Psychoactive Substances Bill

Written evidence submitted by Addaction (PSB 24)

 

Introduction to Addaction

 

1. Addaction exists to help its beneficiaries overcome their problems with addiction, mental health, behaviours and improve well-being. We employ over 1,500 staff members and last year we worked with nearly 70,000 people across all our services.

a. Last year, 27,202 of our service users were engaged in structured treatment.

b. 98% of our service users surveyed said they would recommend us to their friends and family.

c. 97% said Addaction works well with other services.

d. 91% felt that they had made progress in their recovery.

e. 97% said that they had been given the support that they wanted.

f. 41.3% of our service users who were discharged from drug services had successfully completed their treatment plan.

g. 53.5% of our service users who were discharged from alcohol services had successfully completed their treatment plan.

h. We received more than 21,000 referrals to our Mental Health Services with 50% of our clients moving to recovery, compared to 44% nationally.

i. 30,000 school pupils attended workshops and assemblies by the Amy Winehouse Foundation Resilience Programme which is run in partnership with Addation.

j. Over 70% of people who were injecting left treatment with a hepatitis C test booked.

k. Our volunteers contributed an incredible 32,834 hours in total last year.

Overview

2. At Addaction, we pride o urselves on delivering evidence- based interventions across a wide range of services. We regularly consult with experts across a range of disciplines in order to ensure that the work we provide for some of the most vulnerable in our society will have the greatest possible impact, with the best likelihood of achieving successful outcomes and sustained recovery for those with which we work . We constantly strive to improve our services, and to deliver great results for individuals, families and communities.

3. We are concerned that the Home Office did not consult the Advisory Council on the Misuse of Drugs (ACMD) – a panel of substance misuse experts and leaders in the field – on the development or drafting of the Psychoactive Substances Bill. We are also concerned about the inclusion of Nitrous Oxide (laughing gas) in the bill, which is counter to recent ACMD advice . We would urge the G overnment to ensure an approach based on evidence , allowing for detailed consultation with the ACMD when reviewing this bill.

4. Addaction provides services across 16 prisons. Our experience is that New Psycho active Substances (NPS) are becoming widely used within the prison estate, [1] but that those who are using these substances are more difficult to eng age in treatment services than traditional drug users. Anecdotal reports links this to the fact that NPS users within prisons do not consider themselves to be addicte d . Hence, a range of alternative responses will be needed to engage, advise , educate and treat this emerging population. At present there is limited resource for this to be achieved within custodial settings. We would urge the G ove rnment to create an ‘innovation fund’ to rigorously investigate and analyse the effective interventions for these new and emerging su bstances and those at risk of harm from them.

5. T he majority of the work we undertake with young people is in relation to the use of traditional substances and in particular alcohol and cannabis. Nonetheless , there has been a notable increase in both the interest in and the use of NPS from 2008 onwards. The substances of initial focus were stimulant pills and powders including methylone and mephedrone . As time progressed and the range of different types and brands of substances increased it was the synthetic cannabinoid receptor agonist (SCRA) smoking blends that were more widely used by those engaged with our services.

6. We noticed a clear correlation between incr easing levels of NPS use among specific populations and the numbers of different head shops located in certain parts of the county. It is difficult to ascertain whether shops appeared due to increasing demand for substances or conversely whether the appearance of these premises stimulated interest in NPS. However, w hat is apparent giving the town of Maidstone as an example – is that the numbers of young people talking about their experiences of NPS increased as the number of premises selling these substances grew in number.

7. T he demographics using these substances also changed over time . When ‘legal h ighs’ first appeared in the mid- 2000s they were perhaps associated with a more middle class demographic: psychonauts ’ and experimental users interested in pursuing recreational drug diversity. This user group has now significantly changed and the young people most likely to become involved in NPS use are those from deprived backgrounds including those in local authority care or the criminal justice system.

Case example - Kent Young Person’s Services

8. In July 2014 Kent undertook Operation Lantern, a trading standards initiative backed by Kent Police which targeted more than 20 head shops across Kent and Medway. Over four hundred packets were seized as part of this operation and , invoking General Product Safety Regulations , stores were prohibited from selling any of the ‘legal highs’ that they had in stock at the time of the raids . This continued for a six month period while the matter went through the court process. We believe that our experiences in relation to changing user demographics and our observations relating to Operation Lantern and its aftermath are important to share with regard to the potential positive and negative im pacts of the proposed b ill.

9. T here was a discernible decrease in the number of people engaged with our services who were able to access NPS following the trading standards’ initiative. It was clear that the normal supply mechanisms of substances had been disrupted and, for the first four to six weeks after it took place, numerous service users disclosed that the avai lability of NPS had decreased. Therefore an initial conclusion is that prohibiting the supply of these substances was immediately successful in reducing the numbers of young people who were accessing and consuming them on a more recreational or experimental basis.

10. However, a t the same time it was evident that people who had a higher level of dependence on these substances were continuing to try to source these products. It is worth emphasising that it was the SCRA products that were most widely used in this way within our service user populations. As highlighted in DrugScope’s Street Drugs Survey from January 2015, the vulnerable groups most associated w ith the problematic use of SCRA s included prison populations, street homeless or those in hostels, as well as disenfranchised young people including those outside of mainstream education or those involved with the care system. [1] There was clear evidence from fieldwork delivered by our team that more problema tic or entrenched users of SCRA s continued to use them but were acquiring them from different , more dangerous sources.

11. While it was of course unl ikely that head shops were providing substance information or harm reduction advice to people purchasing NPS, it was at least a relatively risk free way of getting hold of desired products. Instead we became aware of young people purchasing substances from street dealers and being far more susceptible to exploitation as a consequence. A concern with the new legislation is that, while it may reduce the number of people using NPS as a whole, it is likely to leave already vulnerable populations increasingly isolated from society and at risk of harm through increased contact with street and online dealers . In other words, the purchase of these substances will be displaced to other, less visible places, but the market itself will remain (as has been seen after changes to legislation in Ireland).

Attitudes toward risk

12. There is a sense that as NPS are often referred to as ‘legal highs’ young people equate them with lower levels of harm . While this might be true for some people this is not the attitude of many of those with whom we work. Surveys carried out within the past year with young people who have linked in with our Early Intervention Service in Kent demonstrate that many are aware of NPS risks; moreover , there was an overwhelming sentiment expressed that NPS were likely to be more dangerous than traditional street drugs. [3]

13. It is our belief that we should not solely focus on highlighting the potential harms of NPS. I t is well established that young people have a higher predisposition to taking risks, and their behaviours will not necessarily change just because there is perceived to be potential danger . I ndeed , it is well understood within the sector that ‘just say no’ style tactics not only do not work, but may in fact e ncourage experimentation .

14. Many of the young people we see who are using NPS and SCRA s in particular are those from the previously mentioned vulnerability groups. These are young people who are likely to have poor self-esteem and self- worth, and those who are from more deprived backgro unds and for whom the more cost- effective SCRA products will be more attractive .

15. We must ensure that any future legislation considers the needs of these most vulnerable populations and allows capacity for work aroun d resilience and safer decision making to be delivered by support services such as substance misuse organis ations , mental health provision and those offering education and pastoral care. Without this in place , any ban is only likely to isolate these hard to reach groups even further. The bill provides an opportunity to implement a statutory duty on local authorities to provide services for NPS users irrespective of age and we would recommend this.

Confusion about relative harms

16. We are also concerned about the potential for confused messages that might be given by a blanket ban on all psychoactive su bstances. The high risk of SCRA s is sometimes conflated by the media with the much mo re widely used nitrous oxide. Often referred to as laughing gas, this has beco me widely consumed, even among groups who might not consider experimenting with drugs in general. It is perceived to be a low risk substance by many young people and offers a short-lived high that will usually impact little on longer-term health or social functioning. While there are some genuine risks from nitrous oxide use , these can typically be managed fairly well. Problematic use and deaths related to its consumption are very rare and young people are often well aware of this . We would support nitrous oxide being exempted as per ACMD advice.

17. 'L egal highs' or NPS are often discussed as though they are one amorphous substance and there can be much confusion about which are risky and which are not. If young people are to make informed choices around use it is vital that products with greater potential harms are identified so that risks might be more easily addressed and managed. As such , there is obvious concern that legislation that incorporates nitrous oxide might divert individuals to other substances, such as alcohol or banned, more dangerous substances . In the context of young people in particular, the potential harms of alco hol should not be ignored given the links to physical and mental health issues, impaired social functioning, unplanned and unprotected sexual activity, as well as crime a nd other anti-social behaviour .

Criminalisation

18. We are extremely pleased that possession and use of psychoactive substances has not been criminalis ed as part of this bill, ensuring immediate safeguards against criminalisation for young people who may be engage d in experimental activity in a very brief way . However, t he Bill has not been able to allay the existing uncertainty ; for example, what constitutes a psychoactive substance or how much of a pr oduct would be for personal use . If these issues remain unresolved and the subject of conjecture for academics, politicians, scientists and service providers , how can we expect more naïve potential users to make choices that will keep them protected by law?

In summary

19. Addaction strives to reduce the harms that communities can face as a result of substance use, both legal and illicit. Some elements of the proposed bill may well reduce the availability of potentially dangerous substances, which would of course be welcomed. However, we have grave concerns that other aspects of the proposed legislation are likely to exacerbate current issues experienced by some of our most vulnerable populations and potentially create a new set of problems. It is imperative that these cohorts are offered support rather than being criminalised or further burdened by societal stigma, making already hard to reach populations increasingly isolated.

Our recommendations

 

20. We would urge the Government to ensure that the legislation is based on evidence, allowing for detailed consultation with the ACMD when reviewing this bill.

21. We would urge the Government to create an ‘innovation fund’ to rigorously investigate and analyse the effective treatment and early interventions for these new substances and those at risk of harm from them.

22. We support nitrous oxide being exempt from the bill as per ACMD advice.

23. We recommend that the bill includes an amendment to implement a statutory duty on local authorities to provide advice, support and treatment services for NPS users irrespective of age.

October 2015


[1] The Forensic Early Warning System (FEWS) in its annual report statse that 738 out of the 893 samples of drugs they collected (from only 20 prisons) were uncontrolled NPS (mainly two types of synthetic cannabinoids).

[1]

[1] http://www.drugsandalcohol.ie/23282/1/DownAStonyRoadDrugTrendsSurvey2014.pdf

[3] www.addaction.org.uk/core/core_picker/download.asp?id=1362

Prepared 29th October 2015