IONA

Identification Of Novel psychoActive substances

Aim

This trial will seek to identify novel psychoactive substances (NPS) that may be involved in toxicity experienced by patients presenting to acute hospitals, especially emergency departments. This will be achieved using routine data collected by UK NPIS poisons centres and NHS Toxicology laboratories together with analytical evidence of exposure to NPS from samples taken either during normal NHS care or, in participating hospitals, for the purposes of the research.

Background/method

Update August 2021 – IONA has now closed to recruitment at the Queen Elizabeth Hospital after reaching our recruitment target

Recreational drug use has been common for many years, but a major recent change in epidemiology has been the increasing use of new recreational drugs, sometimes termed Novel Psychoactive Substances (NPS) or ‘legal highs.’ These substances are numerous and associated with significant acute toxicity including increasing hospital presentations and fatalities. The effects of chronic exposure are usually unknown. Currently, there is no systematic national UK data collection system linking analytically confirmed use of NPS with acute toxicity. This causes a delay before clinicians, public health teams, law enforcement and policy makers can define and mitigate the harms associated with specific NPS. There are typically no published data available on the pharmacology and toxicity of these substances as they emerge into recreational use, leaving healthcare professionals without evidence to guide patient management in the event of toxicity.
This research will help to address this gap by collating information about the acute toxicity of NPS in the UK via four interrelated studies using:

(1) Anonymised, aggregated data collected by the National Poisons Information Service (NPIS).
(2) Anonymised, aggregated data available on positive samples from participating NHS toxicology laboratories.
(3) Further laboratory analysis of linked anonymised samples collected from patients with acute severe toxicity as part of usual clinical care and sent to participating NHS laboratories, where NPS use is suspected.
(4) Collection and analysis of samples from consenting patients presenting to participating emergency departments with severe toxicity associated with suspected NPS use.

Samples will be subjected to detailed toxicology analysis using state of the art methods, informed by the latest information on the NPS being encountered by clinicians in the UK. The research will identify trends in enquiries and positive laboratory samples relating to NPS, identify NPS involved in episodes of acute toxicity presenting to UK hospitals and link specific substances with reported features of toxicity.