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 activity, although not an exact surrogate for clinical harm, is useful as an indirect marker of health professional activity in managing toxicity associated with drug misuse. Because of this, the service continues to provide information on request to official organisations detailing activity relating to specific substances (Box 6.1.1), including 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 2016/17 there were 1,210 NPIS telephone enquiries related to 280 different substances or products, accounting for 2.7% of all NPIS telephone enquiries. This is a 25% reduction on the 1,613 enquiries relating to 385 substances or products received during 2015/16 (3.4% of activity). There was also a 5% reduction in TOXBASE accesses relating to drugs of misuse comparing 2016/17 (64,015, 3.9% of overall activity) with the previous year (67,228, 4.0% of overall activity). Note that these TOXBASE data are likely to under-represent the total contribution made by drug misuse as they exclude licensed pharmaceutical substances (including benzodiazepines, drugs used in ADHD and opioids) that may be taken for abuse purposes rather than toxicity due to medication error or self-harm. 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.

1 These are sold in packages with distinctive branding. Examples (sometimes previously termed ‘legal highs’) include ‘Black Mamba’, ‘Vertex’ and‘Sweet Leaf’. The constitents of these products are often unknown and may be inconsistent. Although many contain SCRAs, they are listed separately because some may contain other drug types.

 

 

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

1 These are sold in packages with distinctive branding. Examples (sometimes previously termed ‘legal highs’) include ‘Black Mamba’, ‘Vertex’ and‘Sweet Leaf’. The constitents of these products are often unknown and may be inconsistent. Although many contain SCRAs, they are listed separately because some may contain other drug types.

 

 


Impact of the Psychoactive Substances Act

 

The Psychoactive Substances Act (PSA) came into law in the UK on 26 May 2016, describing various offences relating to psychoactive substances including production, supply, offer to supply, possession with intent to supply, possession on custodial premises and importing or exporting. Prior to the PSA, while many drugs of misuse were controlled by earlier drugs of misuse legislation, some newer substances (new psychoactive substances or NPS) were not controlled. The NPIS is currently examining the impact of the PSA on activity relating to substances that were commonly legal prior to the PSA, especially branded products (sometimes previously termed ‘legal highs’) and newer synthetic cannabinoid receptor agonists (SCRA). Early analysis shows that for both these groups there has been a reduction in NPIS activity comparing 2016/17 with previous years (Table 2a and 2b). However, more detailed statistical analysis is needed to establish the extent to which these reductions are linked with the introduction of the PSA.

 

A potential concern is that older, previously controlled ‘classical’ drugs of misuse might occupy the share of the drug misuse market vacated by hitherto legal substances. This could result in increasing episodes of toxicity relating to substances such as heroin, cocaine and MDMA. So far, however, NPIS activity data do not show substantial consistent effects for cocaine (increasing TOXBASE activity but little change in telephone enquiry numbers) or MDMA (small increases in telephone enquiries and TOXBASE accesses) and activity relating to heroin has fallen (Tables 2a and 2b). Note that data collected prior to the 2014/15 reporting period are not included in these tables; these are not directly comparable because until that year NPIS did not report activity related to all drugs of misuse but limited monitoring to 61 specific substances.

 

Table 2a. Telephone enquiries for selected substances over the last three reporting years

 

 

Table 2b. TOXBASE accesses for selected substances over the last three reporting years

 


Novel synthetic opioids

 

Concerns have been raised globally regarding the potential harms associated with the emerging misuse of novel synthetic opioids, especially fentanyl derivatives. These are often of higher potency than heroin and have caused severe toxicity including fatalities internationally. NPIS received two telephone enquiries relating to these substances during the year, involving butrylfentanyl and furanylfentanyl with associated cardiac or respiratory arrest or both. Note, however, that NPIS data are likely to underestimate the true impact of these compounds as their presence may not be recognised by clinicians seeking advice from the service. This is because analytical confirmation of the responsible substance is rarely performed in patients with non-fatal opioid toxicity.

 


Longer-term trends

 

Ten year NPIS activity data for various drugs of misuse are shown in Figures 1a and 1b for Class A drugs and Figures 2a and 2b for other substances of misuse. TOXBASE information for the class A substances cocaine and MDMA has been accessed increasingly frequently over the last 7 years (Figure 1b), but without corresponding increases in telephone enquiry numbers (Figure 1a). The recent decline in telephone enquiries and TOXBASE accesses relating to mephedrone has continued, with further substantial reductions in 2016/17. There have also been recent reductions in telephone enquiries and TOXBASE accesses relating to SCRAs (Figures 2a and 2b, Table 1b).

 

Figure 1a. Annual telephone enquiries regarding selected class A drugs of misuse, 2007/8 - 2016/17

 

 

Figure 1b. Annual TOXBASE accesses regarding selected class A drugs of misuse, 2007/8 - 2016/17)

 

 

 

 

Figure 2a. Annual telephone enquiries regarding other selected drugs of misuse, 2007/8 – 2016/17

 

Figure 2b. Annual TOXBASE accesses regarding other selected drugs of misuse, 2007/8 – 2016/17

 


Information from the NPIS Annual Report 2016/17.

 

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