Datura, Salvia divinorum, Ibogaine/Noribogaine, khat) Phenazepam Piperidines (1) Synthetic cannabinoids (1) Tryptamines (3) International Centre for Drug Policy 8
  • What else might we expect? Slimming aids/ dietary supplements DNP (Dinitrophenol); DMAA 2-C drugs 2-CE & 2-CI (phenethylamines similar to LSD). Related to 25I-NBOMe (25I) and 25B-NBOMe associated with non-fatal intoxications in 2013, and 2 deaths. Synthetic opioids AH-7921 - an analgesic selective for the mu opioid receptor. Synthetic cannabinoids There is a plethora of these available; only one UK death (AM2201) so far. Prescribed medications? Anti-epileptics, venlafaxine, etc. International Centre for Drug Policy 9
  • Contact details John M Corkery, BA Hons (Open), MSc, MPhil, PgC in L&T in HE, FHEA Research Co-ordinator, Department of Pharmacy University of Hertfordshire, College Lane Campus Hatfield, Herts. AL10 9AB Tel: +44(0)1707 281053 j.corkery@herts.ac.uk Honorary Research Fellow in Drug Epidemiology & Programme Manager, National Programme on Substance Abuse Deaths International Centre for Drug Policy St George’s, University of London Cranmer Terrace London SW17 0RE Tel: +44(0) 20 8725 2675 jcorkery@sgul.ac.uk UK Focal Point on Drugs expert on Drug-Related Deaths since 2000 Research profile and publications: http://researchprofiles.herts.ac.uk/portal/en/persons/john-corkery%288732f07e-406e-480f-bdff688d14dc4d30%29.html International Centre for Drug Policy 10