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Doctors warn of drug which could leave users blind, bald, and covered in painful rashes

Doctors are warning recreational drug users to avoid using a class A drug, called MT-45, after fears that it is responsible for hair loss, loss of sight, and painful rashes have been confirmed. The study, published in the British Journal of Dermatology, outlines three independently similar cases caused by MT-45, thought to be just the tip of the iceberg.

The study outlined the cases of three men, aged between 23 to 34 years old, all from different parts of Sweden, all suffering from very unusual symptoms, including hair depigmentation, hair loss, widespread folliculitis (inflammation of the hair follicles) and dermatitis (inflammation of the skin). During the following year, two of them rapidly developed severe vision loss, requiring cataract surgery in both eyes.

It is not clear whether these reactions are to MT-45 itself, or whether an error was made in the production of this drug, tainting the supply chain.

MT-45 was originally developed as a potential painkiller in the 1970s, but by 2013 it was being used as a so called ‘legal high’, one of a large number of drugs that mimicked the psychoactive effects of illegal drugs but which circumvented UK legislation. MT-45 was eventually designated a class A drug in 2015, and in 2016 the Psychoactive Substances Act came in to force, banning all drugs previously considered ‘legal highs’.

In the UK MT-45 can be bought illegally over the internet, with a 2014 study1 finding 17 internet sites selling the drug. The same study identified one published scientific paper reporting on the acute harms in nine cases of confirmed MT-45 toxicity, one US government report relating to two MT-45-related deaths and 20 user reports on internet discussion forums relating to the use of MT-45.

Matthew Gass of the British Association of Dermatologists said:

“MT-45 is a class A drug, and that in and of itself, should warn potential users to avoid it. However, on top of this we have seen a number of similar, serious, adverse reactions to the drug, some clinically proven and some anecdotal. This suggests that MT-45 is either itself profoundly toxic, or that there is a problem in the MT-45 supply chain that is causing this complex and unusual combination of symptoms.

Either way it is important that patients and healthcare professionals are aware of the potential for MT-45 to leave users blind, bald and covered in painful skin complaints. I would urge anyone currently using this drug to stop immediately and consider getting medical attention.”

One of the authors of the study, Professor Anders Helander of the Karolinska Institutet in Sweden, said:

“The escalating online availability and use of hundreds of unclassified new psychoactive substances has become a growing health problem worldwide. Most new substances have not been tested on humans, increasing the risk for harmful and unexpected adverse events and overdose deaths. Another risk factor is that the substances are typically manufactured in clandestine laboratories with no product control. The number of medical complications and deaths due to these drugs is constantly increasing, and the cases associated with MT-45 are one serious example.”

Users in internet discussion forums, such as BlueLight.org, have also shared experiences of adverse reactions attributed to their use of products sold to them as MT-45.

One user said:

“I do not say this lightly. If I had known what any of things I experienced were going to happen, I'd never have touched [MT-45]…

“Ok, so the first major one I noticed was dry patches of skin. Doesn't sound too bad right? Wrong, that was just the beginning. The rash began to spread over my entire body. By the time I stopped taking the drug it was too late to do anything. The rash is very widespread. The doctors will tell you it is folliculitis, and that it will go away, however, this has not been the case, as the rash continues to worsten [sic] even though I am no longer taking the drug…

“Now, for the second major side effect. This is the one that scared the crap outta [sic] me. You [sic] hair falls out. No lie, no exaggeration, you will just start tearing clump upon clump of hair out of your head.”

Another user said:

“By the time Christmas came and passed, I had already lost all the hair on my head…I had horrible patches of dry skin and rashes, my skin was so dry it was cracking, BAD! My heels were cracked so deep I could barely walk on them. My lips were chapped, I can't even begin to describe the severity of these symptoms.”

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was published in the British Journal of Dermatology. Although this article has been accepted for publication in the British Journal of Dermatology it is possible that minor changes may be made ahead of publication in the hard copy of the journal.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

1Siddiqi, S., Verney, C., Dargan, P. and Wood, D. (2014). Understanding the availability, prevalence of use, desired effects, acute toxicity and dependence potential of the novel opioid MT-45. Clinical Toxicology, 53(1), pp.54-59. http://www.tandfonline.com/doi/full/10.3109/15563650.2014.983239

Study details: Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45
Anders Helander,1 Maria Bradley,2 Anja Hasselblad,2 Lars Norlén,2 Ismini Vassilaki,3 Matilda Bäckberg4 and Jan Lapins2

1 Karolinska Institutet, Department of Laboratory Medicine, and Karolinska University Laboratory, Departments of Clinical Chemistry and Clinical Pharmacology, Stockholm, Sweden
2 Karolinska Institutet, Department of Medicine Solna, Dermatology Unit, and Karolinska University Hospital, Department of Dermatology, Stockholm, Sweden
3 Dermatopathology Service, Dermipath AB, Stockholm, Sweden
4 Swedish Poisons Information Centre, Stockholm, Sweden

About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk
 

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Doctors forecast a steep rise in skin cancer cases

Cases of the UK’s most common cancers are set to rise by a staggering 78.2% from 20101 to 2025 according to figures released in the British Journal of Dermatology.

The study looked at the two main types of non-melanoma skin cancer (NMSC): Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Treating this epidemic will cost over £338 million a year by 2025, the study found.

The study did not include the deadliest type of skin cancer, called melanoma, which will further add to this burden.

By analysing rates of non-melanoma skin cancer in the East of England since 2003, the doctors, from Norfolk and Norwich University Hospital and the National Cancer Registration and Analysis Service, were able to estimate the number of cases for the years 2020 and 2025 for the region. By analysing census data and data from the Office of National Statistics the team were then able to extrapolate out the predicted number of cases nationwide for these years.

The predicted cost of diagnosing and treating these cases of skin cancer is estimated to be £289 to £399 million a year in 2020, rising to £338 to £465 million in 2025.

Year: 2010 BCC: 180,725 SCC per year nationwide: 32,492 Total NMSC per year nationwide: 213,217 Cost to NHS per year: £189 to £261 million
Year: 2020 BCC: 258,946 SCC per year nationwide: 66,671 Total NMSC per year nationwide: 325,617 Cost to NHS per year: £289 to £399 million
Year: 2025 BCC: 298,308 SCC per year nationwide: 81,694 Total NMSC per year nationwide: 380,002 Cost to NHS per year: £338 to £465 million

Matthew Gass of the British Association of Dermatologists said:

“The UK has been fighting to combat the rising tide of skin cancer over the last few decades, and this research shows that things are going to get worse. As it stands many dermatology departments are struggling to manage the increasing rates of skin cancer, at a cost to people with other skin diseases. This situation will be made even worse by rising staff shortages - we are not being allowed to train an adequate number of doctors to cope with the current workload in dermatology resulting in almost a quarter of Consultant Dermatologist posts in the UK being unfilled. This workforce shortage will only get worse in the future.

“This research is invaluable in that it gives us a snapshot of what the future holds, giving the NHS and the Government the opportunity to plan ahead and prepare, we can only hope that the warning is heeded.”

Dr Peter Goon, one of the researchers, said:

“Our data and analyses show the predicted numbers of cases of both SCCs and BCCs for the UK in 2020 and 2025. These NMSCs are set to increase by 78.2% from 2010 to 2025 if current trends continue in the same manner. The NHS will need to budget wisely to cope with these predicted increases, and invest in personnel and resources, in order to give the country the healthcare it needs.”

Dr Nick Levell, one of the researchers and President of the British Association of Dermatologists said:

“Our study shows that non-melanoma skin cancer, the commonest cancer in the UK, is increasing rapidly. Within ten years we will see over a third of a million cancers per year. Skin cancer can affect all ages of adults and it becomes commoner in the elderly. We need more money spending on public health campaigns, more staff to treat the cancers and more operating theatres in which to do the work, if the public wishes these cancers to be treated promptly by the NHS in the future.”

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be scabby
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was published in the British Journal of Dermatology.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

1Data for 2010 compiled by the same authors, using comparable methods.

2These estimates are based on the following study, and do not take into account inflation: Vallejo-Torres L, Morris S, Kinge JM, et al. Measuring current and future cost of skin cancer in England. J Public Health (Oxf). 2014 Mar;36(1):140-8.

Study details: Predicted cases of UK skin SCC and BCC in 2020 and 2025: Horizon planning for NHS Dermatology and Dermatopathology
P.K.C. Goon1, D.C Greenberg2, L. Igali3 and N.J. Levell1
1 Dept of Dermatology, Norfolk and Norwich University Hospital, Norwich
2 National Cancer Registration and Analysis Service, Public Health England, Unit C, Cambridge
3 Dept of Pathology, Norfolk and Norwich University Hospital, Norwich
http://onlinelibrary.wiley.com/doi/10.1111/bjd.15110/full

Potential skin cancer referrals constitute a dominant and disproportionate number of dermatology referrals from primary care in the UK. The majority of dermatology and pathology departments in the UK are struggling to cope with rising demand for diagnostic and treatment services and recent austerity measures, with cutbacks in all public service budgets have also affected the NHS.

In this study, we have analysed data from the East of England, specifically East Norfolk and Waveney, and estimated the number of cases for SCCs and BCCs of skin for 2020 and 2025. It is hoped that the data will assist in the planning of NHS resource allocation in the short- and medium-term, both for this region and nationally.

About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk
 

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