Background: ‘Legal highs’ began appearing in the UK in the mid-2000s. Whilst many of these substances were controlled under the 1971 Misuse of Drugs Act, novel compounds and new variants of controlled compounds were continuously being introduced to the recreational drug market. The Psychoactive Substances Act (PSA) was therefore implemented in 2016 as a blanket ban on all novel psychoactive substances (NPS). Aim: To evaluate the impact of the PSA on deaths following NPS use in England, Wales and Northern Ireland. Methods: Cases reported to the National Programme on Substance Abuse Deaths where death had occurred 3 years pre- or post-implementation of the PSA were extracted. Cases with NPS detected at post-mortem were analysed and compared against cases non-NPS cases. Results: 293 deaths with NPS detected were identified; 91 occurring before the PSA and 202 afterwards, indicating an 222.0% post-PSA increase. Contrastingly, non-NPS drug-related death case reporting increased by only 8.0%. Synthetic cannabinoid, anxiolytic/sedative and stimulant NPS were detected in the largest proportions of deaths pre-PSA; post-PSA stimulant NPS detections reduced whilst synthetic cannabinoid and anxiolytic/sedative detections increased. Post-PSA, average decedent age increased significantly (mean age pre-PSA 34.4 ± 10.8 vs post-PSA 38.3 ± 9.4), and they were significantly more likely to have been living in deprived areas (pre-PSA 50.0% vs post-PSA 65.9%). Conclusions: Reporting of deaths following NPS use has risen despite introduction of the PSA. Whilst deaths amongst younger individuals and those living in more affluent areas has reduced, additional approaches to prohibition are needed to curb their persistence in deprived demographics.

17Cognitive bias is a well-documented automatic process that can have serious negative consequences in a 18 variety of settings. For example, cognitive bias within a forensic science setting can lead to examiners' 19 judgements being swayed by details that they have learned while working on the case, and which go beyond 20 the physical evidence being examined. Although cognitive bias has been studied in many forensic disciplines, 21 such as fingerprints, bullet comparison, and document examination, knowledge of cognitive bias within 22 forensic toxicology is lacking. Here, we address this knowledge gap by assessing use of contextual information 23 by an international group of forensic toxicologists attending the 54th conference of The International 24 Association of Forensic Toxicologists (TIAFT) in Brisbane in 2016. In a first study, participants read a set of 25 simple post-mortem toxicology results (two drug concentrations in blood) and then indicated what 26 information they would normally use when interpreting these results in their day-to-day casework. Using a 27 questionnaire, we then surveyed the familiarity of toxicologists with contextual bias and captured any 28 suggested bias-minimizing procedures for use in forensic toxicology laboratories. Thirty-six participants from 29 23 different countries and with a range of 1-35 years' forensic toxicology reporting experience volunteered. 30 Analysis of their responses showed that the majority of participants used some contextual information in their 31 interpretation of post-mortem toxicology results (range = 3-15 pieces of information, median  SD = 11  3), 32 the most common being the deceased's history of prescription or illicit drug use. More than three-quarters of 33 participants reported being familiar with the concept of contextual bias, although few (n = 9) worked in 34 laboratories that had a formal policy covering it. Over half of participants knew of at least one bias-minimizing 35 procedure specifically for forensic toxicology casework, but only a quarter (overall) reported using bias-36 minimizing procedures in their laboratories. Our results provide substantial evidence that although practising 37 forensic toxicologists are familiar with contextual bias, many report that they still engage in behaviours that 38 could lead to cognitive bias (e.g., through the use of contextual information, through lack of explicit policies 39 or bias-minimizing procedures). We anticipate that our work will form the basis of further research involving a larger sample of participants and examining other potentially relevant factors such as sex/gender, country 1 and accreditation of laboratories. 2 3 4 Keywords: cognitive bias; forensic toxicology; bias-minimizing procedure; contextual bias 5 6

The phencyclidine derivative 3-Methoxyphencyclidine (3-MeO-PCP) is a potent dissociative hallucinogen. Sought for recreational use as a novel psychoactive substance, it can also induce acute psychological agitation and pathophysiological cardiorespiratory effects. Due to the harms associated with its use, 3-MeO-PCP was added to the ‘Green List’ of materials covered by the 1971 Convention on Psychotropic Substances as a Schedule II substance by the United Nations Commission on Narcotic Drugs in April 2021. There have been 15 previous reports of fatal intoxications following 3-MeO-PCP use, but only one was attributable to 3-MeO-PCP intoxication alone. In this report we detail the first fatality due to 3-MeO-PCP intoxication to be reported in the UK, along with a review of the surrounding literature. Whilst the blood concentrations associated with 3-MeO-PCP toxicity and fatality remain unclear, by providing details of sample collection and storage conditions this case will aid in future interpretations. Furthermore, this case suggests that 3-MeO-PCP toxicity may be exacerbated by exercise. Users of 3-MeO-PCP should be cautioned against its use as a ‘club drug’ or in a similar setting where elevations in heart rate, body temperature and blood pressure may occur.

Studies have compared the chemical properties of tobacco smoke to those of cannabis smoke, with the objective of identifying the chemical attributes responsible for the mutagenicity and carcinogenicity of cannabis smoke. Comparative studies have included small sample sizes and produced conflicting results. The aim of this study was to assess the major chemical and physical variations of cannabis smoke across a range of cannabis samples of different potencies and origins, sourced from the illegal market in New Zealand. Twelve cannabis samples were studied ranging from 1.0% to 13.4% delta-9-tetrahydrocannabinol (D 9 THC) content. A smoking machine was used to smoke "joints" (cannabis cigarettes) and the chemical/physical properties of the smoke assessed. The chemical constituents of the smoke extracts were analysed by gas chromatography/mass spectrometry. A range of different chemical constituents (in addition to D 9 THC) were identified and their concentrations estimated. Terpenoids were identified as the major variable in cannabis smoke, showing a 40-fold range in total terpenoid content. Analysis of the total particulate matter showed that significantly different levels of particulate matter were produced between the different cannabis samples, ranging from 14.6 to 66.3 mg/g of cannabis smoked. The D 9 THC delivery efficiency during smoking was also investigated and produced consistent results showing a mean and median of 12.6% and 10.8%, respectively, of the theoretically available D 9 THC (ranging from 7.2% to 28.0%).

The impact of cognitive bias on decisions in forensic science has been demonstrated in numerous disciplines such as DNA and fingerprints, but has not been empirically investigated in the more objective domains, such as forensic toxicology. In the first experiment, participants (n = 58) were affected by irrelevant case information when analysing data from an immunoassay test for opiate-type drugs. In the second experiment, participants (n = 53) were biased in their choice of tests, for example, the age of the deceased impacted testing strategy: for older people, medicinal drugs were commonly chosen, whereas for younger people drugs of abuse were selected. Based on the results that examiners analyzing case data may have biases if they are given access to case context, we propose that examiners analysing presumptive test data are blind to irrelevant contextual information. Furthermore, that forensic toxicology laboratories use a consistent protocol for selecting tests, and that any deviations are documented and justified.