China versus the world: Impact of international drug policy on postmortem stimulant detections in England, Wales and Northern Ireland

Abstract

To highlight trends in postmortem detections of stimulants in England, Wales and Northern Ireland (2006–2020) and their correlation with UK, Chinese, and UN drug controls. Stimulant drugs increase central nervous system activity, and are used recreationally for their pleasurable and invigorating effects. The number of recreational stimulants available on the illicit drug market was considerably broadened in the mid-2000s by the introduction of novel stimulants within the wave of novel psychoactive substances (NPS), often purported to originate from China. The UK Government sought to reduce NPS use to curb their associated harms and mortality, and consequentially introduced a series of specific and generic controls within the 1971 Misuse of Drugs Act (MDA), followed by the 2016 Psychoactive Substances Act, which automatically bans all NPS not controlled under the MDA. Concurrently and since, the UN Commission on Narcotic Drugs (UNCND) and the Council of China have also banned various NPS: 7 stimulant NPS were added to the International Drug Control Conventions by UNCND, to which China is a signatory, between 2015 and 2021, with the Council of China banning a further 81 stimulant NPS within the same time frame. This study aims to evaluate how deaths following stimulant use in England, Wales and Northern Ireland have evolved over time, considering the introduction of UK, Chinese and UN prohibitive drug controls. The National Programme on Substance Abuse Deaths has collected data on deaths following psychoactive drug use from coroners across England, Wales and Northern Ireland since 1997. Basic decedent demographics are reported (e.g., age, gender) along with details pertaining to their death (e.g., cause of death, drugs detected at postmortem). Cases with stimulants detected at postmortem that occurred 2006–2020 were extracted on November 1st 2021 and analysed. The King's College London Biomedical and Health Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics Sub-Committee (BDM RESC) confirmed in November 2020 that NPSAD does not require BDM RESC review as all subjects are deceased. In 2006–2008 cocaine, amphetamine and MDMA comprised the majority (95%, n = 1651/1738) of postmortem stimulant detections. This fell to below 75% in 2010 ( n = 316/422) due to detections of stimulant NPS (25%, n = 106/422), before rising again to above 90% in 2016 ( n = 798/834). Cocaine detections are currently at an all-time high, having steadily increased from 233 detections in 2010 to 1094 in 2020 – an increase of 470%. Forty-five different stimulant NPS were detected in deaths reported to the NPSAD, and accounted for a total of 1242 detections. Where stimulant NPS were first controlled by UK drug legislation there is, in some instances, a clear effect in reducing detections (e.g., benzylpiperazine detections pre-UK control n = 54, post-UK control n = 11), but in others there was no clear effect (e.g., methylone detections pre-UK control n = 2, post-UK control n = 19). Similarly, when controlled in China, either through the Council of China or the UNCND, there were reductions in detections for some stimulant NPS (e.g., MDPHP detections pre-Chinese control n = 26, post-Chinese control n = 4), but not others (e.g., dibutylone detections pre-Chinese control n = 1, post-Chinese control n = 7). UK and Chinese prohibitive drug policies have had clear effects on overall stimulant NPS postmortem detection trends. The number of deaths following cocaine use has dramatically increased in recent years as the drug has become both cheaper and purer, further cementing the UK's reputation as the ‘cocaine capital of Europe’. Following their control stimulant NPS have fallen out of favour, with users turning or returning to use of classical stimulants, particularly cocaine. Urgent action is needed to address the ever-increasing mortality trend following cocaine use.