Using poisons information service data to assess the acute harms associated with novel psychoactive substances

Abstract

Novel psychoactive substances (NPS) can cause significant acute toxicity but usually little is known about their toxicity when they enter the recreational drug scene. Current data sources include online user forums, user questionnaires, case reports/series, and deaths; however, these are limited by their focus on sub-populations and generally include severe cases and specific geographical areas. Approximately 54% of countries have at least one poisons information service (in 2012 there were 274 worldwide) providing advice to healthcare professionals and/or the public on poisoning. They provide advice on recreational drug and NPS toxicity. In 2012, 2.5% of telephone enquiries to the UK National Poisons Information Service and 2.4% of enquiries to US poisons centres related to recreational drugs. Data are collected at population level and can be used to complement other data sources with clinical details on acute NPS toxicity and geographical/time patterns of toxicity. Like other acute NPS toxicity data, poisons centre data should be interpreted within their limitations, notably the absence of analytical confirmation and reliance on secondary reporting of clinical features. This manuscript demonstrates the breadth and depth of poisons information service data in the literature with a focus on mephedrone and synthetic cannabinoid-receptor agonists. In our opinion it would be possible to develop a more robust and systematic reporting system using a network of poisons information services both within and across countries that would be complimentary to other datasets on acute NPS toxicity and allow more accurate data triangulation.

The new drug phenomenon

“…An important source of this information may be obtained from emergency presentations and poison information services. The opportunity to gain insights from such systems is discussed by Wood et al . who review international literature to offer examples from data obtained from poison information services and how clinically‐relevant data or information about the number of calls or enquiries can play a helpful role in toxicovigilance.…”

Deaths of individuals aged 16–24 years in the UK after using mephedrone

“…The harms of NPS may be physical (intrinsic to the drug) or social in nature, and unfortunately, there is an upward trend in admissions, owing to NPS drug toxicity, for both hospital and pre-hospital presentations (Wood et al, 2014). The ACMD (2011) recommends that the government implements strategies to decrease the request for NPS by including NPS in substance misuse education in schools and developing prevention initiatives.…”

A novel psychoactive substance poses a new challenge in the management of paranoid schizophrenia

“…It is clear that NPS are being more commonly used as recreational substances10 11 and that adverse effects from NPS use are increasing, evidenced by the increasing enquiries and reports of misuse to poisons services 12. Much of the marketing of NPS and the transfer of knowledge about use and effects of the substances between users is internet based, which has allowed for thorough investigation into these topics 13–19…”