National Documentation Centre on Drug Use
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Bromazolam tablet quantification and analysis of post-mortem cases from the National Programme on Substance Use Mortality (NPSUM).
No full textBromazolam is a new psychoactive substance (NPS) benzodiazepine commonly identified by drug checking services and in post-mortem toxicological analyses in the United Kingdom, Europe, and North America. At the time of writing, there are no studies that present quantitative analyses of bromazolam in street tablets. Here we describe the first quantitative analysis of bromazolam tablets, from samples submitted by UK drug checking services and police forces between 2022 and 2025. Using validated GC-EI-MS and H NMR methods, 47 tablet samples were quantified revealing a median bromazolam dose of 0.49 mg (interquartile range = 1.02 mg) per tablet, range of 0.09-5.4 mg. Over half of the tablet submissions (55%) mimicked the appearance of licensed pharmaceuticals alprazolam or diazepam, raising significant concerns around mis-selling of street bromazolam tablets and the risks of unintentional high-dose exposure to an NPS compound. To contextualise these findings, we also report post-mortem data from the UK National Programme on Substance Use Mortality (NPSUM), in which bromazolam was detected in 396 drug-related deaths between April 2021 and July 2024. Bromazolam detections in deaths rose from 28 deaths in 2021 to 160 deaths in 2023. Bromazolam was implicated in causing death in 82.8% of cases, with a median post-mortem blood concentration of 43 ng/mL. Notably, bromazolam was co-detected with an average of seven other substances per case, most commonly other central nervous system (CNS) depressants. These findings underscore the public health risks posed by bromazolam as an NPS benzodiazepine and highlight the urgent need for monitoring, harm reduction and forensic toxicology guidance
Physical multimorbidity and quit outcomes in a publicly funded smoking cessation programme.
No full textOBJECTIVES: To examine the association between physical multimorbidity and 6-month quit outcomes among treatment-seeking smokers.
METHODS: We analysed data from 120 732 adults enrolled in Ontario's largest publicly funded smoking cessation programme. At enrolment, participants self-reported zero, one or two or more chronic physical health conditions. The primary outcome was 7-day point prevalence abstinence at 6 months. We used mixed-effects logistic regression to assess the association between multimorbidity and quit outcomes, adjusting for demographic and tobacco use characteristics.
RESULTS: Of participants, 39.4% reported no conditions, 26.8% reported one and 33.8% reported two or more. Those with multimorbidity were older, had lower socioeconomic status and showed higher tobacco dependence but also greater motivation to quit. Compared to individuals without comorbidities, those with one condition (OR = 0.94, 95% CI: 0.90-0.98) and those with two or more (OR = 0.81, 95% CI: 0.77-0.85) had lower odds of quitting. Mental health conditions further reduced quit success among those with physical multimorbidity.
DISCUSSION: Physical multimorbidity is associated with 19% lower odds of cessation success despite high motivation to quit. Tailored, intensive cessation support may improve outcomes for this high-risk group
National drug related death database (Scotland): analysis of deaths registered in 2021 and 2022.
No full textEvaluation of the National Mission on Drug Deaths. Follow-up frontline staff survey 2025.
No full textThe role of psychotropic medication, alcohol, illicit drugs, and suicidal intention in fatal motor vehicle accidents involving drivers with psychotic disorders.
No full textAntipsychotics, antidepressants, and benzodiazepines are commonly used among patients with psychotic disorders. The use of psychotropic medication, alcohol, and illicit drugs may have a major role in the fatal motor vehicle accidents (FMVA) involving drivers with psychotic disorders. This study on drivers involved in FMVAs in Finland investigates the post-mortem toxicology findings regarding the presence of psychotropic medication, alcohol and illicit drugs among 94 drivers with psychotic disorders and their 188 matched controls without psychiatric disorders. Drivers' suicidal intention, death category, and role in the accident were also investigated. Psychotropic medication was present in 53.2% of drivers with psychotic disorders and in 9.6% of controls at the time of their FMVA. Among the drivers with psychotic disorders, the presence of antipsychotics was detected in 30% of them, and their suicidal intentions behind FMVA were significantly associated with the presence of antipsychotics (OR 2.7) and mood stabilizers (OR 6.0). Our results suggest that, in some cases, traffic suicides among drivers with psychotic disorders may originate from long-term suicidal thoughts and occur despite antipsychotic medication. A thorough fitness-to-drive assessment should be conducted for patients with psychotic disorders, irrespective of their antipsychotic medication status
Consumer price index.
No full textMonthly prices on average. This Includes figures and trends for alcoholic beverages & tobacco in Ireland
Do drinking occasion characteristics differ across individuals using different moderation approaches? A social practice perspective.
No full textNitrous oxide abuse: single centre experience of nitrous oxide induced myeloneuropathy.
No full textBACKGROUND: Over the last 3 years, there has been increasing awareness of nitrous oxide-induced myeloneuropathy, particularly among younger patients.
METHODS: We conducted a prospective and retrospective case series of patients presenting with nitrous oxide-associated myeloneuropathy to Tallaght University Hospital, between October 2022 and July 2024. Data were gathered regarding clinical presentation, investigations, and management of patients.
RESULTS: Eighteen patients were identified (mean age 20 years, 78% male). The most common presenting symptom was paraesthesia (15/18) followed by limb weakness (13/18) and gait impairment (8/18). All patients reported heavy use of inhaled nitrous oxide, with a minority (3/18) also reporting prophylactic use of B12 supplementation. Levels of vitamin B12 were low (4/18) or low normal (7/18) in the majority of patients. Homocysteine was raised in almost all patients in whom it was measured (14/16). Of those cases (16/18) where MR imaging of the spinal cord was available, T2 hyperintensity was noted in the cervical cord in 8/16 cases, and this extended to involve the thoracic cord in five of those cases. Of those who had nerve conduction studies performed (13/18), motor-predominant axonal neuropathy was the most common pattern seen.
CONCLUSION: Nitrous oxide abuse, and its neurological complications, continue to represent a significant public health concern, with associated burden on neurological services
Does alcohol use and related harm differ based on the age of initiation to alcohol? Results from a prospective cohort study.
No full textBACKGROUND AND AIMS: There is evidence to suggest that earlier initiation to alcohol increases the rate and severity of alcohol consumption. However, this often overlooks the fact that earlier initiation also means a longer drinking history. This paper estimated differences in patterns of alcohol use and harm across adolescence and early adulthood, allowing for the fact that the patterns over time may differ depending on the age at which initiation occurred.
DESIGN: Prospective cohort study based in Australia.
PARTICIPANTS: The Australian Parental Supply of Alcohol Longitudinal Study (APSALS), a cohort of n = 1906 adolescents recruited in adolescence (mean age 12.9) from 107 Australian schools and followed up until adulthood (11 annual waves total, 2010-2021).
MEASUREMENTS: We defined age of initiation as the age at which alcohol consumption was first reported in the study. Our outcomes were amount of alcohol consumed, monthly heavy episodic drinking, alcohol-related harm and self-reported symptoms of alcohol use disorder in the years following initiation.
FINDINGS: Those who initiated at age 12 had a lower risk of consumption [risk ratio (RR) 0.01; 95% confidence interval (CI) = 0.01-0.02] in the year following initiation (age 13), compared with those who initiated at age 18. Similarly, those who initiated at age 15 had a lower risk of alcohol use disorder in the year after initiation (RR 0.66; 95% CI = 0.52-0.83), compared with those who initiated at age 18. However, at age 20, those who initiated at age 12 showed higher consumption (RR 1.57; 95% CI = 1.18-2.09), monthly heavy episodic drinking (RR 1.24; 95% CI = 1.02-1.51) and alcohol-related harms [incidence-rate ratio (IRR) 1.73; 95% CI = 1.21-2.46] than those who initiated at age 18. Similar results were seen for symptoms consistent with DSM-IV alcohol dependence (RR 1.20; 95% CI = 1.05-1.38), DSM-IV alcohol abuse (RR 1.54; 95% CI = 1.04-2.29) and DSM-5 alcohol use disorder (RR 1.36; 95% CI = 1.12-1.65). However, there was evidence of ageing out, with risk of heavy episodic drinking and alcohol-related harm peaking around age 20 and then declining, regardless of when initiation occurred.
CONCLUSIONS: Later initiation to alcohol appears to be associated with more rapid escalation in drinking and related harm, but lower 'peak' harm than earlier initiation. The findings support the current guidelines recommending adolescents avoid alcohol until adulthood, and reinforce the need for public health intervention targeting both children and parents
Understanding the role of cessation fatigue in smoking relapse: findings from the International Tobacco Control Four Country Smoking and Vaping Survey.
No full textBACKGROUND AND AIM: Relapse risk among people who formerly smoke is influenced by task difficulty. Cessation fatigue (CF) may be a better predictor than measures such as reported strength of urges to smoke (SUTS) and abstinence self-efficacy (ASE). It may also be affected by quit length and use of other nicotine products. The current study investigated whether post-quitting CF predicts higher relapse risk, its predictive utility relative to ASE and SUTS and whether the CF-relapse prediction was moderated by time since quitting.
DESIGN: Data drawn from longitudinal cohort surveys conducted between 2016 and 2022 of the International Tobacco Control Four Country Smoking and Vaping Survey.
SETTING: Canada, the United States, England and Australia.
PARTICIPANTS: People aged 18 + years who formerly smoked (n = 1914).
MEASUREMENTS: Generalised estimating equations logistic regression models were used to test for associations and moderation.
FINDINGS: In separate individual analyses, CF, ASE and SUTS were statistically significant independent relapse predictors; however, when analysed together, CF was the only statistically significant relapse predictor [moderate CF: odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.21-2.23, P = 0.002; high CF: OR = 1.81, 95% CI = 1.07-3.07, P = 0.027) on top of continuing main effects of vaping and time since quitting, but time since quitting was not a moderator.
CONCLUSIONS: Cessation fatigue appears to predict smoking relapse risk better than other measures related to task difficulty and does so independently of vaping and time since quitting, which are both protective