National Poisons Information Service Annual Report, 2022-23

11 January 2024

The National Poisons Information Service (NPIS) recently published their annual report, summarising service activities for the year 2022-23. The NPIS is comprised of four units based in Birmingham, Cardiff (the Welsh National Poisons Unit), Edinburgh, and Newcastle. It provides toxicology advice to NHS healthcare professionals, helping to avoid unnecessary hospital referrals for patients at low risk of harm, as well as improving the quality of treatment and shortening hospital stays for those with more serious toxicity.

During 2022-23, the NPIS received and provided advice for 38,700 telephone enquiries. The majority of these were from NHS advice providers, primary responders and hospitals; of these 2,140 serious and more complex enquiries involved discussion with and advice from an NPIS consultant toxicologist. The NPIS is responsible for TOXBASE (a clinical toxicology database); there were 812,380 accesses of TOXBASE via the website, and 285,000 accesses by 28,300 users of the TOXBASE app. Uses of TOXBASE online and the TOXBASE app increased by approximately 7.5% and 6.5%, respectively, in the year 2022-23, compared with 2021-22.

The NPIS runs a continuous quality assurance exercise to demonstrate that the services provided maintain a high level of user satisfaction. The proportion of respondents scoring services as very good or excellent was 96.7% for TOXBASE online, 96.6% for the NPIS telephone poisons information service, and 96.3% for the UK Teratology Information Service.

During 2022-23, the NPIS focused on several toxicological issues of particular concern, carrying out additional surveillance, including:

• Drugs of Misuse: Substances that were commonly the subject of telephone or TOXBASE enquires included: cocaine, cannabis, MDMA (ecstasy), ketamine, diazepam and nitrous oxide (N2O).
• Nitrous oxide (N2O): Also known as ‘laughing gas’, N2O is the second most utilised drug of misuse in the UK, and has the potential to cause N2O-related myeloneuropathy. During 2022-23 the NPIS saw a 144% increase in enquiries relating to N2O. These patients typically present with minor or moderate symptoms of paraesthesia and/or hypoaesthesia. Raising awareness among clinicians regarding how to recognise and treat N2O toxicity has been a key focus of NPIS consultant outreach in 2022-23.
• Propranolol: Since 2020 NPIS has specifically monitored enquiries involving propranolol in response to a report raising concerns about the potential under-recognised risk of harm with this drug. In 2022-23 NPIS received 459 enquiries involving propranolol. Patients had a median age of 33 years and were predominantly female (70%); 95 cases reported symptoms that were moderate or severe, with 12 cases documented as fatal. The NPIS will continues to monitor this drug with a view to raising awareness of appropriate prescribing and highlighting the risks posed to patients who self-harm.
• Carbon monoxide (CO): The NPIS continues to monitor enquiries regarding CO to better understand toxicity and how to prevent poisoning in the future. A total of 455 enquiries received during this period were primarily adults (68%), with the most common source of CO reported from faulty domestic boilers (25%). Exposures usually only resulted in minor or moderate symptoms (72%), with central nervous symptoms, such as headache, being the most common. NPIS is continuing to monitor enquiries regarding CO.

In 2023-24 the NPIS will continue to provide 24 hour advice on the management of cases of poisoning to NHS healthcare professionals, as well as taking forward specific areas of research to

better understand the impacts of poisoning and how to treat poisoned patients. Further information about the NPIS Annual Report for 2022-23 can be found here.