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.
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.
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