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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 cannabis1
• Possess extreme potencies that can cause severe cardiac events1
• Are controlled in the UK under the Psychoactive Substances Act (PSA)2
• Appear increasingly popular likely due to their undetectable nature in
routine drug screens3
All SCRA-related cases from England and Northern Ireland reported to the
National Programme on Substance Abuse Deaths (NPSAD) database by
July 24th 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 YOGANATHAN1, H CLARIDGE1, CS COPELAND1, 2
1St George’s University of London, London, UK2King’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 analysis5
SCRAS ARE COMMONLY CO-ADMINISTERED WITH CNS DEPRESSANTSDEMOGRAPHICS
05
101520253035404550
2012 2013 2014 2015 2016 2017 2018
Nu
mb
er
of
de
ath
s
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 humans4
• 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 20172014
0
5
10
15
20
25
30
Nu
mb
er o
f d
eath
s
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 fixedabode
Alone Others Not known
Nu
mb
er o
f d
eath
s
Living Arrangements
0
20
40
60
80
Unemployed Employed Student Invalidity/sickness Not known
Nu
mb
er o
f d
eath
s
Occupation Status