Research and analysis

HPR volume 8 issue 45: news

Updated 23 December 2014

1. Ebola virus disease: international epidemiological summary

Up to the end of 23 November, a total of 15,935 clinically compatible cases (CCC) of Ebola virus disease (EVD), including 5,689 deaths have been reported in the six currently affected countries (Guinea, Liberia, Sierra Leone, Spain, the USA and Mali) and two previously affected countries (Nigeria and Senegal) since December 2013.

Reported case incidence is no longer increasing nationally in Guinea and appears to be stable or declining in Liberia. However, transmission remains high in certain hotspots in both countries and poor data quality may mask local changes in incidence.

In contrast, incidence continues to increase in Sierra Leone, particularly in the western and northern regions (see PHE map). Transmission remains intense in the capital Freetown where 118 new confirmed cases were reported in the last week. Recent weeks have seen very few new confirmed cases in the previously high incidence areas in the south east of the country.

In Mali, as of 23 November, the cluster of cases of infection in Bamako has reached seven, five of whom have died. This latest cluster is unrelated to Mali’s first case who was diagnosed in Kayes on 23 October. The total number of EVD CCC reported in Mali stands at eight.

To date, a total of 22 EVD cases have been cared for outside of Africa: 17 repatriated cases (hospitalised in USA, Spain, UK, Germany, France, Norway, Switzerland and Italy), two imported cases (both diagnosed in USA) and three incidents of local transmission (in Spain and the USA).

The table below summarises Ebola virus disease international epidemiological information as at 23 November 2014.

Country	Total CCCs	Cases in past 21 days	Total deaths
Guineau	2134	374	1260
Liberia	7168	319 *	3016
Sierra Leone	6599	1339	1398
Mali	8	7	6
Nigeria	20	0	8
Senegal	1	0	0
Spain	1	0	0
USA	4	0	1
TOTAL	15 935	2039	5689

* Only data for the previous 20 days available.

Further information on the international epidemiological situation can be found in PHE’s weekly Ebola Epidemiological Update.

2. Guidance for local authorities and NHS on new psychoactive substances

PHE’s alcohol, drugs and tobacco division has issued a toolkit to local authority and NHS commissioners to help them respond to the widespread use of new psychoactive substances (NPS), often misleadingly called “legal highs”. These drugs mimic the effects of existing illicit drugs such as cocaine, ecstasy and cannabis, but in many cases are not yet controlled substances and are widely available at low cost [1].

The new toolkit is a 14-page publication with advice for commissioners on local strategy development, competences required and information available, links being provided to up-to-date resources (including websites, support organisations and charities). It deals in turn with: controlling supply of NPS; prevention and resilience-building in vulnerable groups; obtaining prevalence data and sharing information; responding to acute problems (palpitations, seizures, etc); initiating interventions and treatment; and the specialized response required in prisons.

The term NPS encompasses both proscribed drugs – such as mephedrone, the more recently banned psychoactive substances groups NBOMe and benzofuran compounds, and some synthetic cannabinoids (which mimic cannabis) – and those that can be legally traded, including some newly formulated synthetic cannabinoids. The toolkit acknowledges that the rapid increase in supply of these products – also called “designer drugs” or “club drugs” – presents a unique challenge for government, local authorities and the criminal justice system.

The public health impact of NPS remains low compared with that of traditional illicit drugs (52 NPS-related deaths recorded in England and Wales in 2012, compared with nearly 1500 drug-related deaths overall) and information about harmfulness and dependence-forming potential is incomplete. Nevertheless, in 2012/13 the National Poisons Information Service (NPIS) recorded a 30% increase in enquiries about NPS in general, and a 13-fold increase in telephone enquiries about synthetic cannabinoids (SCs), compared to the previous year [2]. In that year, SCs represented the second most common drug of misuse encountered in NPIS telephone enquiries after cocaine.

A year-long, government-commissioned new psychoactive substances review (NPSR) of the regulatory and public health challenge in England was published in October [3] alongside the government’s response to the review report’s recommendations [4], and the scientific evidence review that underpinned it [5].

The NPSR’s remit was primarily legislative and it considered how other jurisdictions (including Ireland and the USA) have responded to the challenge of NPS. Whereas the existing UK legal framework has enabled hundreds of individual NPS, as well as families of such drugs, to be controlled, it has not been fully effective in restricting supply, and certainly not in the particular case of new synthetic cannabinoids (SCs).

The NPSR report notes that, no sooner specific SC products are proscribed: “new modifications become available at a rapid rate to circumvent [the] legislation. The UK currently controls [only] around 60% of the synthetic cannabinoids that have been reported to the EMCDDA. [F]or other groups of NPS … we have been able to control 80-90%”.

The NPSR therefore recommended, and the government has accepted, that in order to deal with NPS a new “precautionary” legislative approach should be considered whereby such substances are controlled by reference to their neurochemical effects rather than, as at present, their chemical composition (under the Misuse of Drugs Act 1971).

2.1 References

1. PHE (November 2014). “New psychoactive substances: a toolkit for substance abuse commissioners”.

2. National Poisons Information Service annual report 2013/14, HPR 8(41), 24 October 2014.

3. Home Office (October 2014). “New Psychoactive Substances Review: Report of the Expert Panel”.

4. “Government response to the New Psychoactive Substances Review Expert Panel Report”.

5. Stephenson G, and Richardson A (Home Office Science)(October 2014). “New psychoactive substances in England: a review of the evidence”.