New drug controls and reduced hospital presentations due to novel psychoactive substances in Edinburgh.

AIMS: Recreational use of novel psychoactive substance (NPS) has become increasingly common. We aimed to assess the association of national legislation and local trading standards activity with hospital presentations. METHODS: We established observational cohorts of patients with recreational drug toxicity presenting to Edinburgh Royal Infirmary and dying with detectable recreational drugs in Edinburgh. We assessed associations with two temporary class drug-orders (April 2015: methylphenidates, Nov 2015: methiopropamine), the Psychoactive Substances Act (June 2016), and trading standards forfeiture orders (October 2015). RESULTS: The methylphenidate temporary class drug-order was associated with rapid 46.7% (P = 0.002) and 21.0% (P = 0.003) reductions in presentations and admissions, respectively, for NPS drug toxicity, comparing 12 months before with 6 months after. The change was greatest for ethylphenidate toxicity (96.7% reduction in admissions, P < 0.001) that was partly offset by a tripling in synthetic cannabinoid receptor agonist cases (P < 0.001) over the next 6 months. This increase reversed following trading standards activity removing all NPS drugs from local shops in October 2015, associated with 64.3% (P < 0.001) and 83.7% (P < 0.001) reductions in presentations and admissions, respectively, for all NPS drugs over the next 12 months. The effect was sustained and associated with a reduced postmortem detection of stimulant NPS drugs. The two interventions prevented an estimated 557 (95% confidence interval 327-934) NPS admissions during 2016, saving an estimated £303 030 (£177 901-508 133) in hospital costs. CONCLUSIONS: We show here that drug legislation and trading standards activity may be associated with effective and sustained prevention. Widespread adoption of trading standards enforcement, together with focused legislation, may turn the tide against these highly-damaging drugs.

Indoor environmental and air quality characteristics, building-related health symptoms, and worker productivity in a federal government building complex.

Building Health Sciences, Inc. (BHS), investigated environmental conditions by many modalities in 71 discreet areas of 12 buildings in a government building complex that had experienced persistent occupant complaints despite correction of deficiencies following a prior survey. An online health survey was completed by 7,637 building occupants (49% response rate), a subset of whom voluntarily wore personal sampling apparatus and underwent medical evaluation. Building environmental measures were within current standards and guidelines, with few outliers. Four environmental factors were consistently associated with group-level building-related health complaints: physical comfort/discomfort, odor, job stress, and glare. Several other factors were frequently commented on by participants, including cleanliness, renovation and construction activities, and noise. Low relative humidity was significantly associated with lower respiratory and "sick building syndrome"-type symptoms. No other environmental conditions (including formaldehyde, PM10 [particulate matter with an aerodynamic diameter <10 µm], or mold levels, which were tested by 7 parameters) correlated directly with individual health symptoms. Indicators of atopy or allergy (sinusitis, allergies, and asthma), when present singly, in combinations of 2 conditions, or together, were hierarchically associated with the following: increased absence, increased presenteeism (presence at work but at reduced capacity), and increase in reported symptom-days, including symptoms not related to respiratory disease. We found that in buildings without unusual hazards and with environmental and air quality indicators within the range of acceptable indoor air quality standards, there is an identifiable population of occupants with a high prevalence of asthma and allergic disease who disproportionately report discomfort and lost productivity due to symptoms and that in "normal" buildings these outcome indicators are more closely associated with host factors than with environmental conditions. We concluded from the experience of this study that building-related health complaints should be investigated at the work-area level and not at a building-wide level. An occupant-centric medical evaluation should guide environmental investigations, especially when screening results of building indoor environmental and air quality measurements show that the building and its work areas are within regulatory standards and industry guidelines.