New drugs & risk

       Queen’s University, Belfast.

       Friday 5th February 2016

Introduction

This seminar aimed to consider risk within the context of new and emerging drugs. Perspectives were drawn from international, national and regional research, as well as offering insight on policy and practice. The sessions were complemented by presentations from postgraduate students and through representation from members/volunteers from drug advocacy groups that were willing to share their experiences.

Session One

New Drugs & Risk: Research, Policy & Practice

The oral presentations from this session have been podcast in full and can be accessed using the from the podcast section of this website. Karen McElrath offered an international perspective on research around new drugs and risk, focusing on synthetic cannabinoid use in the United States. Karen discussed risk as it related to market factors for synthetic cannabinoids, highlighting risk at the source as well as the point of re-manufacture. Niamh Eastwood from RELEASE examined the impact of the recently passed Act on New Psychoactive Substances (January 2016). Niamh discussed difficulties around enforcing this piece of legislation due to it banning everything and nothing simultaneously. Tony O’Neill discussed risk in the context of psychiatry with a specific focus on synthetic cannabinoids and psychotic episodes associated with use. Dr Aisling Diamond, a consultant of Emergency Medicine closed this session by highlighting the difficulties of treating patients under the influence of these news drugs and the strain this placed on NHS resources. This session covered a diverse range of subject areas within the context of risk in terms of research policy and practice. The questions and discussions following the presentations centred round the viability of this new legislation for NPS and whether there was any possibility of taking a united front and getting the Act overturned. The viability of using peer to peer welfare services at events such as festivals and nightclubs was also suggested and one member from the panel agreed that this means of harm reduction was much more effective and sustainable than bringing young people under the influence to A&E, where they often become confused, irritable and aggressive.

Session Two

The oral presentations from this session have been podcast in full and can be accessed using the from the podcast section of this websiteAshley Bullard opened this session by presenting his doctoral research on cognition enhancers. Ashley explored the social risks associated with these substances in terms of accessibility, autonomy etc. and noted that issues around dependency on cognition enhancers are virtually ignored.

Larissa Sherwood closed this session by presenting data from her postgraduate research which examined polydrug among young people in Northern Ireland. Larissa’s findings were based on secondary analysis of data gathered from young people presenting at one NI service from the voluntary sector. Her findings examined some of the most commonly reported NPS as well as the strongest predictors for use. Larissa proposed that treatment of NPS use should be multifaceted and should consider the range of substances young people use in conjunction with NPS.

 

Session Three

This session focused on new drugs and risk within the context of service provision. Fiona Anderson from Start360, a voluntary organisation working on the frontline with young people using drugs and alcohol, presented on the risks young people face and the importance of using harm reduction approaches. For some of these young people, their end goal was to reduce their NPS use, for some it was abstinence and for others, their goal was to transition from synthetic cannabinoid use to cannabis use – the important message from this presentation was the importance of working alongside the young person to reach an achievable goal.

Anne Campbell closed this session by presenting some findings from a recently completed study looking at service providers’ perceptions of NPS use in Northern Ireland. Anne described the set of skills already in place with those working in the field and the way in which these skills were transferable to working with NPS. Drug and alcohol workers who took part in the research highlighted some of the harm reduction approaches they used but did highlight the need for more consistent updates in terms of information around the pharmacological properties of emerging NPS as well as training and knowledge around ‘what works’ when dealing with individuals using these substances.

Session Four

The final session in the seminar presented the views from two individuals who volunteered to share their own experiences of using New Psychoactive Substances. Due to the personal nature of these presentations they have not been podcast.

 

Speaker One

This speaker discussed her experience with NPS, mephedrone in particular. This speaker started using at weekends and said “it was good fun at first”. Following the ban on mephedrone, the participant noted that the quality of the drug deteriorated considerably, with some batches even looking like they contained glitter. The speaker continued to use stimulant type NPS sold as mephedrone for two years. Sessions could last for two to three days, during which times she would not eat or sleep. She found herself drifting away from family and friends and spending more time using NPS in her own world. When some of the street-based head shops stopped selling mephedrone, the participant turned to street dealers who were able to raise the price of stimulant type NPS and the quality of the drug was further affected. The participant discussed the negative psychological effects she suffered as a result of NPS use, including nervousness and heightened anxiety. She claimed she was ‘’going through hell to stay on it’’. The speaker then read a personal poem about her journey with stimulant type NPS.

 

Speaker Two

This speaker reported using synthetic cannabinoids for a period of time and because it was often referred to as ‘herbal’ she understood how some people could believe it was not very harmful. This individual’s use increased drastically over a few years and the effects of the drug escalated from an initial ‘buzz’ to a stage when she was losing hours at a time. Similarly to speaker one, this individual noticed the changing compounds in synthetic cannabinoids, identified mainly by the smell of the substances – she knew they were routinely altered yet marketed as the same substance. This speaker reported noticing that her family life began to suffer as a result of NPS, but she continued to use synthetic cannabinoids to ‘block this out’. At her lowest point, this speaker felt as though she was ‘totally in the gutter’ and so she went in search of help. This individual reports that there was and still is no sufficient help available for people dependent on synthetic cannabinoids. This speaker went through the withdrawal process without any medical assistance and found her support network through volunteering at a local charity offering support to individuals from the homeless community. This speaker has not used synthetic cannabinoids for a number of months now and has adopted a key peer-mentoring role within this organisation and her knowledge and experience of NPS have proved invaluable.

 

Discussion and Close

The seminar closed with discussion and comments from those attending the seminar. Attendees were asked to note down points for research, policy and practice moving forward in the context of new drugs and risk, as well as feedback in terms of the event.

The feedback received included very positive comments around the inclusion of representatives with personal experience and suggested that this population feature more in future events. Individuals with experience of using NPS should be viewed as experts in the field and their knowledge should be shared across practice and service provision in order to generate more around “what works” for individuals using these substances.

 

Research

In line with discussions and points raised at this event, it was suggested that future research should endeavour to examine the longer term effects of NPS, particularly in terms of the psychological impact on those who started using NPS as adolescents, although this is difficult given the very volatile nature of the market.

Future research could also draw together the perspectives of those working in different sectors in the field. It was suggested that future research should examine NPS use in residential childcare sector. There was some consensus that future research should focus upon the use of synthetic cannabinoid use, specifically the physical and psychological health effects associated with use, as well as effects of withdrawal and the possibility of using medicated assisted treatment in order to assist individuals in the process of withdrawal.

Much of the research examines the negative effects of new drugs but future research could also explore positive experiences with NPS and perhaps examine the meanings users attach to different NPS and how these are integrated into their moral identities. Why do these people choose to use NPS? It was suggested that we take steps towards ending the war on all drugs, including NPS and accept that people will always seek to use psychoactive substances so now it is about focusing on how we help individuals use in the safest way possible.

It was suggested that future research, policy and practice incorporate the views of those with most experience, i.e., those in contact with services. It was deemed that this event and future events should incorporate expert views from participants in order to “put a human face to all the facts and figures and statistics”.

 

Policy

Much of the feedback around policy questioned the viability of the new legislation that seeks to prohibit the sale of NPS. Despite serious issues with the Psychoactive Substances Bill, e.g. definitional issues, enforcement, harm caused, the legislation is passed – this reiterates the need for policy and legislation to be reviewed in line with evidence research and rational debate. A number of participants suggested that those working in research, policy and practice lobby against this piece of legislation. It was also suggested that policy should reflect the views of those it affects most, i.e., those using NPS – the views, experiences and knowledge of these individuals are vital and should be incorporated.

In line with discussions around policy, the following quote depicts frustrations from those working in the field in terms of the ability to bridge policy and practice:

“Re; the service user talks – phenomenal – as a social worker I frequently feel frustrated at the many barriers to service and have to work in increasingly creative ways to make a meaningful difference to peoples lives. This is a public service issue and a fight and voice that needs to be heard. Bringing service users, service providers, statutory and voluntary is always positive but I’d love to have our Health Minister sitting on the panel to hear this and be accountable.”

 

Practice

Feedback received in terms of practice centred round support for grass-root agencies. Approaches with those using NPS should be realistic, person centred and in line with end goals established by client. There was also a need highlighted in terms of consistently communicating relevant and timely information on NPS and effects to those working on the frontline. Greater support is also required for those engaged with services most affected by the legislation, e.g., the homeless community. Multi-agency collaboration should continue to be pro-active and support all approaches – the division between agencies promoting abstinence and those advocating for harm reduction can be destructive. That said, a number of people highlighted the need for harm reduction approaches to be protected and consideration given to the suggestion that NPS are not the problem, rather, it is the lifestyle factors, circumstances and situations leading to problem use that need addressed.