The term Synthetic Cannabinoid Receptor Agonists (SCRAs) describes a group of hundreds of compounds which are not derived from the Cannabis plant but bind at the cannabinoid receptors. These compounds have been available for recreational use since the late 2000s and have been linked to a variety of adverse effects and death. Due to the number of compounds available, and their novel nature, controlling the manufacture, sale and possession of SCRAs has proved challenging under current legislative structure. The introduction of the Psychoactive Substances Act 2016 brought under control the manufacture, distribution and possession in a custodial facility of any SCRA which had not already been controlled by the Misuse of Drugs Act 1971. Whilst clarification has been brought to the legal status of these drugs, what remains largely unknown is the scale of use within Scotland, and different sub-populations. Simple and quick protocols were developed for the extraction of 40 SCRAs (comprising parent compounds and metabolites) from blood and urine. Sensitive Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) methods were developed to detect and quantify the most commonly encountered compounds at realistic blood and urine concentrations. Depending on the timing of cohort sample receipt, one of these methods was then applied to cohorts of individuals from various sub-populations within Scotland. Optimised methods for detection and quantitation in blood and urine then underwent validation. Overall, in 1177 cases tested, SCRA prevalence was found to be low, relative to the prevalence of more ‘traditional’ drugs of abuse such as opiates/opioids or benzodiazepines. The detection of SCRAs was highest in the cohort of individuals presenting at an Emergency Department (ED) with suspected drug toxicity, with 56% of cases tested positive. Second highest was the cohort of deceased individuals undergoing post-mortem (PM) examination, with SCRAs found in 11% of cases tested. It should be noted, though, that samples from both these cohorts were only tested if SCRA use had been suspected. Samples collected from individuals undergoing admission to or liberation from Scottish Prison Service (SPS) facilities were found to contain SCRAs at a rate of 3% for all samples. All of the positive samples in this cohort were admission samples (except one which was not labeled admission or liberation), thus 5% of admission samples were positive for SCRAs. Out of 73 samples collected from individuals under the jurisdiction of the Glasgow Drug Court (GDC), only 1 sample was positive (1.4%). All 95 samples collected from individuals being treated by the NHS Greater Glasgow and Clyde Forensic Directorate (FD) were negative for all SCRAs included in the panel. These results indicate that SCRAs are having negative effects on the health of users and that they are being used by the offending community, both of which have been reported in mainstream media. Another suspected aspect of SCRA use was the intention of avoiding detection by mandatory drug tests. Both the GDC and FD cohorts were aware of their required compliance with drug abstinence and mandatory drug testing regime, but the low findings of SCRAs in these groups suggest this is not the case. It is acknowledged that the numbers of individuals tested in the cohorts were relatively low, and that the studies were not a true calculation of prevalence. In addition to this, not all SCRAs were included in the analytical method, and those not included would not be identified in samples. Nonetheless, important information was gained about the scale and nature of SCRA use within Scotland.
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Synthetic Cannabinoid Receptor Agonists in Scottish sub-populations
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