The Advisory Council on Misuse of Drugs (ACMD) currently monitors 150 drugs as part of a ‘watch list’ of drugs that may be illicitly supplied and abused.
The development of a “prescribed emerging substances” watch list was first recommended in a 2016 ACMD report on the ‘Diversion and illicit supply of medicines‘, in order “to make timely recommendations on revisions to the control status if necessary”.
The report was commissioned by the Home Office in 2013 after the Interdepartmental Group on Drugs and the Home Affairs Select Committee raised concerns that drugs were becoming more widely available for misuse through diversion and illicit supply.
In response to a freedom of information request from The Pharmaceutical Journal, received June 16, 2022, the ACMD disclosed its current watch list, which includes antidepressants, such as sertraline and citalopram; the antihistamines chlorphenamine and diphenhydramine; the beta-blockers atenolol and bisoprolol; as well as warfarin and paracetamol.
Illegal drugs, such as crack, cathinone – a stimulant drug found in the khat plant – and mitragynine – commonly known as kratom – are also on the list, along with some controlled drugs, including gabapentin, pregabalin and tramadol .
In the 2016 report, the ACMD stated that “gabapentin and pregabalin were the main emerging drugs to be the subject of [diversion and illicit supply] during the period of our investigation,” but added that several “other substances appeared in the information we received but not often enough to get a clear picture of substance diversion and abuse.”
“We recommend that these substances form the basis of a watch list to see if abuse is increasing,” the report said.
In addition to the drug list, the watch list also includes data on the number of drug-related deaths and yellow card reports for each drug, as well as the number of items distributed. However, the ACMD declined to comment on how the committee decides which drugs to include on the list.
The list is maintained by the ACMD Technical Committee, which is responsible for providing technical advice on the classification and scheduling of substances under the Misuse of Drugs Act 1971 and its regulations.
Amira Guirguis, an associate professor of pharmacy at Swansea University who specializes in substance abuse, explained that the list contains drugs with psychoactive effects such as opioids, z-drugs and antidepressants, but added that it also contains drugs that could be misused for their image. and performance enhancing properties.
« Levetiracetam, angiotensin converting enzyme inhibitors and angiotensin II inhibitors [are] misused for their potentially enhanced effects on cognition and memory, and others like levothyroxine and liothyronine, [are] commonly abused for weight loss or energy enhancement,” she said.
“The list also contains common adulterants that are used to enhance the effect of recreational drugs, such as paracetamol and caffeine.”
Guirguis also noted that atenolol, bisoprolol and propranolol are included in the list because they could be misused to “inhibit anxiety related to [giving] presentations”.
She added that “clonidine could be used off-label to counter anxiety and opioid- or substance-related withdrawal,” while warfarin “has been found in drug mixtures following several admissions to A&E. with bleeding, mainly in the United States”.
Roz Gittins, director of pharmacy at the charity Humankind, said the list contains “no significant surprises”.
However, she added: “Introducing additional controls such as moving a drug to a different controlled drug schedule may not always be appropriate and each should be considered individually.
“Any changes to controls must be proportionate: such decisions must be made in a balanced manner and based on the actual risk of known harm versus the benefits. If changes are made, there may be unintended consequences, such as people seeking unregulated alternative sources associated with increased risk of harm and appropriate management of any withdrawal symptoms.
Gittins said that if a drug is known to be susceptible to misuse, “priority should be given to educating healthcare professionals, including pharmacy teams, and the general public so that alternative approaches can be adopted from the start and if problems arise, they can be quickly identified”.