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

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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

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Living Arrangements

0

20

40

60

80

Unemployed Employed Student Invalidity/sickness Not known

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Occupation Status