NPS Spotlight Event Notes - 25th January 2017

Attendees

First Name / Last Name / Organisation
Waad / Ahmidi / St Mungo's
Ed / Anderson / Thames Reach
Kevin / Balfour / One Housing
Jane / Bancroft / Homeless Link
Diana / Bejarano / Thames Reach
Francis / Bond / St Mungo's
David / Borwick / Single Homeless Project
Gareth / Bowen / Thames Reach
Lisa / Brown / Sutton Night Watch Homeless Ltd
Douglas / Carey / Sutton Night Watch Homeless Ltd
Tony / D'Agostino / N/A
Chris / Demetriou / ICDAS, Change Grow Live
Sunny / Dhadley / Wolverhampton Voluntary Sector Council
William / Digan / ICDAS, IBUG
Nathan / East / Albert Kennedy Trust
Carla / Ecola / Thames Reach
Maxine / Ferguson / St Mungo's
James / Grech / Caritas Anchor House
Katy / Griffith / Resolving Chaos
Mike / Hall / St Mungo's
David / Hughes / Riverside
Tim / Ibrahim / Centrepoint
Susan / Jarret / Family Mosaic
Henna / Khalique / Solace Women's Aid
Sandra / Lewis / St Mungo's
Ziqian / Liu / Single Homeless Project
Jonathan / Loftus / The Passage
Mubarak / Mohamed / Providence Row
Yassir / Mohammed / Salvation Army
Phoebe / Myers / Outside In
Lana / Newby / Sitra
David / Olney / HAGA
Martin / Olong / One Housing Group
Michelle / Osborne / Centrepoint
Jon / Peet / The Passage
Chloe / Petts / Connection at St Martins
Patricia / Pierce / Connection at St Martins
Peter / Piercy / The Passage
Rikki / Pite / Women in Prison
Jess / Pugh / Hestia
Danielle / Routledge / Genesis
Tracey / Ryan / Change Live Grow
Jeremy / Sare / Mentor
Dee / Saund / Deptford Reach
Nic / Sharifi / St Mungo's
Laura / Shovlin / Thames Reach
Catia / Soares / Resolving Chaos
Rich / Smith / N/A
Oliver / Standing / Adfam
Boguslaw / Szewczyk / Glass Door
Sennaite / Tewolde / Look Ahead
Helal / Uddin / Providence Row
Colin / Wiseman / Resolving Chaos

Introduction and Welcome - Oliver Standing, Adfam

  • NPS use particularly apparent in vulnerable populations, including homeless people and people in prison.
  • Liverpool John Moore University are currently doing some research about mephedrone and synthetic cannabinoids to help gain a better understanding of use – promote to contacts.
  • Synthetic cannabinoids including spice and mamba are now classified as class B drug under the Misuse of Drugs Act (as of 23/1/17). There has been very little publicity about this.

Novel Psychoactive Substances - History, Policy and Legal Background - Jeremy Sare, Mentor Angelus

  • Mentor merged with Angelus in October 2016. Angelus were the first legal highs charity – mainly awareness raising to 14-18 year olds.
  • NPS have caused a lot of confusion amongst policy makers.
  • The Misuse of Drugs Act 1971 contained many loop holes and weaknesses. With many new drugs coming onto the market eg synthetic cannabinoids, mephedrone, the Act was unable to cope, which led to the Psychoactive Substance Act being introduced..
  • Ability to buy these drugs via the internet, head shops and street trade saw increased use.
  • Many NPS contain a mixture of products – what’s inside the packet varies and is rarely what was on the outside of the packet.
  • ACDM advised a Temporary Class Drug Order (TCDO) used for a limited time – no possession offence which would have been a move to a less criminalised approach.
  • The Home Office set up an expert panel which looked at what the best solution should be, looked at various models eg analogue model, NZ model, blanket ban.
  • 4 main drivers to demand: legality, potency, price, availability.
  • Government must consult the ACMD by law – ACDM said that the definition of “psychoactive” was inadequate, however the Government over-ruled their advice and amendments were not voted through.
  • ACDM had concerns about the ability to proving psychoactivity. Tests imposed by the Home Office won’t catch all substances. Unethical to demonstrate pyschoactivity by human trails.
  • Blanket ban, with some exceptions (caffeine, alcohol, tobacco etc) option deemed best option by the Government. This lead to the Psychoactive Substance Act 2016
  • Psychoactive Substances Act was rushed through so legally fairly weak.
  • In certain populations eg schools the act has led to lower levels of NPS use since over 500 head shops have closed, however amongst high risk groups NPS use very high eg prison, homeless populations.
  • All party parliamentary group on NPS and solvent use is in dialogue with the Home Office, to continually review what treatment is necessary.
  • NPS market moves very quickly, there are many unknowns and very difficult to plan more than 1 year ahead.
  • Synthetic cannbinoids are not controlled under the Misuse of Drugs Act as a class B drug.
  • Police won’t know if synthetic cannabinoid is 3rd generation. There has been very little media coverage/publicity, so those in possession can now be arrested and charged with supply, but the likelihood is people won’t be, since the police are very low on resources. Police may take person into the station, caution and test the substance.
  • Lots of grey areas about amounts for personal use/distribution amount.
  • Substance Misuse Act is now not very helpful. Class A is supposed to be drugs creating high dependency, but include ecstasy, mushrooms and LSD.
  • Many NPS have negative effects on someone’s mental health.
  • With NPS continually evolving, this means there are complexities for front-line staff (police, hostel staff, day centres, substance misuse etc).

Novel Psychoactive Substances Overview – Tony D'Agostino

  • All NPS fall into one of the common drugs categories ie stimulant, psychedelic, hallucinogen etc. Important to identify and how they work.
  • Cocaine is still the number 1 class A drug used (about 1 million users in the UK).
  • Mephedrone now fairly non-existent in clubs, mainly gone to the streets.
  • The purity of coke and MDMA has recently improved eg some coke is now 95% pure, which has led to more deaths. Perhaps trying to challenge the NPS market?
  • Drug use in the UK has been decreasing, however drug use on the streets has been increasing. Are people switching to non-detectable drugs?
  • Hard for dogs to detect some NPS. Undetectable drugs getting into prison and selling at 10 times their street value.
  • Some substances have been rediscovered egmephedrone and some such as methoxetamine are new.
  • B2P could be bought from the internet, basically worming tablets. “Not for human consumption” put on the packets to get around the law.
  • Mephedrone purchases spiked around 2009-2010, 1 site mainly supplied, but was then taken down, then the substance was banned, however still a problem NPS at the moment for certain populations.
  • Likely the future of drugs will be more synthetic, rather than plant based – more potent, cheaper, can be mass produced.
  • Much NPS production outsourced to China and India. Drugs now produced without supplier having pharmacological knowledge.
  • National Crime Agency estimate 19% of NPS batches contain illegal substances.
  • User often has no idea what they are taking.
  • “Blend” – often contain high caffeine or all caffeine content.
  • Nitrous oxide (laughing gas), leading to light headed feelings. Canisters and gas can be brought from Amazon. Have been dangers around use and harm reduction messages need to get to users.
  • Ketamine is an anesthetic, giving the user vivid hallucinations. Can create a dependency issue and users can develop urinary tract conditions.
  • Current treatment has an opiate focus - No warnings from NHS around ketamine.
  • Methoxetamine (MXE, Mket) supposed to be stronger than K and “bladder friendly”.
  • Many NPS are heavily marketed.
  • Mephedrone – has a fishy/cat pee smell, so while it looks similar to coke, smells v different.
  • Tony has recently been researching NPS use amongst NPS users in Buckinghamshire.Some homeless people are injecting mephedrone 20-50 times a day. Injecting sites take longer to heal, sores develop. Some users now bombing.
  • In the 1980s high potency cannabis skunk and haze emerged. 25% si the maximum level of TCH in buds, 3-5% in hash. Some synthetic cannabinoids have 50-65% THC, with some “shatter”, oils and waxes very high, up to 84%.
  • Spice gold was the first synthetic cannabinoid to mimic skunk. 3.5g costs about £20. Other street names include black mamba, annihilation. Spice has become the generic name for synthetic cannbinoids.
  • Spice can cause vomiting, respiratory failure, collapsing. Drugs are getting stronger.
  • Annihilation – some users reported loosing days, v hallucinogenic and users hospitalised.
  • 1 chemical a week was hitting the UK – NPS seen expediential growth. We now have 1st, 2nd and 3rd generation NPS.
  • Brand names tell you very little about the drug eg matrix, benzo fury – what chemicals are they. Need to know so we can help users.
  • NTA produced a report about populations who hadn’t injected drugs before, but were now injecting stimulants. Available at

Experience of NPS Use in Prisons and Amongst Homeless People – Sunny Dhadley, Wolverhampton Voluntary Sector Council

  • Has lived experience of Class A drug dependence and the CJS. He detoxed in 2007 (had to push for detox).
  • He felt relieved to be discharged from services, but felt a bit at a loose end. Went to volunteer with SUIT and quickly progressed to paid staff and then manager.
  • SUIT - Peer/lived experience-led service.
  • If volunteering is done right, it has a very positive impact on a person.
  • Very important to allow drug users to shape the services they use.
  • SUIT also gives support and guidance and signposts to other services. Worked with 900 individuals in 63 support areas and 522 organisations.
  • Clients don’t always present with a substance misuse issue.
  • SUIT has representatives on the Local Police and Crime Board, naloxone group and cross parliamentary group – has taken a while to get onto these groups, but so important to have lived experience voices heard.
  • Synthetic cannabis (mamba/spice) most widely used NPS.
  • Most users used alcohol and drugs previously but NPS cheaper way to get a hit.
  • NPS dealing very lucrative. One person claims to have made £80K in a few months.
  • Cumbersome service access and pathways don’t allow clients to move forward.
  • Challenge people’s belief and stigma to get the most out of them.
  • Many treatment services are unable to effectively understand/tackle NPS use. Staff competency and inconsistent community connection (for those leaving prison – many released NFA, with no money).
  • Drugs wheel – outlining drug groups is very useful -
  • With the reclassification of spice/mamba on the 23/1/17, will vulnerable people be made more vulnerable? How will clients find out about the reclassification?
  • Some of the effects of NPS use include increased heart rate, suicidal thoughts, seizures and violent behaviour.
  • It can be very hard to engage with NPS users, to create an effective joint care plan, impart harm reduction messages and advocate on their behalf around housing, benefits etc.
  • Spice use in prison can be used for entertainment, 5 drag challenge, to test potency, used as punishment, initiation and to pass time.
  • Withdrawals from spice can include chills, cravings, headaches, insomnia, nightmares, hallucinations, agitation and anxiety, “zombified state”.
  • Be honest about the type of interventions – never over-promise and be realistic.
  • Individuals need help. Feeling that criminalising user doesn’t help – stigma and prejudice attached.
  • Holistic approach – take ownership of care for that person eg drug use, sanctions, housing etc.
  • Be flexible around appointments – person can come back as many times as they want. Don’t bar people for missing appointments.
  • Peer support in the planning, set-up and delivery of services.
  • Many cross cutting themes eg employability – lack of opportunities due to criminal records, are all DB requests overused? Social exclusion – needs to devise policy and practice to ensure people aren’t excluded. Substandard living conditions – work with landlords to improve accommodation standards and make sure they are part of a pathway. Media and propaganda – challenge negative stereotypes. Austerity/cuts in services – look at alternatives and innovation.
  • Develop working relationships with key agencies eg DWP, named links in Job Centre and addiction services.
  • AA and NA can provide positive networks.
  • Has been a reduction in the use of Community Based Treatment Orders. These can reduce the number of people going into prison, however can be hard to stick to in terms of times, expectations, regime implementation.
  • What can we do to support clients using NPS? Phasing interventions, giving people opportunities eg refer to courses, refer to CA/NA/AA, volunteering, empower people at the start, keep person safe, find out about their interests, contact person regularly to offer support around reducing use.

New NPS Strategy in Belmarsh Prison – Tracey Ryan, Change Grow Live (CGL)

  • Romany traveler background, experienced lots of prejudice, which led to feelings of shame and feeling like the odd one out.
  • School life not great, feelings of having to prove yourself all the time.
  • Eventually trained as a counsellor and was offered her first job as a CARAT worker with CRI (now CGL).
  • Lots of drug problems in prison, use of NPS especially spice, which is huge problem across the prison estate. NPS use is huge and has almost brought prisons to their knees.
  • NPS use often goes hand in hand with other drug use.
  • People present in very unpredictable ways. NPS mixed with other substances eg even caffeine can be even more chaotic.
  • Lots of money to be earnt from selling NPS in prisons.
  • Prisoners prepared to give up their food to buy spice.
  • Recognise the Prison Service needs to do something specific about spice use in prisons so Belmarsh has developed a pilot programme which is expected to roll out nationally.
  • Need better links to other services in prison eg mental health, health, security and housing to help support those using NPS.
  • Harm minimisation main issue.
  • Training for both prison staff and prisoners.
  • Prisons do mandatory drugs testing and have dogs to detect drugs but not always easy to detect. It has been known that drawings sent from prisoners children have been sprayed with psychoactive substances. Drones are used in some prisons, but Belmarsh is a no fly zone and is netted.
  • First Night Centre offers a drug use assessment. Tests often show prisoners are often withdrawing from an opiate, despite the person saying they are not using opiates.
  • Prisoners often unaware of what they are taking. Some are used as Guinea pigs to test the potency.
  • Staff/prisoners haven’t got a full understanding of NPS.
  • Trying to get prison staff on board – people need help. Prison may not always be the right environment, some may be better supported externally.
  • NPA covers many but not all NPS. Covers staff and visitors.
  • To get on the programme a prisoner needs to declare they are using, which many are not keen to declare, since prisons operate in a punitive way. What else can be done to support, rather than to punish?
  • Tracey struggles with what’s the pull to use spice repeatedly? Delegates suggested – to get them off their script/heroin/crack, relieve boredom, availability, builds a bond/connection between people, the element of risk ie not knowing how it’s going to make them feel and the fact some NPS are addictive, sense of numbing.
  • DRDs are the highest on record. Could NPS and the effect on mental health be part of the cause? Those with poor mental health give huge concerns – are they in the right setting?
  • There are lots of unanswered questions around NPS. Lack of a clinical evidence base, long term interventions.
  • Need to identify which family of drugs the NPS sit in and then can treat (see drugs wheel).
  • Need to treat the symptoms – treat what you see.
  • Psychological input/therapy can be helpful to manage feelings and emotions.
  • Spice the Bird Killer – what prisoners think about NPS use in prisons -

Summing up

  • The sythetic cannabinoid spice seems to be the main NPS used amongst homeless clients.
  • There remains lots of uncertainties in the NPS field eg clinical guidance, long term harms, use in different populations, etc. We need to share expertise and innovative practice.
  • Situation is increasingly complex when happening in the context of cuts.
  • State of the Sector research occurring at the moment – safety net for the most vulnerable is being eaten away.
  • Likely to be less money for drug and alcohol services in the future, with the removal of ring fencing. Also with income for services coming from business rates in the future, this will be of great concern for some areas.
  • Positive to see lots of good work in the sector and meet committed individuals.

NPS Spotlight Group work