Characteristics of NPS use in patients admitted to acute psychiatric services in Southeast Scotland: a retrospective cross-sectional analysis following public health interventions

Objectives: Assess the impact of selective prohibition and seizure of NPS supply on NPS use prevalence within psychiatric admissions and evaluate demographic characteristics of current NPS users. Design: A 6-month retrospective cross-sectional analysis of discharge letters between 1st October 2015 – 31st March 2016. Setting: General Psychiatry inpatients and Intensive Home Treatment Team community patients at a psychiatric hospital in a Scottish city. Participants: All participants were between the ages 18-65. After application of exclusion criteria, 473 discharge letters of General Psychiatry patients were deemed suitable for analysis and 264 Intensive Home Treatment Team (IHTT) patient discharge letters were analysed. Interventions: A nationwide Temporary Class Drug Order (TCDO) was placed on 10th April 2015 reclassifying methylphenidate-related compounds as Class B substances. On 15th October 2015, local Forfeiture Orders were granted to Trading Standards permitting the seizure of NPS supplies. Primary and secondary outcome measures: The primary outcome measure was to determine the prevalence of NPS use in two cohorts. Secondly, demographic features of patients and details regarding their psychiatric presentation were analysed. Results: The prevalence of NPS use in General Psychiatry and IHTT patients was 6.6% and 3.4%, respectively. Inpatients using NPS compared to non-users were more likely to be male (OR: 2.92, 95% CI: 1.28-6.66, p=0.009), have a forensic history (OR: 5.03, CI: 2.39-10.59, p<0.001) and be detained under an Emergency Detention Certificate (OR: 3.50, CI: 1.56-7.82, p=0.004). NPS users were also more likely to be diagnosed under ICD-10 F10-19 (OR: 9.97, CI: 4.62-21.49, p<0.001). Conclusions: Compared to previous work, psychiatric inpatient NPS use has fallen. NPS continue to be used by a demographic previously described resulting in presentations consistent with a drug-induced psychosis and at times requiring detention under the Mental Health Act. Further research is required to evaluate the effectiveness of the recent prohibition of all NPS.

研究目的：评估选择性禁止与扣押新精神活性物质（New Psychoactive Substances, NPS）供应对精神科收治患者中NPS使用流行率的影响，并分析当前NPS使用者的人口统计学特征。
研究设计：对2015年10月1日至2016年3月31日期间的出院记录开展为期6个月的回顾性横断面分析。
研究场景：苏格兰某城市一所精神科医院的普通精神科住院患者及强化家庭治疗团队（Intensive Home Treatment Team, IHTT）社区患者。
研究对象：所有受试者年龄介于18~65岁。经排除标准筛选后，共纳入473份普通精神科患者的出院记录用于分析，同时纳入264份强化家庭治疗团队患者的出院记录进行分析。
干预措施：2015年4月10日，全国范围内实施临时分类药品命令（Temporary Class Drug Order, TCDO），将哌甲酯相关化合物重新归类为乙类管制药品。2015年10月15日，当地向贸易标准局（Trading Standards）签发没收令，准许其扣押新精神活性物质货源。
主要与次要结局指标：主要结局指标为明确两个研究队列中NPS使用的流行率。次要分析内容包括患者的人口统计学特征及其精神科临床表现细节。
研究结果：普通精神科住院患者与IHTT社区患者的NPS使用流行率分别为6.6%与3.4%。与未使用NPS的住院患者相比，使用NPS的住院患者更可能为男性（优势比[Odds Ratio, OR]=2.92，95%置信区间[Confidence Interval, CI]=1.28~6.66，p=0.009）、具有法医前科（OR=5.03，CI=2.39~10.59，p<0.001），且依据紧急拘留证被拘留（OR=3.50，CI=1.56~7.82，p=0.004）。此外，使用NPS的患者更易被诊断为ICD-10 F10-19类精神障碍（OR=9.97，CI=4.62~21.49，p<0.001）。
研究结论：与既往研究相比，精神科住院患者的NPS使用比例有所下降。当前NPS使用者仍属于既往报道的人群特征，其临床表现与药物诱导性精神病一致，部分病例需依据《精神健康法》实施拘留。未来仍需开展进一步研究，以评估近期全面禁止新精神活性物质相关措施的有效性。