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Michael Lawrence is NPS Development Lead at Crime Reduction Initiatives. This presentation for the ADEPIS seminar on NPS - held on Monday 19th May - is intended to introduce facts about NPS and key advices to face the challenges.
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Novel Psychoactive Substances & Emerging Trends
Michael Lawrence – NPS Development Lead
NPS Development LeadTo co-ordinate an education and treatment response to NPS within all service areas across CRI. The key responsibilities are to raise the awareness amongst staff of the availability, effects and risks associated with NPS use and to act as a focal point for collating and disseminating information about NPS.
The lead has close links to members of the ACMD and various universities conducting research into NPS and emerging trends (Liverpool John Moores University and the University of Hertfordshire).
Is a member of DrugWatch.
The NPS lead is involved at a strategic level in the emerging field of NPS awareness and development.
NPS? Novel WHAT? Legal Highs? But
mephedrone is Class B??
Herbal Highs? Is that mystery white powder
‘herbal’??RC’s ?! Club Drugs?
Prevalence
“While overall drug use has declined, the number of people needing treatment for club drugs has risen. Club drug users make up just 2% over-18s and 10% of under-18s in treatment.”- Club Drugs: Emerging Trends & Risks, NTA (2012)
“The advent of novel psychoactive substances has changed the face of the drug scene remarkably and with rapidity. The range of substances now available, their lack of consistency and the potential harms users are exposed to are now complex and multi-faceted.”- Advisory Council of the Misuse of Drugs (Oct 2011)
A 2011 report from the EMCDDA stated that novel psychoactive substances were a “major feature of Europe's drugs problem today”. - European Monitoring Centre for Drugs & Drug Addiction
Prevalence
“There is an upward trend in admissions, due to NPS drug toxicity, for both hospital and pre hospital presentations” and “the harms of NPS are multi-faceted and may be physical (intrinsic to the drug) or social in nature. Health services are starting to see health and other problems caused by regular use of NPS affecting NPS users' employment and education.
Cases of dependence which require detoxification and psycho-social treatment (e.g. GHB/GBL dependence) are also presenting to specialist substance misuse and other services (sexual health services, youth support services etc.).
The primary characteristics of NPS that differentiates them from
common illicit substances:
• No clear data on measures of incidence or prevalence
• No clear data on motivations for use• No clear data on patterns of use• No clear data on objectively measured adverse
drug reactions
Why do NPS pose a particular challenge to policy makers, health practitioners,
researchers, drug workers, etc.?
•Large number of substances
•Rate at which new substances emerge
• Internet
There are thousands of substances catalogued
New substances emerge at a rate of approximately
1 per week
Dr Alexander Shulgin – his books
PiHKAL and TiHKAL have
been the starting point
for most chemists/che
micals
New drugs & the art of pulling a rabbit out of a hat!
Discovered: By trawling through scientific literature to discover existing, but long forgotten, drugs that have similar subjective effects to common recreational drugs. For e.g. Mephedrone and MDMACreated: By tweaking the molecular structure of existing drugs.
From the hat to …1. Internet forums2. Promising compound identified:
- Lab commissioned- Marketing
3. As compound becomes more widely known, other producers and labs begin producing same compound
4. UK – buyers either source directly from the lab or from wholesalers. Compound is branded and sold via head shops, internet, etc.
5. Compound is controlled6. Above process is repeated
First Contact & The UnknownMystery white powders and products that either don’t, or incorrectly, list active compounds
They don’t know, you don’t know
How do you provide meaningful treatment in this environment?
Harm Reduction can act as the scaffolding that bridges the gap between the unknown and meaningful treatment. In that all important first contact:
Ask questions to establish effectsPopulate the scaffolding with generic HR informationTouch on the Key Issues (dose, duration, naïve users, etc.)
The importance of that first contact must not be underestimated
Key Issues
- Dose- Duration of session- Active substance often unknown
- Naïve users- Underlying health (mental/physical) issues- Poly-drug use
General NPS Harm Reduction- Advice around ROA (route of administration)
- Test dosing and dosage information
- Avoid poly-drug use including alcohol
- Consider ‘set’ and ‘setting’
- Have a ‘sitter’
- Thinking about safe sex
- Getting home safely
- Consider sleep and nutrition
Key Issues
Main harms“Arguably the greatest harm to YP from legal highs is to their education and relationships, not to their health” – Prof. Harry Sumnall (Professor in Substance Use, LJMU; ACMD)
Social: CJS; social exclusion; relationships; family/children; education; debt; Health: dependence; anxiety; psychosis; ROA damage; acute intoxication; OD; accidents; suicide;
So …. Don’t focus on the chemistry and the
seemingly never-ending list of new drugs – focus on
the Effects & Presenting Issues
Interventions & TreatmentInterventionsMotivational InterviewingCBTSMARTFellowshipsOther counselling/psychotherapy (Person Centred, Solution Focused; etc.)
Treatment (prescribing)GBL – Chlordiazepoxide and baclofenBenzodiazepinesAnti-anxiety medications-SSRI’s; beta blockersAnti-psychoticsZopiclone and other sleep-aid medication
Useful Techniques
Harm reduction
Goal setting – SMART
Tracking patterns of use – drug diaries
Identifying and developing strategies for managing triggers
Looking at pros and cons of change
Motivational Interviewing
Brief interventions
Focus on clients strengths and skills
What is being done? LegislationMoDA (Misuse of Drugs Act) – over 600 drugs listed with more being added end Feb 2013
Medicines Act – largely avoided due to being advertised as ‘not for human consumption’
TCDO (Temporary Class Drug Order) – nBOMe compounds and 5 & 6-APB added on 10th June 2013
Consumer protection legislation – “The powers available in the Consumer Protection from Unfair Trading Regulations (2008) (CPRs) and General Product Safety Regulations (2005) (GPSRs) should be fully utilised to control the trade in NPS” - Consideration of the Novel Psychoactive Substances, ACMD (Oct 2011)
Advertising Standards Authority – investigate claims made by NPS websites
Monitoring
European Monitoring Centre on Drugs & Drug Addiction: EMCDDA Early Warning System - for new synthetic drugs
FEWS – UK Home Office Forensic Early Warning System
DrugWatch - an informal network of organisations, charities and individuals working in the UK drug treatment field. From the mission statement, “It was set up as a bottom up initiative in response to the lack of any systematic, accurate or practically useful warning system during the 2010 heroin drought and in response to the new psychoactive substances now on the market. DrugWatch covers both the more traditional illegal drugs as well as ‘newer’ substances that may still be legal, as in reality drug users use both, often at the same time.”
Critical ThinkingWhat exactly is novel about Novel Psychoactive Substances?
Simply by asking this question we are prompted to think critically by:
setting the contextframing the challengerecognising our own assumptions and values
Answering the question has the impact of:
reducing anxiety reducing alarmism reducing complexityformulating an appropriate responseempowers staff