new psychoactive substances & early warning systems
TRANSCRIPT
New Psychoactive Substances & Early Warning Systems
Dr David Caldicott (FCEM)
Emergency Specialist, Nevill Hall Hospital, Abergavenny, Wales
Co-Founder & Coordinator
WEDINOS
Nevill Hall Hospital,Abergavenny
A Candy Store?
Types of Drugs Involved…
• Natural– Kratom– Salvia – Hallucinogenic mushrooms – Cactus – JWH-018 (cannabinoid) – JWH-250 (cannabinoid) – Ayahuasca (active principle DMT) – Hawaiian baby woodrose (active
principle lysergamides)
• Synthetics– aminoindanes (MDAI, 5-IAI) – arylcyclohexylamines
(Methoxetamine) – benzofurans (6-APB, 5-APB) – cathinones (4-MEC, MDPV,
Methylone, Mephedrone, 3,4-DMMC)
– thiophenes (Methiopropamine) – benzoates (Dimethocaine) – cannabinoids (AM-2201, JWH-
122) – tryptamines (AMT) – aminotetralins (MDAT) – phenethylamines (4-FA) – GHB related (GBL, 1,4BD)
Dizzying array of products…
“If you can’t Measure it, you can’t Manage it…”
Drug Information Systems
• Many now in place globally e.g.– DAWN
– IDRS
– EMCDDA
• Different methodologies- different strengths & weaknesses
• Designed with different purposes in mind
• Designed with different drugs in mind
Are Current systems fit for Purpose in the era of Legal Highs?
Drug Abuse Warning Network
• Based in USA
• Harm-based information
• Uses a retrospective ED data extraction methodology from patients notes
• Sentinel monitoring hospitals- complex national extrapolation
• Dependent upon doctor’s documentation and patient’s information
Illicit Drug Reporting System• Based in Australia
• three components: – interviews with people who inject drugs (PWID) regularly; – interviews with key experts (KEs); – analysis and examination of indicator data sources related to illicit drugs( (price, purity, availability and patterns of use of heroin, methamphetamine, cocaine and cannabis).
• designed to be sensitive to trends
• Yearly reports, state and federal
European Monitoring Centre for Drugs and Drug Addiction
• Decentralized EU agency
• Established 1993, based in Lisbon
• Centralized collation of National collected data
• Produces succinct and insightful reports in timely fashion
• Capability to respond to rapidly emerging trends
Problems with measuring health impacts of legal highs
• Present with a set of symptoms, not name of drug
• ICD10 Coding for drug related problems
• No chemical standards
• Poorly understood metabolic pathways
Non-Toxicological Problems
• Assault
• Self Harm
• Rape & Sexual Assault
• IVDA-related
Behavioral & Social Problems
Haemorrhagic Cystitis
From Chu et al, BJU International, 102 (11), 1616-1622
From Raja et al, BJU International, 2011
What are we treating?
• What are the substances?
• Who is using them and why?
• How much medical harm are they causing?
WEDINOS
• Welsh Emergency Department Investigation of Novel Substances Group
• ‘Wedi nos’ is also Welsh for ‘after dark’
• 3 tiers of investigation…
– Identify products associated with harm
– Identify patterns of harmful use
– Develop acute brief interventions for consumers
Network of Monitoring Hubs
WEDINOS
• Identify products associated with Harm
WEDINOS
• Identify products associated with Harm
ED Amnesty Bins
Neo-organics
Alcohol vs Mephedrone
Alcohol vs Mephedrone
Recreational Drug Use- RAH
0
100
200
300
400
500
600
2000 2001 2002 2003
Alcohol
Everythingelse puttogether
Impact of legislation
From Wood, et al, Emerg Med J, 2011 in press
WEDINOS-Identifying patterns of harmful use
WEDINOS-Intervening with high risk patients
• Screening, Brief Interventions and Referral to Treatment (SBIRT) for young adults presenting at the Emergency Department (ED) with problems related to (poly)drug use
• 6 EDs, over 3 EU countries
• The partners involved in this project are: • VAD, Belgium (coordinator);
• Liverpool John Moores University, UK;
• Trimbos-Institute, The Netherlands;
• Irefrea, Spain;
• Eotvos Lorand University, Hungary;
• Dr. David Caldicott, UK and Msc Jan Krul, The Netherlands.
WEDINOS-Engagement with Consumers
• Critical to engage consumers in a language they understand
• Their involvement advances the data streams several steps
• Don’t get ‘nuthin’ fer nuthin’-need to decide what the consumers get for participating
Where do the Dangers Lie?
• Most of these drugs are not natural born killers
– No better or worse than others
– Much less common than the old favorites
• Danger lies in mutation rate and market
– Remember PMA? MPTP?
What of the Future?
• The future is not bright...
• Global economic crisis
• Sense of a shift in global drugs realpolitik?
• Need to add in monitoring systems that can cope with new markets…
A Novel Psychotropic
Substance
• WEDINOS Collaborative• Joe Donne (Data management, ABHB)• Mike Hemming (GIS Analysis, WAG IM&T)• Gareth Hughes -Graphic Design• Department of Public Health, Welsh Assembly Government
Thank You’s and Acknowledgements…
And not forgetting… The Daily Mail
