BULLETIN. This quarter (October 2015 to December 2015) Samples. analysed. 53 Samples pending. f 41. Samples. rejected

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1 BULLETIN Issue 7 Oct - Dec 2015 WEDINOS Quarterly Newsletter Collecting, Testing, Inorming wedinos.org WEDINOS Headlines The WEDINOS project has been designed or the collection and testing o substances and, most importantly, dissemination via o pragmatic evidence based harm reduction inormation or users. WEDINOS aims to go beyond identiication o novel substances, to address the harms associated with use o New Psychoactive Substances (NPS), new combinations o established drugs and NPS. TOTAL number o samples received by WEDINOS October 2013 to December analysed 87 pending 306 Substances identiied in either combination or isolation This quarter (October 2015 to December 2015) 278 analysed 53 pending 41 rejected 79 Substances identiied in either combination or isolation Temporary Class Drug Order (TCDO) Methylphenidate related New Psychoactive Substances (NPS) Methiopropamine - N-methyl-1-(thiophen-2-yl)propan-2-amine Methiopropamine (MPA) was irst synthesized in 1942 by F.F. Blicke and J.H. Burkhalter. It is a thiophene ring analogue o the controlled Class A substance methamphetamine, however, it eects are very dierent to Methamphetamine. S H N WEDINOS sample W Methiopropamine In 2010 MPA appeared or sale online as a uncontrolled / legal stimulant, with internet orums describing it as accompanied with mild euphoric eects. Temporary Class Drug Order article continued overlea 1

2 Temporary Class Drug Order continued On 27th November 2014 ollowing a review o the evidence o use and harm by the Advisory Council on the Misuse o Drugs, the Government issued a Temporary Class Drug Order (TCDO) on MPA. The TCDO will last or up to 12 months: possession o MPA during this time is not an oence, however, anyone caught making, supplying or importing the drug will ace up to 14 years in prison and an unlimited ine submitted to WEDINOS that were identiied as containing MPA came in a variety o dierent orms: powder, crystalline, capsule, tablet and solid, the most common orm or this substance was powder. MPA can be purchased as a substance in isolation, however it is also common in branded products sold not or human consumption, but that are consumed or a psychoactive eect. These branded products oten contain a blend o several substances. WEDINOS has identiied MPA in the ollowing brands (It must be noted that manuacturers oten change the blends o substances used in branded products and that blends have been ound to vary rom region to region): B3 Banshee Dust Synthacaine Madcat Gogaine Purple Bomb Pink Panthers Charlie Sheen Dizzle Dust Dust Til Dawn Diablo XXX NRG-3 NRG-2 Project X Crank Rush Black Cats Blue Snowball China White Blow Bliss Ultra Sel-reported eects rom MPA use include: Increased Energy Increased Conidence Euphoria Relaxed Nausea Empathy Irregular Heartbeat Vomiting Depressi on Memory Loss Headache Suicidal Ideation Insomnia Enhanced Senses Increased Stamina Agitation Paranoia Increased Libido Conusion Auditory & Visual Hallucinations Chest Pains Panic Attack Loss o consciousness Inormation provided by WEDINOS sample provider eects database There is very little inormation available in relation to the human eects o MPA or its toxicity. The National Programme o Substance Abuse Deaths 1. (NPSAD) reported 30 cases where MPA was ound in post mortem toxicology, between 2012 and In 22 o these, MPA was implicated in the cause o death National Programme on Substance Abuse Deaths (NPSAD) (October 2015) Report to ACMD on deaths involving novel psychoactive and resurging substances.

3 FINDINGS WHERE... were submitted rom all 7 o the Welsh Health Boards. G F A B D C Breakdown o sample submissions by Health Board areas A - Betsi Cadwaladr University Health Board 19 samples. B - Powys Teaching Health Board 2 samples. C - Aneurin Bevan University Health Board 93 samples. D - Cwm Ta University Health Board 4 samples. E - Cardi & Vale University Health Board 54 samples. F - Abertawe Bro Morgannwg University Health Board 17 samples. G - Hywel Dda University Health Board 1 sample. 66 samples were received rom England, 11 rom Scotland and one rom Northern Ireland. WEDINOS does not analyse samples received rom outside o the United Kingdom. In relation to Welsh Health Board areas, the highest proportion o samples came rom Aneurin Bevan University Health Board, 93 samples were received, accounting or 34 per cent o all samples analysed. Psychoactive Substances WHo... Where a WEDINOS Eects Record was submitted and gender completed; 87 per cent (n=159) o submissions were rom males. The remaining 13 per cent (n=23) were emales. E The median age or all mind altering / psychoactive sample providers (Wales and wider UK) was 30 years (average age was 30 years old); with an age range o years. Females - median age was 32 years and an average age o 30 years (range: years) Males - median age was 29 years, with an average age o 30 years (range years) Gender / Age proile o samples providers Psychoactive 35% 30% 25% 20% 15% 10% 5% Female (Oct-Dec 15) Male (Oct-Dec 15) Female (Oct 14 Sept 15) Male (Oct 14 Sept 15) 3

4 Reason or purchase All samples 258 Mind Altering / Psychoactive samples were submitted or during this quarter. 20 were submitted via Public Health Wales agreed sentinel providers o Steroids and Image Enhancing Drug (SIED) samples as SIEDs WHAT... O the 258 Mind Altering/Psychoactive samples: 39 samples were purchased in the belie that they were Class A substances 15 Class B 6 Class C 5 were subject to a TCDO 63 were believed not to be controlled A urther 130 were submitted without any inormation relating to purchase intent, or perceived legal status Post we see that Class A increased rom 39 samples to 102. Class B increased rom 15 to 23 and Class C rom 6 to 13. Substances that are not controlled increased rom 63 to 109. It must be noted that although all groups increased with the post categorisation o the unknown substances, several samples moved between classiications. Proportion o controlled and not controlled / legal Perceived and Actual (Psychoactive Substances) Submitted rom Wales 87 per cent o Welsh samples were submitted via 26 services / organisations; with the remaining 13 per cent being submitted anonymously. Examples o this include: Sample believed to be 2C-B ound to contain Cocaine upon Five samples believed to be Cocaine ound to contain Ethylphenidate upon Sample believed to be Dextroamphetamine ound to contain Cocaine upon Sample believed to be MDMA ound to contain alpha-pvp upon Sample believed to be Methoxetamine ound to contain 5-MeO- MiPT upon Sample believed to be Methoxphenidine ound to contain Ketamine upon Sample believed to be Cannabis ound to contain 5F-PB-22 upon Sample believed to be LSD ound to contain 25C-NBOMe upon Sample believed to be Diazepam ound to contain Diclazepam upon Sample believed to be MDPV ound to contain 25I-NBOMe upon O the 20 samples purchased and submitted as a legal high or research chemical ; 11 contained controlled substances. These substances included Methylone, MDMA, Cocanine, 5-MeO-DALT, 2C- B, Cannabis, MZBP, Ketamine, and Methiopropamine. 60% 50% 40% 30% 20% 10% 0% Class A Class B Class C TCDO Not Controlled Unknown Perceived legal status Actual legal status (Perceived) Actual legal status (Unknown) 4 NB. Following samples were categorised based on the highest classiied substance present. Order o classiication / control Class A, B, C, Temporary Class Drugs Order, Not controlled.

5 Most commonly identiied substances Most commonly identiied substances in Mind Altering / Psychoactive Substance samples Cocaine levamisole MDMB-CHMICA caeine 5F-PB-22 Heroin Noscapine Paracetamol 5F-AKB48 Cannabis Controlled substances Substances currently not controlled Bulking / Cutting agents The most commonly identiied psychoactive substance was Cocaine. The most commonly identiied psychoactive substance that is not currently controlled was the synthetic cannabinoid receptor agonist MDMB-CHMICA; a position the substance has held since April Levamisole was the most commonly identiied bulking / cutting agent; however, this substance was ound exclusively in samples that also contained cocaine Top Ten New Psychoactive Substances TOP 10 Oct 2015 to Dec 2015 Number 1 Up 5 MMB-CHMINACA Number 2 Down 1 5F-PB-22 Number 3 Down 1 5F-AKB48 Number 4 Non Mover Methiopropamine Number 5 Non Mover Diazepam Number 6 New Entry 2C-B Number 7 Down 3 3-Fluorophenmetrazine Number 8 New Entry 4F-MPH Number 9 New Entry 5-MeO-Mipt Number 10 New Entry Diclazepam B B B MMB K KKK Since the launch o WEDINOS in October 2013 Synthetic Cannabinoid Receptor Agonists (SCRAs) have been the most prevalent NPS submitted to and identiied by the project. This quarter is no dierent with SCRAs sitting at Numbers 1, 2 and 3. What we have seen over the last quarter is rise o MDMB-CHMICA, meaning that or the irst time since early 2014 neither 5F-PB-22 nor 5F-AKB48 occupy the position o most commonly identiied NPS. This quarter six SCRAs were identiied either in isolation or combination in 35 samples (this accounts or 14 per cent o psychoactive samples). 5

6 Ten most commonly identiied New Psychoactive Substances (Oct 2013 Dec 2015) SCRAs 5F-PB-22 5F-AKB48 Mephedrone Methiopropamine Diazepam Ethylphenidate 5-MeO-DALT MDMB-CHMICA 3-Fluorophenmetrazine Etizolam SCRAs total 559 shows all SCRAs as a group. 5F-AKB48, 5F-PB-22 and MDMB-CHMICA are synthetic cannabinoid receptor agonists. Methiopropamine, Ethylphenidate, Mephedrone and 3-Fluorophenmetrazine are stimulants. 5-MeO-DALT is a psychedelic tryptamine. Diazepam is a Benzodiazepine. Etizolam is a benzodiazepine analogue. MDMB-CHMICA a worrying chart climber MDMB-CHMICA is a synthetic cannabinoid receptor agonist (SCRA). First notiied to the European Early Warning System ollowing its identiication in Hungary on 11th September 2014 ollowing a seizure o 0.19g o green/brown herbal product. Believed to have a greater toxicity than most other synthetic cannabinoids. There have been a number o atalities and non-atal intoxications in Europe associated with this substance. Non-atal intoxications have been characterised by loss o consciousness. MDMB-CHMICA is structurally related compound MDMB-FUBINACA, which has been associated with atalities and over 700 non-atal intoxications in Russia (reported by the media). Currently a legal substance in the United Kingdom, MDMB-CHMICA can be purchased either as a ready to smoke product in a herbal incense blend or in powder orm. MDMB-CHMICA was irst identiied in a sample submitted to WEDINOS on 26th September Since that time MDMB-CHMICA has been identiied on 39 occasions. MDMB-CHMICA prevalence over the last quarter o 2015 not only saw it move into the WEDINOS quarterly Top Ten most commonly identiied new psychoactive substances, but climb to be the number one substance. Reported adverse eects rom those submitting samples include: Agitation Nosebleeds Euphoria Auditory Hallucination Panic Attack Increased Conidence Breathlessness Paranoia Increased Energy Chest Pains Relaxed Increased Libido Conusion Seizure Insomnia Depression Suicidal Ideation Irregular Heartbeat Empathy Visual Hallucination Memory Loss Enhanced Senses Vomiting Nausea The is limited inormation around the eects o this substance or its toxicity. MDMB has been proiled by WEDINOS in the ollowing branded products: Sweet Lea Obliteration SKYHIGH Vertex Pirate Edition Insane Joker K2 Black Edition 6

7 HOW... Form o Sample & Method o Consumption Mind Altering/Psychoactive Powder remains the most prevalent sample orm provided that would have a Mind Altering/Psychoactive eect came in a variety o orms, consistent with previous quarters and reports where a method o consumption was identiied the most prevalent sample orm was powder. Mind Altering/Psychoactive - Form o Sample 2% 2% 1% 1% 1% Where samples were purchased as Mind Altering/Psychoactive & a method o consumption was recorded (42 per cent, n=109), and assuming that all plant matter and plant matter Synthetic Cannabinoid Receptor Agonists are smoked, samples were used consumed through a variety o methods, the most common method was to smoke (38 per cent) a substance ollowed by oral consumption (35 per cent). Snorting / sniing as a route o administration made up 23 per cent o responses, with 4% stating they used their substance via intravenous injection. However, this chart may alter dramatically, i the route o administration was captured or all samples; or example 83 powder samples were submitted without any method o consumption data. 13% 5% 31% 44% Powder Tablet Plant Matter Crystaline Solid Capsule Blotter Paper Liquid All samples where intravenous injection was selected as the method o consumption were purchased in the belie that they were heroin. The presence o heroin was analytically conirmed in all samples. These samples were submitted by individuals who had experienced unexpected eects ollowing their use or via services who had concerns over the welare o their service users. Mind Altering/Psychoactive - Method o Consumption Granules 4% 23% 38% Smoked Oral Snort / Sni Intravenous 35% Changes o Methods o Consumption or Powders Focusing on the method o use or powders and crystalline materials we see the most common method was to consume a substance by snorting / sniing. However, although snort/sni ollows the trend o Oct-14 to Sept 15, by remaining the most common method o consumption or these materials; its prevalence has allen. Intravenous use was higher or this quarter compared to the previous twelve months and related solely to the use o heroin. However, it should be noted that a method o consumption was recorded or 39 per cent o all powder and crystalline sample submitted during this quarter. To enable the accurate monitoring o trends in substance use, and or this to be ollowed by pragmatic and relevant harm reduction advice WEDINOS requests that as much o the sample and eects record is completed as possible. This includes method o consumption. Reported Methods o Consumption (%) 60% 50% 40% Oct - Dec 2015 Oct Sept % 20% 10% 0% Snort / Sni Oral Smoked Intravenous 7

8 GEOGRAPHIC PROFILES / LOCAL TRENDS Abertawe Bro Morgannwg University Health Board (ABMU) Cumulative total: 219 samples. 17 samples were received rom ABMU this quarter. During eight substances were identiied either in combination or in isolation. Three samples had no active compound identiied. The SCRA, MDMB-CHMICA, was identiied in a sample rom Bridgend. Aneurin Bevan University Health Board (ABU) Cumulative total: 613 samples 93 samples were received ABU this quarter. During o those samples, 30 substances were indentiied either in combination or in isolation, with three samples having no active compound identiied Cocaine was the most commonly identiied substance within the in ABU; a statistic that is inluenced heavily by the o night club amnesty bins rom within Newport city centre. Several other stimulant substances were identiied including: amphetamine, mephedrone and methamphetamine. containing MDMA were also submitted. Three synthetic cannabinoid receptor agonists were also identiied including nine samples that contained MDMB-CHMICA o interest include: A sample submitted as diazepam that upon was ound to contain diclazepam. A study by Babbini et al. showed that diclazepam is approximately 4 8 times more potent than diazepam. Betsi Cadwaladr University Health Board (BCU) Cumulative total: 159 samples 19 samples were received rom BCU this quarter During o those samples, 20 substances were indentiied either in combination or in isolation. One sample was ound to contain no active compound. SCRA s were the most commonly identiied substances within BCU, with three strains being identiied: MDMB-CHMICA 5F-PB-22 5F-AKB48 Also identiied were substances rom the stimulant, depressant, hallucinogenic and dissociative substance categories; including MZBP, diazepam, 1p-LSD and ketamine. A sample submitted as methoxpheidine was ound to contain ketamine. A sample submitted as ethylphenidate was ound to contain cocaine Cardi & Vale University Health Board (CVU) Cumulative total: 511 samples 54 samples were received rom CVU this quarter During 34 substances were identiied either in combination or in isolation. One sample did not contain a suicient amount o sample material or to be completed. Four SCRAs were identiied, including MDMB-CHMICA. Also, identiied were 4 benzodiazepines / benzodiazepine analogues. Cwm Ta University Health Board (CTU) Cumulative total: 62 samples 4 samples were received rom CTU this quarter One sample was ound to contain caeine, another 5F-AKB48. A blue tablet was identiied as diazepam, the ourth sample contained no active ingredient. We do not believe that the number o samples submitted rom CTU relects the prevalence or any trends in substance use within the locality and would happily accept an increase in samples o psychoactive substances submitted. I you require urther inormation on submitting a sample please visit or admin@wedinos.org Hywel Dda University Health Board (HDU) Cumulative total: 70 samples 1 samples were received rom HDU this quarter During the two SCRA compounds 5F-PB-22 and 5F-AKB48 were identiied in combination. 8

9 Powys Teaching Health Board (PT) Cumulative total: 22 samples 2 samples were received rom PT this quarter During two substances were identiied in isolation, or combination. One sample contained ethylphenidate and the other the SCRA MDMB-CHMICA News rom the Home Oice and abroad Preventing opioid overdose deaths with take-home naloxone - EMCDDA, Lisbon, January Drugnet Europe 92 - November 2015 Newletter o the EMCDDA Report on the risk assessment o 4,4 -DMAR in the ramework o the Council Decision on new psychoactive substances - EMCDDA, October Report on the risk assessment o MT-45 in the ramework o the Council Decision on new psychoactive substances - EMCDDA, October Misuse o Drugs Act 1971 (Temporary Class Drug) (No. 3) Order 2015 subjects N-methyl-1-(thiophen-2-yl)propan-2-amine (methiopropamine or MPA) and its simple derivatives, to a temporary class drug order under the Misuse o Drugs Act th November order-2015/circular misuse-o-drugs-act-1971-temporary-class-drug-no-3-order-2015-si ACMD s temporary class drug order report on Methiopropamine 26th November MPA.pd How can opioid substitution therapy be optimised to maximise recovery outcomes or service users? ACMD, 23rd October The WEDINOS project does not test ood samples, biological samples, samples submitted within paraphernalia o use, samples that are submitted with an incomplete eects orm. On Friday 25th July 2014 WEDINOS stopped accepting samples o Steroids and Image Enhancing Drugs other than those submitted by sentinel contributors. may be rejected i no postcode is supplied, demographic inormation is missing or where a sample has been consumed the grey Dose and Eects section on the sample and eects record has not been completed. 9