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Powder cocaine is the most commonly used stimulant in the UK. The prevalence of use in the last year reported in England and Wales in 2018 to 2019 (2.9%) was the highest since 2008 to 2009. Lifetime use among 15 year olds in England increased from 2% in 2013 to 4.2% in 2018, and was 5.4% in Scotland in the same year. There is consensus in published literature suggesting a clear association between anticholinergic burden and mobility. Consideration of cognitive anticholinergic effects may be important in interpreting results regarding the association of anticholinergic burden and mobility as anticholinergic drugs may affect mobility through cognitive effects. of adults aged 16 to 24 years had taken a Class A drug in the last year (approximately 274,000); a fall of 37% compared with 7.4% in year ending March 2020 Ethical approval was noted for all published papers included in the review. Data extraction and synthesis
Lechevallier-Michel N, Molimard M, Dartigues JF, Fabrigoule C, Fourrier-Reglat A. Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study. Br J Clin Pharmacol. 2005;59(2):143–51.Drug misuse data included in this release are sourced from the Crime Survey for England and Wales (CSEW). Our User guide to crime statistics for England and Wales provides detailed information about the crime survey. Increasing occurrence of new psychoactive substances (NPS), in particular a plethora of synthetic cannabinoids and stimulants (mostly cathinones) ( 12– 14). Selecting the title and abstract of the publication, studies retrieved were screened by two independent reviewers for its eligibility for inclusion in the review process (M.S.S. and P.S.N.). The eligible studies were subject to a thorough full text analysis for relevance and pre-defined inclusion criteria. Studies that met the following criteria were included in the final review. We cordially thank Jennifer Haverkemper, MSc (Psychology), for her assistance in developing the questionnaire for Cohort 1, and Ann-Christin Kanti, MD, for data entry and maintenance. We also thank Gabriele Lührmann, chief secretary of the Department for Psychiatry, Psychotherapy, and Psychosomatics at the EVK Castrop-Rauxel for organizing correspondence with colleagues. We also thank the many physicians who kindly took the time to participate in this project. Supplementary Material
In conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes. Boustani M, Baker MS, Campbell N, Munger S, Hui SL, Castelluccio P, et al. Impact and recognition of cognitive impairment among hospitalized elders. J Hosp Med. 2010;5(2):69–75. Lampela P, Lavikainen P, Garcia-Horsman JA, Bell JS, Huupponen R, Hartikainen S. Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging. 2013;30(5):321–30.
Methods
The overall prevalence of drug use reported in the UK has remained relatively stable throughout the last decade. However, the most recent surveys covering England and Wales, and Scotland reported the highest prevalence of drug use in the past 10 years. Despite the self-completion methodology of the survey, which is intended to encourage honest answers, disclosure issues still exist around willingness to report drug use. An unknown proportion of respondents may not report their behaviour honestly. However, the CSEW provides consistent measures of drug use and comparisons over time remain valid. The citation analysis of individual scales revealed that ACB scale by Boustani et al. [ 24] was the most frequently validated expert based anticholinergic scale on adverse outcomes (N=13) followed by ARS [ 19] (N=11], ADS by Carnahan et al. [ 9] (N=9), CrAS scale by Han et al. [ 22] (N=3) and 2 other scales [ 23, 26]. The review found only two RCTs that showed an association with higher anticholinergic burden and adverse outcomes. The RCT that used the CrAS scale to quantify anticholinergic burden showed a positive association with functional outcome and quality of life and the RCT using the ADS scale reported a negative association with cognitive functioning. The adverse outcomes reported in the cohort studies included mainly cognitive and physical outcomes. The cognitive outcomes reported included mild-cognitive impairment, confusion, dizziness, falls, delirium, psychomotor speed and executive function. The functional outcomes reported were pertaining to activity of daily living, instrumental activity of daily living, quality of life, physical function, hospitalisation, length of hospital stay, and mortality. A detailed summary of validated studies for individual anticholinergic scales with critical appraisal is illustrated in Table 3.
Boustani M, Schubert C, Sennour Y. The challenge of supporting care for dementia in primary care. Clin Interv Aging. 2007;2(4):631–6. Shah RC, Janos AL, Kline JE, Yu L, Leurgans SE, Wilson RS, et al. Cognitive decline in older persons initiating anticholinergic medications. PLoS One. 2013;8(5):e64111. Alcohol and drug misuse and treatment in adults from Public Health England's (PHE’s) national drug treatment monitoring system (NDTMS). Substances such as mephedrone, spice, GBL or GHB, salvia and other emerging substances are collectively known as new psychoactive substances (NPS), often previously referred to as "legal highs". These substances are usually intended to mimic the effects of "traditional" drugs such as cannabis, ecstasy, or cocaine and can come in different forms such as herbal mixtures that are smoked, powders, crystals, tablets, or liquids. Frequent drug user Estimates within this publication are based on data from the CSEW self-completion module. The upper age limit for respondents eligible for the self-completion module was removed from 2019 to 2020, but remains in place for questions on drug use because of the low prevalence of drug use in those aged 60 years and over. New psychoactive substances
While this is the first comparable survey data with pre-coronavirus (COVID-19) pandemic data, they are not National Statistics and caution must be taken when using these data. The CSEW statistics presented in this release are based on nine months of data collection between October 2021 and June 2022, rather than the normal 12-month interview period and are based on a lower response rate, which may affect the quality of the estimates. Significance testing has been conducted to compare estimates for the year ending June 2022 with year ending March 2020, year ending March 2012 (ten-year comparison) and year ending December 1995 (earliest data available) to understand trends over time where possible. Other comparison years have been used where these data are not available. A similar pattern was seen for visiting a pub in the previous month and past year drug use (See 3.06 in the accompanying dataset).
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