Appendix: Government response
Letter from Rt Hon Mike Penning MP, Minister for
Policing, Crime, Criminal Justice and Victims, dated 19 January
2016
I am grateful to the Home Affairs Select Committee
for its report on the Psychoactive Substances Bill, published
on 23 October 2015.
I welcome the Committee's important contribution
to the scrutiny of this Bill. I agree that this legislation is
needed, and that the Bill must be drafted very carefully to ensure
that it has the desired effects. In that vein, I have carefully
considered the Committee's conclusions and recommendations, to
which I set out the Government's responses below.
As you know, Report stage of the Bill has been scheduled
for 20 January. I would therefore be very grateful if the Committee
could arrange publication of this response before then.
Conclusion/recommendation 1:
Britain has the largest usage of psychoactive
substances of any country in Europe. The public is shocked when
it hears of a case of a young person who has died as a result
of using these substances on a night out. The scenario is every
parent's worst nightmare. The Government is right to legislate
on this issue. However, the speed at which the Government has
brought forward this legislation, without any consultation on
the specific detail of the Bill, has resulted in some weaknesses
in the legislation being identified. We would have preferred the
concerns to have been addressed in a less piecemeal manner. Communication
with the Advisory Council on the Misuse of Drugs (ACMD) has been
unsatisfactory, which has required months of letters back and
forth to try and resolve the issues that have arisen.
Taken with
Conclusion/recommendation 2:
On 15 September, the Minister indicated to us
that second reading of the Bill would be in November. Since then
the Government has moved ahead with the Parliamentary stages of
the Bill, such that this Report was not available to Members at
the second reading debate which took place on 19 October. Furthermore,
it is intended that the Committee stages will be completed before
the end of October. It is regrettable that the Government has
proceeded with such speed, without the benefit of our Report.
In general, limiting the time available for effective scrutiny
by committees of the House reduces the opportunity for concerns
to be addressed, and most importantly, for improvements to be
made to legislation. We welcome the Minister's statement during
the second reading debate, when he said "I look forward to
the report, not least because of the excellent work that I know
has been carried out not only by the Chairman and other Members
but by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes)".
Taken with
Conclusion/recommendation 4:
To be effective, it is essential that the Government
draws more extensively on the experience and expertise of key
stakeholders. That is what they are there for. Even at this late
stage, the Government must consult with stakeholders. We recommend
that the Government begins to work closely with them to draw up
the guidance which will accompany the legislation. We also recommend
that stakeholders are involved fully in establishing the scale
and scope of the statutory review into the operation of the legislation,
once it is enacted.
Government response
The Government wholeheartedly agrees with the Committee
that it is right to legislate on this issue. The Committee has
called for action for a number of years. In its Twelfth Report
of Session 2013/14, the Committee said that "the creation
of new psychoactive substances will continue to increase in the
future unless immediate action is taken" (paragraph 9) and
that "The Home Office should introduce a new legislative
model, taking into account the benefits of other systems in use
abroad" (paragraph 14). The Committee clearly understands
the urgency of this problem, and the speed at which the Government
has brought forward this legislation reflects this. That said,
the Government has proceeded in a measured way. The New Psychoactive
Substances Review Expert Panel was appointed in December 2013
to examine the options for legislating in this area. The Expert
Panel's report was published in October 2014 and the legislation
only introduced in the Lords at the start of the new session on
28 May. The Bill was brought from the Lords on 21 July. The Bill
will not complete its parliamentary stages until late January,
some eight months after introduction and 16 months after the Expert
Panel reported.
The Government has consulted extensively on the specific
detail of the Bill with a number of stakeholders, including the
Department of Health, the Medicines and Healthcare Products Regulatory
Agency, the Academy of Medical Sciences, the devolved administrations,
the Advisory Council on the Misuse of Drugs (ACMD), and the National
Policing Lead on Psychoactive Substances, Simon Bray.
Indeed, engagement with stakeholders has been at
the heart of the development of this Bill, even in its embryonic
stages. The Expert Panel, which considered a range of legislative
options drawing on international evidence, included representatives
from the Police, National Crime Agency, Border Force, the Local
Government Association, the Crown Prosecution Service, DrugScope
and the European Monitoring Centre for Drugs and Drug Addiction.
The Panel also included individuals with a background in medical
and social sciences.
We greatly value the ACMD's input, and we have been
in close contact with them throughout the passage of this Bill.
In addition to the exchange of correspondence between the Home
Secretary and the Chair of the ACMD, Prof. Les Iversen, the Home
Secretary met with Prof. Iversen in September to discuss the issues
raised by the Advisory Council. We are confident that we have
given the ACMD the opportunity to raise any issues in respect
of the drafting of the Bill and we continue to work with them
as we move towards the implementation of the legislation. In addition,
we will work closely with the ACMD on scoping the statutory review
of the operation of the Bill as provided for in clause 58.
This engagement with the ACMD and others, together
with the debates throughout the passage of the Bill, reflects
the value of the scrutiny process both in and outside Parliament.
The fact that we have made amendments to the Bill during its passage
is a positive demonstration that we have been open to representations
as to how the drafting of this legislation could be improved.
We will continue to work closely with our other stakeholders
to ensure that the guidance accompanying the legislation is clear
and effective, and to establish the scale and scope of the review,
which (under clause 58 of the Bill as amended in Committee) must
be laid before Parliament within 30 months of the main offences
coming into force.
Conclusion/recommendation 3:
This Bill is based on legislation introduced in
Ireland in 2010. It would have been preferable to legislate in
the UK with the benefit of an assessment of the effectiveness
of legislation introduced in Ireland. This Committee has not seen
any evidence that any such assessment is available or would have
been available in the timescale within which the Government wished
to operate.
Government response
It is clear that the approach adopted in the Republic
of Ireland has been beneficial. The Irish Government and Garda
National Drugs Unit gave evidence to the Expert Panel which showed
the positive impact of the blanket ban in Ireland. Prior to the
introduction of the Criminal Justice (Psychoactive Substances)
Act 2010 there were 102 head shops operating in Ireland - none
are now left in operation, nor are there any Irish domain websites
selling these substances.
It is a matter for the Irish Government to review
the operation of their own legislation. While the Government agrees
that a formal assessment of the 2010 Act would have been a valuable
contribution to the work of the Expert Panel and our own consideration
of how best to take forward their recommendations, given the expert
evidence presented by the Expert Panel in their report, it is
incumbent on the Government to take forward this legislation as
expeditiously as possible in order to reduce the harms caused
by the widespread availability of non-controlled psychoactive
substances.
Conclusion/recommendation 5:
The terminology used to describe substances of
this nature has long been ill-defined. The use of the term 'legal
highs' is both misleading and inappropriate. It sends out a message
to young people that these substances are both 'legal' and will
have a 'desirable' effect. This has tempted people to experiment
with these substances, sometimes with disastrous consequences.
Government response
The Government fully agrees with the Committee's
finding that the term "legal highs" is a misleading
and inappropriate term. Describing these substances as 'legal'
can be incorrect - many of them contain controlled drugs which
are banned under the Misuse of Drugs Act 1971. "Legal highs"
can also convey a message of "safety", when in fact
these substances are potentially dangerous. It is for these reasons
that it is not the Government's terminology of choice. If we do
use the terminology in our communications, we do so sparingly
and often with heavy qualification.
The enactment of the Psychoactive Substances Bill,
whereby the trade in these substances will be unlawful, will further
reinforce the inappropriate nature of this term and provide opportunities
to shift the nomenclature used by the media and the public, including
young people, to more accurate terminology and consequently, a
new basis for a better understanding of the harmful nature of
these drugs.
Conclusion/recommendation 6:
Regarding the terminology contained in the Bill,
there has been no consultation on the definition of psychoactive
substances. We recommend that the Government reconsider the definition
of a psychoactive substance, with the benefit of the advice the
ACMD have provided.
Taken with
Conclusion/recommendation 7:
If the legislation is to achieve its aims, it
must deter producers and suppliers from making psychoactive substances
available. According to Police Scotland, it is questionable how
this will be done if these people cannot be successfully prosecuted.
It appears that the ACMD might have provided a solution through
their definition of psychoactive substances, and we call on the
Government to assess whether this approach would result in more
successful prosecutions.
Government response
The Government did not develop the definition of
a psychoactive substance in isolation. Its framing was informed
by similar legislation in Ireland, New Zealand and at state and
federal level in Australia, and consultation with the Governments
in those countries. Legal and scientific advice also influenced
the form of the definition adopted in clause 2 of the Bill.
We have fully considered the advice received from
the ACMD, including that set out in its most recent letter of
23 October[1]. The Home
Secretary's response to the ACMD of 27 October[2]
sets out the Government's further consideration
of the ACMD's advice and recommendations.
In summary, the Government's view is that the definition
in the Bill is fit for purpose. The definition provides that a
substance must be capable of producing a psychoactive effect.
It is the Government's view that this is legally robust and that
it will be possible to evidence the offences in the Bill to the
requisite criminal standard. It is worth noting that in relation
to the making of prohibition orders and premises orders the civil
standard of proof will apply and the test for the exercise of
the stop and search powers in clause 36 is that the police or
customs officer has "reasonable grounds to suspect"
that a person has committed, or is likely to commit an offence
under clauses 4 to 9 or 26. In both instances, the test is lower
than which is required to be met to secure a criminal conviction.
The underpinning science and testing techniques to
establish psychoactivity of substances are key elements of the
Bill's implementation. The Government is building on the success
of the Home Office's Forensic Early Warning System (FEWS) to ensure
that the UK continues to have world-leading capability and capacity
to meet the forensic requirements of the Bill.
We are therefore developing a bespoke forensic strategy
to accompany the implementation of the Bill. This work is progressing
well, led by the Centre for Applied Science and Technology with
valuable input from the ACMD. The ACMD advise that the forensic
strategy that we are currently putting in place will reflect the
best available science in this area.
The ACMD's latest and final advice provides additional,
not alternative, text to the definition by setting out how psychoactivity
could be measured and providing a non-exhaustive list of the classes
of drugs covered by the definition. While the Government is not
persuaded that these additions are required or are suitable for
inclusion on the face of the Bill, they can steer and strengthen
the forensic strategy.
The forensic strategy will continue to be developed
in consultation with the ACMD to ensure its scientific input is
reflected in the operation of the Bill. We will work with the
Council to understand the application of its proposed text at
a policy and operational level, for inclusion in the forensic
strategy as well as any other relevant document(s).
In parallel with the definition, the scope of the
Bill is also managed through the exemptions in Schedules 1 and
2 to the Bill. As a result of the scrutiny of the Bill in the
House of Lords, the Government brought forward amendments to Schedule
1 to strengthen the exemption for medicinal products. These amendments
will ensure that the regulatory framework for psychoactive substances
and human medicines complement rather than overlap with each other,
with the Medicines Healthcare products Regulatory Agency (MHRA)
enforcing compliance with the requirements under the Human Medicines
Regulations.
Conclusion/recommendation 8:
We accept the evidence given by Professor Iversen,
the National Aids Trust, and the Gay Men's Health Collective on
alkyl nitrites, also known as 'poppers'. Professor Iversen said
'poppers' were "not seen to be capable of having harmful
effects sufficient to constitute a societal problem" and
therefore we recommend they should not be banned. If in the future
there is any evidence produced to the contrary, then 'poppers'
should be removed from the exempted list or controlled under the
Misuse of Drugs Act.
Government response
The Government has given careful consideration to
the inclusion of the alkyl nitrites in the Bill, mindful of the
evidence of their harms and prevalence of use.
There are a number of specific, recognised health
harms associated with "poppers", some of which could
result in death. These include:
· chemical
burns and irritation around the nose and mouth;
· feelings
of sickness, faintness, disorientation and weakness, including
drop of blood pressure to a dangerous level;
· injury
to red blood cells and reduced oxygen supply to vital organs;
and
· temporary
or permanent loss of vision.
The Government's understanding of these harms aligns
with the evidence of expert witnesses to the Committee, including
Professor Iversen and Dr Owen Bowden-Jones. Professor Iversen
noted that the ACMD is aware that "the use of 'poppers' can
lead to methaemoglobinaemia in users which may cause significant
tissue hypoxia, leading to severe, potentially life-threatening
clinical features and/or death"[3].
There have been 20 deaths since 1993 where alkyl nitrites were
mentioned on the death certificate. Whilst the Committee quoted,
at paragraph 44 of the report, the first part of Dr Owen Bowden-Jones's
oral evidence on this issue, the transcript of his oral evidence
(Q148) shows that he went on to say, "Having said that, there
are associated harms. As we see with a lot of NPS harms, they
tend to be unpredictable. When ketamine came out, we had no idea
it was going to damage the bladder. Who would have thought? Now
we are getting a link between poppers and eye damage and, again,
it is just the sort of thing that is unpredictable".
On the advice of the ACMD, the alkyl nitrites group
are not controlled under the Misuse of Drugs Act. This is not
because they are harmless, but because they do not meet the high
threshold required under that Act.
However, in recognition of these harms, the supply
and sale of several substances in the group have been subject
to controls under various domestic legislation over the years.
In England and Wales and Northern Ireland, for example, the sale
of alkyl nitrites to under 18s has been caught by the Intoxicating
Substances (Supply) Act 1985 (the 1985 Act will be repealed by
the Bill in recognition of the fact that the offence in section
1 of that Act overlaps with the supply offences in the Bill).
As with many psychoactive substances, we have seen a game of cat
and mouse, with manufacturers tweaking the chemical structure
of poppers to create new substances which evade more specific
prohibitions set out in other regulations, such as cosmetic and
dangerous substances laws. Furthermore, in order to avoid consumer
protection legislation, these substances are often marketed as
"room deodorisers" or other similarly misleading descriptions.
Other countries have also had restrictions on alkyl
nitrites for some time. They are caught by Ireland's blanket ban,
and controlled in Canada, where they cannot be sold without a
licence by Health Canada. France has prohibited the sale of products
containing certain substances in the group since 1990. All non-medicinal
alkyl nitrites were outlawed in America in 1988.
The inclusion of alkyl nitrites under the Bill will
bring a more comprehensive, yet proportionate, legal framework
(having regard to the lower maximum penalties for the offences
in clauses 4 to 8 of the Bill as compared with those in the 1971
Act, and the absence of a general possession offence) to address
the supply of alkyl nitrites as a group. It will ensure that our
focus is on those who manufacture and supply "poppers",
rather than criminalising users.
However, the Government recognises that representations
have been made to the effect that 'poppers' have a beneficial
health and relationship effect in enabling anal sex for some men
who have sex with men, amid concern about the impact of the ban
on these men. In consultation with the Department of Health and
the Medicines and Healthcare products Regulatory Agency (MHRA),
the Home Office will now consider whether there is evidence to
support these claims and, if so, whether it is sufficient to justify
exempting the alkyl nitrites group (or individual substances in
the group). Clause 3 of the Bill enables the Home Secretary, by
regulations (after statutory consultation with the Advisory Council
on the Misuse of Drugs and subject to the affirmative procedure),
to add to the list of exempted substances in Schedule 1 to the
Bill. The Government intends to complete such consideration in
time to enable any such draft regulations to be laid before both
Houses and approved before the summer recess should the Government
conclude that a case had been made to include alkyl nitrites in
the list of exempted substances. Subject to parliamentary approval
of the Bill, it remains the Government's intention to bring its
provisions into force from April.
Conclusion/recommendation 9:
Given the growth in the use of nitrous oxide,
otherwise known as 'laughing gas', and the associated social harms,
we recommend that the ACMD be asked to review whether it should
be controlled under the Misuse of Drugs Act. If it does not reach
that threshold, we are content that it should be covered by the
provisions of the Bill, which should slow the growth in its consumption
as a psychoactive substance. If in the future there is any evidence
produced that indicates it might be added to the list of exemptions,
this should be taken into consideration. Nitrous oxide does have
genuine benefits when used legitimately, particularly within the
dentistry profession and for pain relief during childbirth.
Government response
The Government shares the concerns of the Committee
and those expressed by the ACMD (in their letter to the Home Secretary
of 4 March[4]) about the
misuse of nitrous oxide. We are committed to protecting people
from the harms that it can cause.
Alongside the Psychoactive Substances Bill, the Government
is taking a number of actions to tackle its supply for recreational
purposes, outlined in the Government's response (16 September)
to the ACMD's advice. These include highlighting the risk associated
with nitrous oxide to festival organisers, working with major
online retailers to implement mechanisms which discourage the
sale of nitrous oxide for recreational use on their websites,
and working through NHS Protect to ensure that NHS Trusts and
associated medical facilities are fully informed about the issue
of misappropriation of medical gas cylinders.
Together with the ACMD, the Government will keep
the harms and prevalence of the recreational use of nitrous oxide
under review. However, the current consensus is that the Psychoactive
Substances Bill is the most appropriate legislative vehicle to
restrict availability on the recreational market, following the
ACMD's recent assessment that the individual and societal harms
are not sufficient to warrant control under the Misuse of Drugs
Act 1971. While the substance has widespread industrial use, the
offences in the Bill have been framed such as to target the reckless
trade in nitrous oxide for recreational purposes, and will have
no adverse impact on legitimate industrial use.
Any medical use of nitrous oxide is also out of the
scope of the Bill. In circumstances where it is supplied with
the intention of having a beneficial effect on health, and not
simply to induce a state of intoxication, nitrous oxide falls
under the exemption in Schedule 1 to the Bill. In addition, as
a "belt and braces" approach, the Government amended
the Bill in Public Bill Committee to explicitly exempt all healthcare-related
activities.
Conclusion/recommendation 10:
We accept the evidence that there is a lack of
clarity in the Bill with regard to the relative harm associated
with different types of NPS and the appropriate sentence commensurate
with the offence. We recommend that the Sentencing Council be
requested to produce appropriate sentencing guidelines taking
account of relative harms.
Government response
The Bill provides a proportionate way of dealing
with psychoactive substances which are yet to have their harms
assessed. First, outside of a custodial institution, it will not
be a criminal offence simply to possess psychoactive substances.
Second, the Bill provides for civil sanctions in order to allow
law enforcement agencies to employ a graded response to offending
behaviour. Third, the maximum penalty for the offences in clauses
4 to 8 of the Bill is seven years' imprisonment, whereas under
the Misuse of Drugs Act 1971, the maximum penalties range from
14 years' imprisonment for supply of a class C drug to life imprisonment
for supply of a class A drug.
Once harms have been assessed by the ACMD, the Government
can decide to control a particular psychoactive substance under
the Misuse of Drugs Act where it considers the substance to be
harmful enough to justify the higher penalties.
When sentencing a person for an offence under the
Bill, the Government is satisfied that the courts will have no
difficulty in determining the appropriate penalty, subject to
the statutory maximum, based on the circumstances of the case
and relevant aggravating and mitigating factors.
Under section 125(1) of the Coroners and Justice
Act 2009, every court must follow any sentencing guideline when
sentencing an offender which is relevant to the offender's case
unless the court is satisfied that it would be contrary to the
interests of justice to do so.
The concept of harm is already fully embedded in
these sentencing guidelines. Indeed, section 121(3) of the Coroners
and Justice Act refers expressly to sentencing guidelines specifying
sentencing ranges by reference to, among other things, "the
harm caused, or intended to be caused or which might foreseeably
have been caused, by the offence".
The drug offences guidelines identify a number of
harm-related factors increasing the seriousness of an offence,
including the quantity of the drug supplied and any established
evidence of community impact. The guidelines also identify various
statutory and non-statutory aggravating factors. These factors
will equally be relevant to the sentencing of offenders for offences
in this Bill.
The Minister for Policing, Fire, Criminal Justice
and Victims will write to the Sentencing Council to draw its attention
to the Committee's recommendation and to the debates on sentencing
which have taken place both in the House of Lords and in Public
Bill Committee in the House of Commons.
Conclusion/recommendation 11:
It is expected that the implementation of the
Act will result in the closure of 'head shops', the main retail
outlets for NPS. This should substantially reduce the ease of
access to NPS. Furthermore, removing them from the high street
should counter the perception that these are safe substances.
We expect that this may result in potential users no longer choosing
to experiment with these substances. However, established users
are likely to seek to continue using NPS, either through choice
or dependence. Therefore it is highly conceivable that the market
will continue away from the high street.
Taken with
Conclusion/recommendation 12:
There is substantial evidence that the market
for NPS is already moving online, which, due to the anonymity
that the internet can provide, is a challenge for prosecuting
authorities to monitor and control. Enactment of this legislation
will enable the closure of UK websites selling NPS, but it does
not address those in overseas jurisdictions. We recommend that,
within one month of Royal Assent of the legislation, the Government
and the police publish an action plan setting out how they will
tackle the challenges of displacement of sales to the internet,
including by working with internet providers and overseas jurisdictions.
We are particularly concerned about the importation of psychoactive
substances via courier services. The Government must ensure that
the amendments already made to the Bill will cover this supply
route.
Government response
The Government agrees with the Committee that this
legislation is not a silver bullet. However, we do believe that
the Bill contains valuable tools to restrict supply of psychoactive
substances to complement the work that we are already doing to
reduce demand.
According to the 2014/15 Crime Survey for England
and Wales, less than 1% of adults who used drugs in the last 12
months sourced them from the internet. We acknowledge that this
may increase once the Bill comes into force and the more readily
available sources of supply are closed down. However, this will
be mitigated by the civil powers for enforcement agencies and
local authorities provided by the Bill, which will help to deal
with suppliers whether the psychoactive substances are sold through
head shops, street dealers, or websites. The criminal offences
outlined in the Bill also apply to internet sales, and are likely
to be highly effective on domestic websites - as we have seen
in Ireland. The National Crime Agency has a good relationship
with Internet Service Providers, who have been happy to assist
in law enforcement by taking down websites selling controlled
drugs; we expect that relationship to extend to websites selling
substances covered by this Bill. In Keith Bristow's letter to
the Committee of 2 October 2015, he noted that over 100 websites
selling "controlled NPS" have been taken down under
the Misuse of Drugs Act.
To deal with websites based abroad, the UK continues
to work with international partners to develop an effective response
to the supply of drugs and to react swiftly to emerging threats.
The UK is recognised as a global leader of international efforts
against the supply of psychoactive substances and works bilaterally
and through the G7, UN, and EU to this end. We engage in particular
with China and India, two of the largest producers of psychoactive
substances, to tackle supply at the source. This work will continue
once the ban on psychoactive substances comes into force. There
is also ongoing work with the EU and other international regulatory
agencies to ensure that, wherever possible, offending websites
are compelled to comply with the law.
Even when overseas websites have not been taken down,
the unambiguous powers that the Bill provides for Border Force
under clause 55 will make it much easier for them to seize psychoactive
substances at the border. This makes it far less likely that psychoactive
substances bought from abroad will reach the intended recipient.
As is the case with all items subject to importation
restrictions, the potential for importation of psychoactive substances
using postal or courier services is a concern for us. In order
to combat this, clause 55 of the Bill applies certain powers under
the Customs and Excise Management Act (CEMA) 1979. These powers
will enable customs officials to tackle the trade in psychoactive
substances at the border by operating a standard and familiar
set of powers in relation to psychoactive substances as that already
available to them in respect of other goods subject to customs
control. Crucially, by applying the CEMA framework of enforcement
powers, it will mean customs officials have the requisite lawful
authority to intercept and take appropriate enforcement action
in respect of psychoactive substances contained in international
postal packets.
The enforcement of the Bill is an operational matter
for the police and other law enforcement agencies rather than
for the Government. We have drawn the Committee's recommendation
to the attention of the National Policing Lead for Psychoactive
Substances, Commander Simon Bray, who is already preparing an
action plan to ensure that the Bill is implemented consistently
across the country.
Conclusion/recommendation 13:
We remind the Government that in our previous
Report we suggest that more effective action be taken by trading
standards against retailers. The powers contained in the Bill
will provide enforcement agencies with the tools to address the
problems associated with NPS more effectively and we would expect
that in areas where the sale and supply of NPS is high, the new
powers will be welcomed by enforcement agencies. However, the
level of priority accorded to this in each area (of England and
Wales) will be decided by the Police and Crime Commissioner. We
urge PCCs carefully to consider the significant risk which NPS
can present, particularly to young people in their communities,
when making these assessments. Chief Constables should also inform
the public of the steps that they have taken with regard to NPS
by publishing an action plan on their websites.
Government response
We are working closely with law enforcement agencies
across the UK to ensure that plans are in place for them to have
the necessary guidance and tools to enforce this legislation.
The National Police Chiefs' Council (NPCC) is chairing a monthly
working group to ensure that there is co-ordinated police activity
across the country after Royal Assent and subsequently after the
provisions come into force.
In addition, the Home Office is chairing a cross-agency
working group on implementing the Bill. The meeting is attended
by all those with a role in enforcing the legislation, such as
the police, the Local Government Association, the devolved administrations,
the National Crime Agency and Border Force, so that plans for
implementation are mutually supportive and that there is consistency
of delivery.
In February, we will be holding two workshops, jointly
with the NPCC, on the implementation of the legislation. Police
officers and trading standards officers will be invited to attend.
Police and Crime Commissioners will be represented at the event
which will enable them to be fully briefed on the legislation.
As indicated in our response to recommendation 12,
the enforcement of the Bill is an operational matter for the police
and other law enforcement agencies rather than for the Government
or Police and Crime Commissioners. We have also drawn this recommendation
to the attention of the National Policing Lead for Psychoactive
Substances.
Conclusion/recommendation 14:
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.
Government response
We take a broad approach to the prevention of substance
misuse, in line with international evidence and recent evidence
provided by the independent experts, the ACMD. It combines universal
action with targeted action for those most at risk of already
misusing drugs. This includes investing in a range of evidence-based
programmes, which have a positive impact on young people and adults,
giving them the confidence, resilience and risk management skills
to resist drug use. Resilience-building activities have the best
evidence for helping people to avoid drugs and drug problems.
We recognise that effective drugs education plays
a critical role in helping to ensure that young people are equipped
with the information they need to make informed, healthy decisions
and to keep themselves safe. We want to see all young people leave
school prepared for life in modern Britain. This means ensuring
that young people receive a rigorous academic education and helping
them to develop personal and emotional wellbeing. In addition
to drugs education being part of national curriculum science at
key stage 2 and key stage 3, many schools include drugs education
as part of their personal, social, health and economic (PSHE)
education. We do not, however, want to prescribe exactly which
issues schools should have to cover in PSHE or other related parts
of the curriculum or to specify which resources they should use.
Teachers are best placed to understand the needs of their pupils
and we believe that it is for schools to tailor their local PSHE
programme to reflect the needs of their pupils.
The Government has also invested in resources to
support schools. For example, Mentor UK runs the Alcohol and Drug
Education and Prevention Information Service which provides practical
advice and tools based on the best international evidence, including
briefing sheets for teachers on best practice. The Department
for Education has published an evidence paper for teachers: Personal,
Social, Health and Economic (PSHE) Education: A Review of Impact
and Effective Practice[5],
which summarises the best evidence on effective PSHE practice
for teachers including on drugs education.
Public Health England (PHE) has published a guide
to evidence-based prevention for people who commission, develop
and implement prevention strategies which summarises the UN Office
for Drug Control prevention standards.
Going forward, we are developing a strategic communications
plan to support implementation leading into the Bill's commencement
in April 2016. In developing our plans, we recognise the value
in raising public awareness of the harms of drug misuse but we
need to be mindful of the evidence base here. It is clear that
mass media campaigns on their own are ineffective and - at worst
- are associated with increased drug use. It is therefore critical
that any such awareness raising activity is targeted and part
of a wider strategy.
The amount of Government spend referred to in the
report (paragraph 71) relates only to two Home Office summer communications
campaigns aimed at raising awareness of the risks, consequences
and harms of psychoactive substances and signposting FRANK as
a source of information. The campaigns were targeted towards those
already contemplating using or dabbling in psychoactive substances,
and cost a total of £180,556. The latest estimates (2011/12)
suggest that the Government spends around £341m on early
interventions and education on tackling drug misuse.
The Government funds some important online resources
which can help young people to be more aware of drug dangers,
build resilience and prevent them developing problems. These include:
· Rise
Above, a national campaign run by PHE to build resilience and
healthy behaviour in young people[6].
· Talk
to Frank, which is a trusted source of advice on drugs[7].
In relation to prisons (paragraph 78 of the report),
the National Offender Management Service (NOMS) has already introduced
a number of measures to tackle the use of psychoactive substances,
including a major push on prison communications to make sure that
offenders are aware of the consequences of taking psychoactive
substances, as are visitors who attempt to bring them in. This
has been issued alongside a series of articles and briefings to
Governors and staff to improve our corporate knowledge of the
dangers associated with psychoactive substances. NOMS has been
working with PHE on the development of a toolkit for health practitioners
and operational staff in prisons, which was issued earlier this
month[8]
and provides staff with
a comprehensive source for understanding the behaviours associated
with psychoactive substance use and practical advice on referral
to, and treatment by, health colleagues.
In addition there have been a number of local initiatives
involving prisons, the NHS, PHE and substance misuse providers
to tackle this issue and raise awareness of the very serious risks
that these substances present.
Conclusion/recommendation 15:
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.
Government response
High quality treatment is fundamental to helping
people recover from their dependency. We have a well-embedded
and comprehensive drug treatment system and within this there
are a range of services responding to the challenges and harms
posed by psychoactive substances.
The Government continues to work with our partners
to develop our understanding and consider how we can best support
those working in the treatment field to manage those who have
taken a psychoactive substance. This includes:
· developing
world leading evidence-based clinical guidelines through Project
NEPTUNE to aid in the detection, assessment and management of
users of psychoactive substances. This is aimed at clinicians
working in a range of frontline settings, such as hospitals, sexual
health services, primary care and drug treatment services. The
Government has shared this approach internationally, including
with the World Health Organisation, United Nations and the G7;
· developing
on-line learning and clinical tools in phase 2 of NEPTUNE, as
well as exploring how the guidance might be adapted for staff
working in non-medical settings;
· publishing
a toolkit[9], supported
with regional events, to help local areas to prevent and respond
to the use of psychoactive substances. The toolkit gives a broad
overview of the challenges and provides commissioners with resources
and advice to inform a suitable local response; and
· setting
up a clinical network as a reference group to look at the feasibility
of sharing intelligence on psychoactive substances and drug-related
adverse reactions and harms. PHE is developing a NPS information
system to help clinicians and other front-line workers access
accurate and up-to-date information about NPS. Part of this work
is exploring the feasibility of piloting a system for recording
adverse drug effects (similar to MHRA's Yellow Card Scheme) to
cover NPS and other drugs.
Conclusion/recommendation 16:
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.
Government response
Data on hospital admissions and attendance is collected
using the International Classification of Diseases (ICD). The
ICD is the international standard diagnostic classification for
diseases and other health problems and enables the storage and
retrieval of diagnostic information for clinical, epidemiological
and quality purposes. It also provides the basis for the compilation
of national mortality and morbidity statistics by World Health
Organization Member States. The classification provides high level
categories for mental and behavioural disorders due to psychoactive
substance abuse, but does not specifically identify psychoactive
substances as defined in the Bill.
It is unlikely that the data collected would be robust,
as the reports of psychoactive substance users are unreliable;
they have no way of knowing if what they took was the substance
they thought it was. Furthermore, the cost of testing everyone
who presents at hospital in an intoxicated state to see if a known
psychoactive substance is implicated would be disproportionate
and not clinically justified; such information is not normally
needed in these circumstances, as the treatment focuses on the
symptoms rather than the substance.
The National Poisons Information Service already
collects data on acute problems caused by psychoactive substances.
This information is available to clinicians when required through
the Toxbase system[10].
PHE is developing a psychoactive substances information
system to help clinicians and other front-line workers access
accurate and up-to-date information about psychoactive substances.
Part of this work is exploring extending the national system of
recoding adverse drug effects (the MHRA's Yellow Card Scheme)
to cover psychoactive substances and other drugs.
Conclusion/recommendation 17:
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.
Government response
The key to effective treatment is ensuring the approach
is personalised to an individual's specific needs and tailored
as they progress on their treatment journey. Drug treatment services
can largely adapt current approaches to existing drugs to treat
those presenting after taking a psychoactive substance.
Local authorities are responsible for assessing local
need and commissioning services to meet that need, including services
for psychoactive substance users and staff with the skills to
meet the needs of users of psychoactive substances. Some large
drug treatment providers are already leading the way in ensuring
their workforce is skilled up to meet requirements.
As indicated above, PHE has launched a toolkit to
help local areas to prevent and respond to the use of psychoactive
substances. The toolkit gives a broad overview of the challenges,
and provides commissioners with resources and advice to inform
a suitable local response.
We will continue to work with our partners to take
further action, including enhancing Project NEPTUNE which will
move into Phase II to develop on-line learning and clinical tools,
as well as exploring how the guidance might be adapted for staff
working in non-medical settings. PHE is committed to using its
networks and other resources to share the findings and advice
of Project NEPTUNE.
Conclusion/recommendation 18:
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.
Government response
The Government agrees that the Psychoactive Substances
Bill is only one strand, albeit an important strand, of a wider
strategy needed to tackle the threat posed by these harmful substances.
We will continue to work with a wide range of stakeholders to
ensure that we provide effective prevention and treatment services
to complement the Bill's approach of criminalising those engaged
in production, supply, importation or exportation of psychoactive
substances. Further, the ACMD will continue to support us throughout
the implementation of the Bill, and will directly assist us in
evaluation and in developing the bespoke forensic strategy.
1 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470421/ACMD_definitions_advice_final-23-October-2015.pdf
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2
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/471366/2015_10_27_HS_-_Prof_Les_Iversen__Psychoactive_Substances_Bill_.pdf
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3
http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/home-affairs-committee/psychoactive-substances/written/22358.pdf
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4
https://www.gov.uk/government/publications/acmd-advice-on-nitrous-oxide-abuse
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5
https://www.gov.uk/government/publications/pshe-education-a-review-of-impact-and-effective-practice
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6
http://riseabove.org.uk/ Back
7
http://www.talktofrank.com/ Back
8
http://www.nta.nhs.uk/uploads/new-psychoactive-substances-in-prisons-a-toolkit-for-prison-staff.pdf
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9
http://www.nta.nhs.uk/uploads/nps-a-toolkit-for-substance-misuse-commissioners.pdf
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10
https://www.toxbase.org/ Back
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