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

1. 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
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2. 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
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3. 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.
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4. 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.
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5. 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.
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6. 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
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7. 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
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8. 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)
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9. 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.
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10. 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
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