**13. Acknowledgements**

374 Pharmacology

motivational interventions and appropriately adapted psychosocial intervention may be

A number of limitations need to be borne in mind in respect of this study: (a) not all suspected cases may have been identified; (b) remaining 'positive' cases are awaiting further inquiries or inquest; (c) the fact that mephedrone may have been involved in death cannot be confirmed until the relevant Coroner or Procurator Fiscal has concluded her/his inquest or other formal inquiry; (d) the presence of mephedrone in post mortem toxicology does not necessarily imply that it caused or contributed to a death; (e) not all completed cases have been formally notified to the Programme for recording. Hence, the number of identified

It is thought unlikely that the changes in fatality rates over time observed here are related to parallel changes in coroner methods, which would in turn affect surveillance. Data collection methods have remained unchanged. However, greater awareness of the phenomenon, improved case identification methods, and the devopment of new approaches in forensic toxicology and the range of substances now routinely screened for may have led

Further limitations of the present report may include: lack of analytical attention to the role of the possible triggering environmental factors (i.e. overcrowding; hot settings etc); lack of total geographical coverage of coroner's jurisdictions; possible incomplete information relating to the prescription of psychoactive medications; and lack of information for some fatalities on the concentration of mephedrone detected in body fluids, so that some victims might have had only traces of the substance. Finally, since mortality rates (e.g. number of deaths out of number of mephedrone intake occasions) were not here calculated, it may be difficult to determine the true extent of risks associated with mephedrone consumption. However, in at least one case death occurred on the first use of mephedrone (albeit in

This chapter has highlighted the dangers associated with mephedrone consumption, especially with regard to recreational use. This study represents the most detailed analysis to date of the largest number of mephedrone-related fatalities world-wide. It is hoped that it will thereby make a major contribution to the evidence-base being built up on this drug, and

Although identified on its own in only a minority of cases, present data confirm concerns regarding the acute toxicity potential of the drug. It is of concern that about 1 in 3 cases of

The number of mephedrone intake occasions was not calculated here, and so it may be difficult to determine the true extent of risks associated with mephedrone consumption. It may be possible to compare the lethality of mephedrone with other substances building on

the current sample used particularly violent means to terminate their own lives.

employed to treat mephedrone addiction (Winstock et al., 2010).

cases reported here is likely to be an underestimation.

to more potential cases being notified and registered.

combination with amphetamine).

therefore, to reducing drug-related deaths.

methods developed by King and Corkery (2010).

**12. Conclusions** 

**11.4 Limitations** 

The authors wish to thank coroners and their staff in England & Wales, Northern Ireland, and the Islands; Procurators Fiscal in Scotland; and the Scottish Crime & Drug Enforcement Agency for their assistance in providing data to the National Programme on Substance Abuse Deaths. Thanks are also due to colleagues in UK forensic toxicology agencies for assistance in identifying and confirming suspected deaths in which mephedrone consumption was positive. The np-SAD regularly received support from the Department of Health in the time frame 2004-2010.

This publication arises as well from the activities of the ReDNet Research Project, for which FS has received funding from the European Commission, in the framework of the Public Health Programme (2009 12 16).
