New synthetic recreational drugs are a considerable issue worldwide, and New Zealand is not immune to the harm that these types of drugs pose. During the second half of 2017 there was a significant spate of non-fatal hospitalisations connected with the use of synthetic cannabinoids, and at least 30 suspected deaths referred to the Coroner.
The ‘Unknown Substance use in Emergency Departments’ (USED) programme is a unique pilot that ESR and Capital & Coast District Health Board (CCDHB) Wellington Hospital Emergency Department (ED) have been running over the past year. The programme involved testing patients who show specific symptoms of intoxication at the ED to identify any substances, such as synthetic cannabinoids, that may be present. The focus was on identifying new synthetic recreational drugs as they emerge on the drug scene, to allow for faster response by health, police and community agencies.
The pilot was established through a collaboration between CCDHB’s Dr Paul Quigley and Diana Kappatos, a Forensic Toxicologist from ESR. The value of this program is that enables the early detection of outbreaks of poisoning from particular groups of novel agents. This information can then be shared with other emergency departments and toxicologists, providing information on treatment, care and expected outcomes. Providing this information in a collaborative form between Emergency Departments, Regional Public Health, Ambulance services, Police and Customs will enable a more informed approach to reducing harm to the public.
Following the success of the pilot ESR has proposed the national roll out of the USED programme. The programme has the support of the Ministry of Health, who have written to the District Health Boards (DHBs) to encourage them to participate. Being able to better correlate patient clinical signs with treatment options is an obvious outcome for ED’s, particularly when faced with previously unknown drugs. By developing a database of key clinical signs and investigations it is possible to create a standardised treatment policy for these agents. In particular, there is current lack of knowledge on what is the best treatment for the cardiac effects of synthetic cannabinoids. As more information is collected this will become clearer with improved patient outcomes.
Patients must give their consent to take part in the USED programme, but will not be identifiable to ESR or anyone outside of the DHB. Results will be sent back to the relevant ED for follow up patient care.
The USED programme is part of ESR’s wider 'Border to Grave' drug surveillance activities, which has been established to identify new synthetic drugs as they enter New Zealand and track their real-time use in the community. The drug intelligence insights gained from ‘Border to Grave’ will be important in informing Health, Police and Justice sector responses to these new drugs, and will be an important part of the development of a drug early warning system.
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