The impact of legislation on acute synthetic cannabinoid harms resulting in ambulance attendance

Jasmin Grigg; Jessica J Killian; Sharon Matthews; Debbie Scott; Shalini Arunogiri; Victoria Manning; David A Taylor; Rose Crossin; Karen Smith; Dan I Lubman

doi:10.1016/j.drugpo.2020.102720

The impact of legislation on acute synthetic cannabinoid harms resulting in ambulance attendance

Int J Drug Policy. 2020 Apr 9:79:102720. doi: 10.1016/j.drugpo.2020.102720. Online ahead of print.

Authors

Affiliations

¹ Turning Point, Eastern Health, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia. Electronic address: jasmin.grigg@monash.edu.
² Turning Point, Eastern Health, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia.
³ Turning Point, Eastern Health, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
⁴ Eastern Health, Melbourne, Australia.
⁵ Turning Point, Eastern Health, Melbourne, Australia.
⁶ Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.

PMID: 32279004
DOI: 10.1016/j.drugpo.2020.102720

Abstract

Background: Synthetic cannabinoid receptor agonists (SCRAs) have been challenging current drug policy due to the rapid emergence of new variants, and their propensity for acute harm. In Australia, as in other parts of the world, multiple regulatory changes have occurred in response to these new psychoactive compounds, and population surveys indicate use is declining. This suggests that related harms would also be declining. We examined the impact of drug legislative changes on acute SCRA-related harms resulting in ambulance attendance. Secondary aims were to describe patient and attendance characteristics.

Methods: A retrospective analysis of coded ambulance attendance data from Victoria, Australia (January 2014-December 2018). Interrupted time-series was used to analyse the trajectories of SCRA-related attendances relative to legislative changes.

Results: During the study period, 3727 SCRA-related ambulance attendances were identified. There was an upward trend in attendances following legislation scheduling specific SCRAs in Victoria in October 2016 (slope = 1.31, 95% CI 1.17, 1.45). A downward trend in attendances followed 'blanket' legislation targeting all new psychoactive substances, implemented in Victoria in November 2017 (slope = -1.87, 95% CI -2.27, -1.46). Patient median age was 33 years, 80.5% were male, co-occurring substance use was identified in 30.4% cases, and 15.2% had >1 SCRA-related attendance. Overall, 69.4% cases were transported to hospital, with the odds of transport to hospital increasing each year from 2016.

Conclusion: This study represents a population-level examination of the impact of drug policy on acute SCRA-related harms resulting in ambulance attendance. Scheduling of specific SCRAs was associated with a spike in attendances, likely due to the introduction of more harmful variants in the drug market. Blanket legislation was associated with a reduction in SCRA-related attendances, however, a corresponding increase in cases transported to hospital indicates a greater severity of harm that may have been inadvertently promoted by this policy.

Keywords: Ambulance attendance; Drug policy; Drug trends; Drug-related harm; Synthetic cannabinoid receptor agonists.