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 inter-related 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.
ISARIC/WHO Clinical Characterisation Protocol for Severe Emerging Infections in the UK (CCP-UK)
People who develop an Acute Kidney Injury (AKI) often have a poor prognosis and many go on to develop chronic kidney disease (CKD). The recognition that AKI and CKD are linked is recent and the molecular pathways that control the transition from acute injury to chronic disease are not well defined. Currently there are no specific treatments that reduce the risk of progressing to CKD after AKI.
Preliminary investigations (not yet published) suggest that AKI causes sustained activation of the endothelin (ET) system to the long-term detriment of renal and systemic haemodynamic function. These pilot data form the basis of our project that seeks to determine whether the ET system is active in patients with AKI and, thus, represents a potential target for therapeutic intervention.
KRAKIL aims to recruit altogether 100 patients from across the emergency department, acute medical unit and inpatient wards at the Royal Infirmary. 50 of which with AKI’s and 50 matched controls with normal kidney function. We will monitor their bloods and urine for 90 days and compare the data from between the two groups.