Friday, 3 October 2014

Pills & Powders, Pleasure or Pain

Posted by Andrew Brown, Director of Policy Influence and Engagement.

On the 24th September the London Drug and Alcohol Policy Forum held a seminar focusing on new and emerging drugs, the current understanding of what is out there, how some users appear to be acquiring them, the sorts of harms they are experiencing and how services might respond.

The following are the notes I made of the contributions of the three panelists: John Ramsey, Adam Winstock and Owen Bowden Jones.

Dr John Ramsey - the risks of taking NPS & the compounds they contain

TICTAC, the company John runs, legally obtains controlled drugs to test them – they have a database of over 3,000 compounds which can be accessed (on a paid-for basis) by healthcare and other services.

Names for these drugs are difficult, and we’ve used a range of ways to try and describe them, including designer drugs, legal highs, NPS and club drugs.  Names of individual drugs are even worse if we are trying to be understood by the public; lots sound very similar, the brand names that retailers have devised don't tell us what's in them, and retailers avoiding calling them drugs (e.g. bath salts) to try and avoid falling foul of the law.

John described how they find new compounds which come through a variety of sources; amnesty bins at nightclubs and festivals (but he pointed out that only 2% of the drugs collected in the amnesty bin at Glastonbury this year were uncontrolled NPS), buying off the Internet and through headshops, substances that are seized by the police & BorderForce.

The Global Drug Survey suggests that 22% of respondents said they bought drugs from the Internet and it is clear that this is increasingly important as a retail source.  As has been the growth of headshops, where young people don't need credit cards to access, and which normalises drug use. John suggests that in his experience headshops sell between 30-50 compounds and some of those are likely to be controlled, although his sense is that this maybe because wholesalers aren’t clear about them being controlled drugs).

John talked about nitrous oxide, which is currently quite widely used by younger people and is being sold at £2-4 a balloon.  He pointed out that nitrous oxide is not a new drug, and that it had been used as drug of misuse before it was used as a medical drug.

John spoke about a drug developed in the 1980s, MPTP, which caused the 18 people who took it to develop irreversible Parkinson's. He contrasted the limited distribution of that drug with the potential for more widespread harms in the NPS market, where none of the drugs currently on sale have been tested for safety.

He also talked about changes to the technology available for ingesting drugs, for example e-cigarettes where there are refills available which contain synthetic cannabinoids – as he explained these don’t need to smell like traditional cannabis and so it will be very difficult to test or tell what is being used.

He suggested that it is currently difficult to assess the scale of the problem; many deaths that at first appear to be caused by NPS end up being more complicated, and while self-reported use is a helpful indicator it has limitations, either because the surveys are self selecting (like the Global Drug Survey) or don’t capture important populations (the Crime Survey for England and Wales for example doesn’t survey students or prisoners).

As a result there is increasing interest in analysing sewage - in particular urine collected from city centres - (although this is limited to men).  The experience that TICTAC has is that this does find NPS, but John thought the technology was currently not very good at identifying synthetic cannabinoids.

Adam Winstock – Global Drugs Survey

Adam suggested that it is important to find ways to share information about the drugs that people are using with those users, but that it was critical that it wasn’t done within a framework that implied that taking drugs was immoral. He argued that providing information on how to take drugs more safely is common sense if the aim is to reduce drug harms.

He argued that as the Internet has changed the way we buy all sorts of everyday products, so it is changing the way many drug users buy drugs. This has been accelerated by the emergence of cryptocurrencies like Bitcoin and the Darknet which make it harder to detect people who are breaking the law.

Seen from the perspective of users, what they are looking for are better quality drugs, available at their convenience and delivered to their home.  He wondered if there is displacement from street dealers to the Internet and whether this has a potential to reduce some harms while also having the potential  to make a wider range of drugs available and to raise the number of overdoses (because the purity is higher than is available on the street).

He suggests that most people who use drugs are picky and while they may experiment with some new drugs they tend to stick with drugs that have been widely used for the last few decades – cannabis, ecstasy, cocaine, etc. There may be a question as to whether nitrous oxide is the exception to this rule, with prevalence rates rising dramatically in the last few years.

Adam stressed that there are a number of very clear risks associated with current drug use, for example the number of people who tell the survey that they have taken a white powder that they can’t identify.  He pointed out that there were high rates of people ending up in A&E after using synthetic cannabinoids (1 in 40 users in the UK and 4% in NZ). 

This has led him to try and develop harm reduction messages that might be attractive and effective with users.  He suggested that research tells us that "safer drug use is more pleasurable drug use."

Owen Bowden Jones - treatment

Owen talked about his experience running the Club Drug Clinic in London and argued that in his view the users of NPS are different from those that use opiates and crack cocaine.  He suggested that unless drug services recognise this they will struggle to attract NPS users.

Owen suggested that people who need services for their NPS use can be found in other settings, for example in sexual health clinics, in prisons, and through mental health services and it was important to make partnerships with those settings.

He also set out some of the limitations to the evidence base, pointing out that we can't be sure that our responses to heroin, crack and the other drugs that have dominated treatment services for the last two decades will work for NPS and other club drugs.  For example he suggested that ketamine users face particular problems managing their pain when reducing their dose if their bladder is badly injured.

Owen and others have been developing evidence-based guidelines for clinicians and others that they hope will be useful to the field and which will be available shortly.

In discussion during the question and answer session that followed the presentations, he talked about GBL being of particular concern. People who are dosing themselves almost continuously are at very high risk of death if they are forced to be abstinent.  He also talked about some of the very serious neurological symptoms that seem to be associated with some NPS, which are scary for patients even if the symptoms are transient.

No comments:

Post a Comment