Psychoactive substances Contents

8 Education and harm reduction

67.The Bill provides enforcement agencies with new powers to help them to address the sale and supply of NPS. However, if the proposed legislation is to achieve its aim of protecting people from the risks posed by NPS, this will need to be accompanied by measures to communicate the changes, to improve drug education and to support harm prevention.

Education

68.Mentor (which provides the Government backed Alcohol and Drug Education and Prevention Information Service (ADEPIS)), believes firmly that the legislative controls in the Bill on their own will not be sufficient to arrest the growing use of NPS. They have pointed to the experience of Ireland, where NPS use increased despite the blanket ban introduced in 2010. They recommend two forms of intervention: universal prevention and targeted early intervention. Mentor argues that universal school-based programmes would promote attitudes and behaviours proven to reduce the likelihood of problematic drug use, whilst targeted interventions, with young offenders and children in care, have shown the long-term benefit of conducting focused work with young people who face multiple disadvantages.105

School based programmes

69.YMCA England emphasised that early education was key to young people making informed decisions and limiting the use of NPS.106 The Angelus Foundation told us that their activity was concentrated mainly on the 14 to 18 year-old group, but that they had been told by pupils that this education was required at age 11 or 12, and this was echoed in other evidence we received.107

70.YMCA England stressed that messages at school had to be given in an engaging way, particularly as many young people thought Personal, Social and Health Education (PSHE) was used as a ‘filler’ class rather than a meaningful lesson. They believed that the use of peer mentors, volunteers and recovering users who could speak on a more individual level would help to break down barriers between young people and service providers. Additionally, social media should be included in any Government education strategy.108

71.The Government has invested in a range of resources to support schools, for example ADEPIS provided by Mentor UK which provides practical advice and tools, including briefing sheets for teachers.109 However, Home Office figures show that Government spending on education and prevention campaigns for NPS between 2013 and 2015 was only £180,556.110

72.Jan King told us that the Angelus Foundation and other voluntary sector organisations had also created a variety of materials for schools, including films, which had had a positive impact in providing young people with information to which they did not otherwise have access. However, she was concerned that the information was not yet distributed widely enough and that it did not have the necessary weight of Government backing needed to promote effective education and wide awareness.111

73.The Minister acknowledged that the legislation was “not going to be perfect” and that a lot of work with the voluntary sector and schools was required to make sure young people were educated about the dangers of NPS.112 It therefore seems inevitable that additional public funds will need to be allocated to education programmes if they are to be effective in reducing NPS use and harm.

Targeted interventions

74.Targeted action has a key role to play for those most at risk or already misusing drugs. The Government has launched an online resilience building resource ‘Rise Above’, which is aimed at 11 to 16-year-olds, to help develop skills to make positive choices for their health, including avoiding drug misuse. The Government has also developed the role of Public Health England to support local areas through sharing evidence to support commissioning and the delivery of effective drug prevention activities.113

75.Jan King of the Angelus Foundation told us that it was trialling a piece of targeted work which aimed to make those in a deprived community much more resilient to the issues that affected them, so that they did not resort to the misuse of drugs. Other NGOs were trying other approaches, but greater focus was needed on sharing knowledge of what works, and then spreading that throughout the UK.114

76.Successive governments’ spending on education on the dangers of NPS has been shockingly inadequate to date. Action must be taken now, to educate young people about NPS, through stronger and wider public information campaigns. There is already a range of materials, produced by voluntary sector organisations, notably the Angelus Foundation, which could be used more effectively. We recommend that the Government oblige schools, with the assistance of the voluntary sector, to promulgate these existing resources as a matter of urgency.

Prisons

77.HM Inspector of Prisons (HMIP) told us there has recently been a rapid increase in the availability of NPS within prisons. While to some extent this reflects their greater use in the community, NPS are also an attractive alternative to controlled drugs because they are difficult to detect.115 The concern about use within prisons has resulted in the National Offender Management Service commissioning a study to detect and identify which compounds are being used.116 HMIP is also preparing a thematic report on substance misuse, which has found that ‘Spice’, a synthetic cannabinoid, was the new ‘drug of choice’ in prisons in England.117 Between 2010 and 2014, finds of ‘Spice’ in prisons increased from 15 to 436.118

78.Due to this rapid increase in use, there is a particular need to improve education on NPS within prisons. HMIP told us that, due to testing methods not detecting many NPS, prison officers required training in recognising markers of intoxication.119 They also informed us about effective prison education programmes which resulted in a reduction in the number of NPS-associated medical emergencies in several prisons.120

Front line clinicians

79.We were told that many professionals feel ill-equipped to deal with substance misuse issues, which has increased with the emergence of NPS, and this can mean that opportunities for positive intervention can be missed.121 However, the London Drug and Alcohol Policy Forum emphasised that, while the emergence of NPS can appear baffling to many, the substances do fit within the context of traditional drugs of misuse. Therefore, de-mystifying NPS would help young people, professionals, parents and the public to understand the nature of the problem and to guide positive responses.122 The Central North West London NHS Foundation Trust told us that developing a clinical network, spanning the clinical frontline, should be a priority.123 This would assist those dealing with behavioural emergencies, and drug-induced psychoses, which often leads to multi-agency involvement.124 Furthermore, Professor Iversen told us that a system for recording NPS and their harmful effects would be useful. The current system in place in hospitals to categorise drugs does not recognise NPS as a class, and therefore hospitals do not collect data on NPS use as they do for controlled drugs.125

80.The Government must take a lead role in developing and commissioning appropriate and credible resources aimed at the clinical frontline so that professionals feel equipped to deal with issues related to NPS use. This should include the development of a clinical network, including drug services, sexual health services, emergency rooms, mental health services, primary care and prisons. This would enable services from across the country to share their experience specifically relating to NPS harms.

81.It has been suggested to us that data on the harmful effects of NPS would be useful. However, we were told that this data was not collected in hospitals, because the system for categorising drugs does not allow NPS to be entered as a class. We do not see any reason why the category of NPS cannot be added to the existing system, and we therefore recommend that, as soon as possible, NPS data be collected at hospitals in a similar way to that which already happens for controlled drugs. If there are any practical difficulties, we would expect them to be overcome by the time the new legislation is commenced.

Harm reduction

82.Education programmes may be appropriate in alerting people to the risks associated with NPS, and for diverting those who might be tempted to experiment. However, for existing users, the focus needs to be on harm reduction, with a view to a longer-term cessation in use.

83.One of the challenges in providing a harm reduction strategy for NPS is that a new population of users has emerged. In addition, as the Royal College of Psychiatrists explained, NPS describes a range of different substances with strikingly different effects, which appeal to different groups of users and as such there is no ‘typical’ NPS user. Instead, there is a mosaic of different social groups including students; clubbers; prison populations; young professionals; ‘psychonauts’ (a person who explores the psyche through the use of hallucinogens); and the LGBT communities.126 YMCA England believed that it is important that users whose drug use is particularly entrenched are taught how to mitigate some of the dangers associated with drug use so as to reduce harm and increase the likelihood of them accessing more intensive services at a later date.127

84.The Home Office told us that effective intervention and treatment is at the heart of the Government’s Drug Strategy. They cited a “well-embedded and comprehensive drug treatment system” within which there is a range of services responding to the challenges and harms posed by NPS.128 However, other witnesses pointed out that many people who use NPS are reluctant to approach traditional drug treatment services for help, because they believe these services only cater for alcohol, heroin and crack users.129

85.Dr Owen Bowden-Jones told us that NPS also presents a challenge for conventional treatment services because those services have relatively poor knowledge of NPS, including how NPS work, the people who use them, the context in which they are used, and ways of engaging NPS users. As a result, a small number of specialist services, such as the Club Drug Clinic, have been established and have been successful at engaging NPS and club drug users.130 He said that drug services were there to meet the needs of the local population, so if a location had a particular level of NPS problem, a similar service to that offered by the Clinic might be required. However, there was a need to maintain the focus on heroin and crack, whilst also being skilled to manage the new harm of NPS.131

86.The Royal College of Psychiatrists (RCPsych) referred to steps that can be taken so that traditional drug services can meet the needs of NPS users. Firstly they can “widen the front door” so that they make the needs of NPS and club drug users part of their ‘core business’. The second step is to “support the front line” by educating drug service staff to manage harm related to NPS and club drug use. The third is to “connect the front line”; because of the negative perceptions of existing drug services, NPS users draw on a range of health services, including emergency and urgent care departments, acute care hospitals, mental health services and sexual health clinics. The RCPsych believes that these non-specialist services need to establish much better links with drug services so that specialist support and expertise can be shared, onward referrals can be made more effectively and intelligence and insight can be exchanged.132

87.Harm reduction via the provision of sexual health services has been highlighted by the EMCDDA in the context of hepatitis and HIV transmission, with the injecting of ketamine being linked to pronounced sexual health risks. Additionally, the European Drug Report 2015 identified needle and syringe exchange facilities as helping to reduce harm. These programmes are seen as an important response to the challenges posed by NPS.133 The Edinburgh Division of Police Scotland told us that needle exchanges could also promote the use of Noxalone for those who are returning to using heroin after a period of NPS use. They and the British Pharmacological Society have highlighted a danger of overdose as tolerance levels will be lowered.134

88.The alarming increase in the use of psychoactive substances has seen the emergence of a new population of users, who are reluctant to approach traditional drug services. Nor are existing drug services always confident in recognising the harms associated with these types of drugs. It is important that the focus on treating controlled drugs is not lost, particularly heroin and crack addiction, and specialist NPS services will not be required everywhere. Nevertheless, NPS use has the potential to create significant problems in some localities and drug services need to do more to recognise this and adapt. We recommend that those who run our existing drug services develop the necessary skills to deal more effectively with the challenges that NPS users present and take steps to ensure that their services are accessible and relevant to this new group of users.

89.We are at risk of being overwhelmed by the sheer scale of the use of new psychoactive substances. We are dealing with unscrupulous people, involved in activities thousands of miles away, who tweak a chemical formula to create a new substance every time action is taken to ban an existing harmful one. This Bill is only one staging post in tackling this problem; but this must not be the end.

105 Mentor (PAS003)

106 Centrepoint (PAS026)

107 Q159 and 161, Newcastle City Council (PAS023), Dr Richard Stevenson (PAS011)

108 Centrepoint (PAS026)

109 Home Office (PAS042)

111 Q158

112 Q133

113 Home Office (PAS042)

114 Q160

115 HM Inspectorate of Prisons (PAS019)

116 Newcastle City Council (PAS023)

117 HM Inspectorate of Prisons (PAS019)

118 Prison Reform Trust (PAS033)

119 HM Inspectorate of Prisons (PAS019)

120 HM Inspectorate of Prisons (PAS019)

121 London Drug and Alcohol Policy Forum (PAS041)

122 London Drug and Alcohol Policy Forum (PAS041)

123 Central North West London NHS Foundation Trust (PAS020)

124 Dr Richard Stevenson (PAS011)

125 Q67

126 Royal College of Psychiatrists (PAS014)

127 YMCA England (PAS032)

128 Home Office (PAS042)

129 Royal College of Psychiatrists (PAS014), Central North West London NHS Foundation Trust (PAS020), YMCA England (PAS032), Portsmouth NPS Working Group (PAS034)

130 Central North West London NHS Foundation Trust (PAS020)

131 Q147

132 Royal College of Psychiatrists (PAS014)

133 Amira Guirguis and Dr Christine Heading (PAS008)

134 Edinburgh Division of Police Scotland (PAS030), British Pharmacological Society (PAS016)




© Parliamentary copyright 2015

Prepared 22 October 2015