ADEPIS - NPS - Michael Lawrence- CRI

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

Michael LawrenceNPS Development Lead

CRI07880 357282

[email protected]