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Novel psychoactive substance

Mark Pucci, Sally Bradberry and Loretta Ford
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DOI: https://doi.org/10.7861/clinmed.Let.21.4.9
Clin Med July 2021
Mark Pucci
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Roles: Consultant in acute medicine and clinical toxicology
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Sally Bradberry
Birmingham Unit, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
Roles: Consultant clinical toxicologist and director of National Poisons Information Service
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Loretta Ford
Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
Roles: Consultant clinical chemist
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Editor – We read with interest the article entitled ‘Acute neurological consequences of novel psychoactive substance use: a retrospective review in a large UK hospital’ by Tanti et al.1 The team have effectively highlighted the high rates of psychiatric comorbidity, unemployment, homelessness and incarceration in this vulnerable group in society. However, the paper may have benefitted from involvement of a clinical or analytical toxicologist to prevent several inaccuracies. Lack of analytical confirmation in any patient is a major limitation; self-reporting of substances of abuse (especially novel psychoactive substances (NPS)) is known to be unreliable. It is misleading to state ‘unfortunately, drug screens do not detect novel psychoactive substances’ since, while basic point-of-care immunoassay-based tests will not detect NPS, analytical confirmation of NPS is now available in several NHS laboratories. The authors refer to testing being possible only ‘by specialised techniques like gas chromatography’; most NHS laboratories have moved away from gas chromatography to ultra-performance liquid chromatography (UPLC), tandem mass spectrometry (MS/MS) or time of flight (TOF) for NPS detection.

The abstract states ‘Synthetic cathinone users presented with psychiatric disturbance or seizures (55%)’; this percentage does not correlate with the values in Table 2. There are certain errors of nomenclature in the article. The authors refer to ‘THC receptors’ while the correct terminology is cannabinoid (CB1 and CB2) receptors. Synthetic cannabinoids have been abbreviated in the text to SCs, yet ‘SCRAs’ (synthetic cannabinoid receptor agonists) is the widely accepted acronym used.

Finally, there seems to be some confusion regarding the provision of toxicology guidance and advice to the NHS. The authors refer to ‘poisons services like TOXBASE’; the National Poisons Information Service (NPIS) is a service commissioned by the UK Health Security Agency (formerly Public Health England); TOXBASE is the primary clinical toxicology information database written by the NPIS.

  • © Royal College of Physicians 2021. All rights reserved.

Reference

  1. ↵
    Matthew Tanti, Jeremy Cosgrove, Charles Kelleher, Rebekah Jones and Melissa Maguire. Acute neurological consequences of novel psychoactive substance use: a retrospective review in a large UK hospital. Clin Med 2020;21:189–94.
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Novel psychoactive substance
Mark Pucci, Sally Bradberry, Loretta Ford
Clinical Medicine Jul 2021, 21 (4) e430-e431; DOI: 10.7861/clinmed.Let.21.4.9

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Novel psychoactive substance
Mark Pucci, Sally Bradberry, Loretta Ford
Clinical Medicine Jul 2021, 21 (4) e430-e431; DOI: 10.7861/clinmed.Let.21.4.9
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