Lowry E, Woodman RJ, Soiza RL, Mangoni AA. Clinical and demographic factors associated with antimuscarinic medication use in older hospitalized patients. Hosp Pract (1995). 2011;39(1):30–6.

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. In 2018, opioids were mentioned or implicated in around 80% of deaths registered in each of the countries of the UK, with the highest proportion in Scotland (86%). 4.2 Cocaine A number of studies have reported on the adverse effects associated with higher anticholinergic burden. Studies have found that anticholinergic medicines may adversely affect cognitive and physical function [ 4- 13] and anticholinergic burden is a strong predictor of cognitive and physical impairments in older people living in both community and residential care [ 4- 7, 12, 14]. A retrospective study conducted in Finland found that the use of medicines with anticholinergic properties is a strong independent predictor of mortality in older people [ 15, 16]. More recently, several studies in the older population have also reported an association between anticholinergic exposure and mortality with an increased risk of hospitalisations [ 1, 6, 17, 18].There has been an increase in the prevalence of 15 year olds in England who have used benzodiazepines at some time in their life, from 0.5% in 2014 to 1.7% in 2018. Prevalence has also risen in Scotland, from 1.7% in 2015 to 2.8% in 2018. This has coincided with reports of increased alprazolam use (‘Xanax’) among school children. 4.4 MDMA and ecstasy With increasing age comes age-related comorbidities that may be influenced by lifestyle, genomic makeup and other demographic factors. The increasing number of health issues require multiple medications (polypharmacy) to treat them. A 2005 study found that as of 2002, older adults defined as ≥ 65 years comprised 12% of the population of the United States but constituted 33% of its prescription drug expenditure (50 billion dollars) [ 1]. Whilst polypharmacy may be beneficial in treating underlying health conditions in older adults, it increases the risk of adverse drug events. In particular, taking multiple drugs with anticholinergic effects increases the risk of anticholinergic burden (AB) in older adults because of age-related pharmacokinetic and pharmacodynamic changes [ 2]. of Addiction Medicine, Helios Medical Center Schwerin, Carl-Friedrich-Flemming-Clinic, Schwerin, Germany The definition of any drug has changed over time. For more detailed descriptions on what drugs are included in each year, see Section 1 of the accompanying dataset. New psychoactive substances

In 2015, just over half (53%) of people starting treatment for primary MDMA use were under 20 years old, but in 2018, 75% of those starting treatment were in this age group. Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2013;9(4):377–85. Subjects in 3 groups; healthy controls (N=211), MCI (N=768) and AD (N = 133) of mean age 70.0±7.0, 75.7±7.6, and 78.0±8.6 years 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 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.Illicit drugs such as methamphetamine, heroin, and cocaine, and also alcohol were judged particularly harmful.

of Psychiatry and Psychotherapy University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany Kashyap M, Belleville S, Mulsant BH, Hilmer SN, Paquette A, le Tu M, et al. Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline. J Am Geriatr Soc. 2014;62(2):336–41. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethics StatementIn the year ending June 2022, 2.6% of adults aged 16 to 59 years reported being frequent users of drugs (using them more than once a month in the past year); this was similar to the year ending March 2020 (2.1%). 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. Ancelin ML, Artero S, Portet F, et al (2006) Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. doi: 10.1136/bmj.38740.439664.DE. Synthetic cannabinoid receptor agonists, such as Spice, are widely used in prisons. They were detected in more random drug tests than cannabis in England and Wales in 2018 to 2019. In Scotland, buprenorphine was the most commonly detected drug in addiction prevalence tests carried out in prisons in 2018 to 2019. 2. Drug-related harms