Development and application of a real-time Integrated Drugs Surveillance System (iDSS) for NPS in New Zealand

Abstract

To develop an interactive database solution to provide real-time information on what novel psychoactive substances (NPS) are emerging on the New Zealand (NZ) market, track their real time use and monitor their potential risk and harm in our communities. The iDSS is a rapid information sharing tool used within ESR and also across NZ enforcement and health agencies (including customs, police, justice sector, health providers and hospitals, ambulance services, mental health services and the Ministry of Health). It provides information of what drugs have been identified, where and when these drugs are found, and the level of harm they are causing. The collated information is then used to develop harm reduction strategies at a community level and to develop a national drug forecasting and management strategy. Synthetic cannabinoids are a dominant group of drugs associated with drug-related deaths in NZ. From May 2017 until March 2022 one or more synthetic cannabinoids were detected in 127 deaths where the cause of death was not ascertained after autopsy and in a further six cases with pre-existing heart disease and death following use of these drugs. The cause of death was determined by autopsy in a further 16 cases where synthetic cannabinoids had been used, with hanging being the cause of death in seven of those cases. The development of ESR's iDSS was driven from a need to develop a national perspective of NPS drug use across the spectrum of ESR's drug testing capability, including drugs seized at the border and through NZ Police, drug presentations from hospitals, impaired drivers, road accidents and fatalities, and drugs found in post-mortem toxicology cases. The ESR iDSS provides real time information of the temporal and geographical trends of each NPS found entering NZ that enables the development of harm reduction strategies at a community level. The use and harm caused by synthetic cannabinoids has changed over the last five years in NZ. Initially AMB-FUBINACA was causing the most harm and was dominant in the upper North Island, and 5F-ADB was also common and was associated with harm in the lower part of the North Island. As time has progressed the change to new synthetic cannabinoids is becoming more rapid and can differ between communities. Most synthetic cannabinoid related deaths are preventable by timely hospital treatment therefore community-based knowledge of drug use is essential to develop appropriate drug harm reduction strategies. The use of ESR's iDSS is a key tool in understanding the changing pattern of use and harm from NPS and will be an important part of on-going harm reduction activities at a national level.