NOT THE SPICE OF LIFE: SYNTHETIC CANNABINOID DEATHS IN ENGLAND AND NORTHERN IRELAND (2012-2018) Synthetic cannabinoid receptor agonists (SCRAs): • Contain tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis 1 • Possess extreme potencies that can cause severe cardiac events 1 • Are controlled in the UK under the Psychoactive Substances Act (PSA) 2 • Appear increasingly popular likely due to their undetectable nature in routine drug screens 3 All SCRA-related cases from England and Northern Ireland reported to the National Programme on Substance Abuse Deaths (NPSAD) database by July 24 th 2019 were extracted and analysed using IBM® SPSS software. To identify: • Patterns in SCRA-related deaths in England and Northern Ireland (2012-2018) • The impact of the PSA on SCRA-related deaths 1. Karila et al., (2016). Curr Pharm Des, 22: 6420-25. 2. The Psychoactive Substances Act. http://www.legislation.gov.uk/ukpga/2016/2/contents/enacted 3. Ford & Berg (2018). Ann Clin Biochem, 55: 673-78. • SCRA-related death reporting has increased. Harm reduction measures are urgently required. • New SCRA variants are detected each year. This hampers detection: true death rate is likely higher. • The PSA has not reduced SCRA-related deaths. Increases in use, SCRA toxicology testing requests, & library of detectable variants likely co-contributed. P Y OGANATHAN 1 , H CLARIDGE 1 , CS COPELAND 1, 2 1 St George’s University of London, London, UK 2 King’s College London, London, UK 1. Introduction 2. Aims 3. Method 5. Conclusions: NEW SCRA VARIANTS HAVE BEEN DETECTED AT POST -MORTEM EVERY YEAR SINCE 2012 • Alcohol was the most commonly co-detected drug at post-mortem (n=69/123 cases) at levels consist with alcohol consumption • Alcohol is generated during decomposition. Alcohol levels less than 10 mg/dl were therefore excluded from analysis 5 SCRAS ARE COMMONLY CO-ADMINISTERED WITH CNS DEPRESSANTS DEMOGRAPHICS 0 5 10 15 20 25 30 35 40 45 50 2012 2013 2014 2015 2016 2017 2018 Number of deaths Year of Death • The first SCRA-related but death was reported to NPSAD in 2012 • A total of 123 SCRA-related deaths were reported from 2012-2018 (England: =115; N Ireland: n=8) • SCRAs were a direct cause of death in 84.5% of cases (n=104/123) • Death was deemed accidental in all these cases (n=104/104) • There has been a drastic increase SCRA-related death rates since 2012: a 2300% increase in 2017 (2012: n=2; 2017: n=46) • *Deaths are projected to plateau in 2018 (based on prior reporting rates) and remain high SCRA-RELATED DEATHS HAVE RISEN EACH YEAR SINCE FIRST DETECTION Co-administered drug type % of cases Alcohol Opioid Benzodiazepines/ZED Cannabis Anti-depressants Illicit Substances 56% 42.3% 28.5% 28.5% 28.4% 23.6% * 4. Results 6. References *Other synthetic cannabinoids: AM2201, AM2233, AKB-48F, STS-135, BB-22, AB-PINACA • 13 different SCRA variants have been detected in deaths reported to NPSAD since 2012 • Since 2015 there has been a surge in deaths reported with the 5F-ADB variant • 5F-ADB is one of the most potent SCRAs, eliciting severe cardiac and psychiatric symptoms in humans 4 • Introduction of the PSA has not reduced SCRA- related deaths, likely due to a combination of: • Increased SCRA use • Increased requests for SCRA toxicology tests • Increased library of known SCRAs to test for 4. Asaoka et al., (2016). J Toxicol Sci, 41: 813-16. 5. Cowan et al., (2016). Regul Toxicol Pharmacol, 78: 24-36. 2012 2013 2015 2016 2017 2014 0 5 10 15 20 25 30 Number of deaths 5F-AKB-48 5F-PB-22 AB-FUBINACA AB-CHMINACA MDMB-CHMICA 5F-ADB AMB-FUBINACA Other synthetic cannabinoid* Introduction of the PSA Year Gender of Decedents Age Range of Decedents Male Female Age 0 5 10 15 20 25 30 35 With others No fixed abode Alone Others Not known Number of deaths Living Arrangements 0 20 40 60 80 Unemployed Employed Student Invalidity/sickness Not known Number of deaths Occupation Status