Legal (and not so legal) Highs Tom Heaps Consultant Acute Physician.
'Legal Highs or Legal Killers' Conference Presentations
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Legal highs or legal killers? Tackling the spread of New Psychoactive Substances
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Mentor lead the conference 'Legal Highs or Legal Killers? Tackling the spread of New Psychoactive Substances' on 18th September 2014. Its aim was to bring together a wide range of professionals to: raise awareness of the nature and potential harms of NPS understand where to find useful resources get up-to-date on government approach to NPS, and to the current status of substance misuse law, and laws and guidance affecting trading standards look at options for prevention and for building resilience in young people assess options for tackling the marketing and sale of NPS, and the most effective role for the criminal justice system This slideshare gives presentations from nearly all the speakers who were present. For more details, head to http://www.mentoruk.org/2014/10/legal-highs-conference/.
Transcript of 'Legal Highs or Legal Killers' Conference Presentations
Legal highs or legal killers?
Tackling the spread of New Psychoactive Substances
Welcome & introduction from the chair
Michael Lawrence, CRI
Tackling the spread of New Psychoactive Substances
Doing nothing is not an option: a parent’s perspective
Maryon Stewart, Angelus Foundation
Tackling the spread of New Psychoactive Substances
Nottingham Conference Centre – 18th September 2014
PARENT’S PERSPECTIVEMENTOR CONFERENCE
Maryon StewartFounder of The Angelus Foundation
Hester1987 - 2009
The Mephedrone Explosion
Temporary Banning Order
Focus Groups and Surveys
Films
National Poster Campaign
Whynotfindout.org
Focus Groups and SurveysOur schools programme was delivered to over 1,200 young people
Our data shows:
Before viewing the film 50% of young people believe legal highs are not safe at all to not safe
After viewing the film 91% of young people believe them to be not safe at all to not safe
96% of young people said that watching the film has put them off experimenting with legal highs
71% expressed feelings of being misled by so-called “legal” highs
Schools Programme
25 Festivals blackout their website
The Real Deal
• Online challenge - The Real Dealwww.yourvine.com/realdeal
Parent’s Films
Website for parents:
www.angelusfoundation.com
To download parents handbook:
http://www.angelusfoundation.com/parents-handbook/
Parent’s Community
Contact details
www.angelusfoundation.orgwww.whynotfindout.org
Email: contact @angelusfoundation.comOr
Tel: 02037007185Mobile: 07973713139
Angelus Foundation is a registered charity (number 1139830)
A brief tour through the world of legal highs
Ricky Bhandal, Public Health Birmingham
Tackling the spread of New Psychoactive Substances
Ricky Bhandal@ranjitbhandal
A VERY Brief Tour Through The World Of Legal Highs: What challenges Do They Pose?
Ricky BhandalBirmingham Public Health
Copyright Ricky Bhandal
Please do not reproduce without permission
Ricky Bhandal@ranjitbhandal
Definitions: NPS, legal highs, club drugs
• ‘New psychoactive substances’ (NPS) are drugs which mimic, or are claimed to mimic, the effects of illegal drugs. They are either ‘new’ or ones that until recently were little used in the UK.
• ‘Legal highs’ – see above. Although marketed as legal, this doesn’t mean that they are safe or approved for people to use. They are still normally considered illegal to sell under medicines legislation. Some drugs marketed as legal highs actually contain some ingredients that are illegal to possess.
• ‘Club drugs’ is a collective term for a number of old (e.g. ecstasy, ketamine, methamphetamine and GHB/GBL) and new drugs (e.g. mephedrone) typically used by people in bars and nightclubs, at concerts and parties
• ‘Blah, Blah, Blah’: All these terms are often used interchangeably even in official reports
Ricky Bhandal@ranjitbhandal
Past / Present Topical Legal Highs• BZP Benzylpiperazine – De-worming for animals• MPTP - Parkinson's• Neo Dove 3• Neo Malt• Methadrone – Similar to Mephedrone • Khat• MDPV – focused > Cocaine > annoying• Methylone (M1) – More Ecstasy feel £16 and £20 per gram • Butylone – Similar to other Cathinones
Ricky Bhandal@ranjitbhandal
NRG-1 Prices
•1 grams - £20
•2 grams - £30
•10 grams - £100
•100 grams - £550
•500 grams - £1500
•1kg - £2800
Ricky Bhandal@ranjitbhandal
Who’s to blame? Social Media
• Twitter• Facebook• Youtube• Erowid• Bluelight• Drugs Forum• http://youtu.be/VMZngerFxjs
Ricky Bhandal@ranjitbhandal
New psychoactive substances – stocktake
• New psychoactive substances (NPS) are emerging at an unprecedented rate, though treatment numbers are small
• NPS (typically sold as ‘legal highs’) may contain substances that are not legal or even safe. The availability of these substances, especially over the internet and in ‘head shops’, has radically changed the nature of the drugs market.
• UK purchases 4 x more NPS than any other European country (EMCDDA 2012)• Increasing public and government concern• Heavy use can lead to acute health harms and dependency• Little information on new NPS and their associated health risks – surveillance
data takes time to catch up • Problems can be treated, but treatment/GUM services need to be vigilant and
adapt
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Ricky Bhandal@ranjitbhandal
Health risks and dependence-forming potential
• Users also tend to binge on NPS. As a result, they are more likely to show up at A&E or their GP surgery reporting acute health effects such as heart irregularities or feeling paranoid.
• Evidence suggests a minority will use compulsively and develop a psychological dependence that requires treatment. We don’t yet understand why some people develop problems and others don’t
• NPS can kill, very risky when used with alcohol/other sedatives. • Injecting: NPS mostly not injected, but increasing concern about the
injection of mephedrone and methamphetamine• Heavy use can develop into a dependency
Ricky Bhandal@ranjitbhandal
Treatment
• Treatment should typically involves psychosocial interventions, which address basic motivation and prevent relapse.
• Promote reliance on core drug working competences, dealing with the individual and HR advice that fits the main 'clusters' of drugs (e.g. encourage services to focus on people not the drugs they are using)
• Support improvements in needs assessment, commissioning and provision for NPS
• Commitment to disseminate NPS clinical guidelines (NEPTUNE) • Encourage better links between treatment, health and sexual health
Ricky Bhandal@ranjitbhandal
6 Ways to Deal with NPS
• Acknowledge ignorance
• Work symptomatically
• Share Knowledge
• Cluster Drugs
• Keep sight of skill sets
• Get tech savy
Open forum for questionsfollowed by coffee
Tackling the spread of New Psychoactive Substances
Integrating legal highs into wider education & prevention interventions
Professor Harry SumnallLiverpool John Moores University
Tackling the spread of New Psychoactive Substances
The role of the criminal justice system
D.Supt. Jason Hudson, TITAN
Tackling the spread of New Psychoactive Substances
Open forum for questions followed by lunch
Tackling the spread of New Psychoactive Substances
Public health messages & working with young people
Andrew Brown,Drugscope
Tackling the spread of New Psychoactive Substances
NPS Education and PreventionA tricky balance
Photo by Flickr user stephenjohnbryde
A visible presence
Awareness, knowledge and general attitudes towards “legal highs” amongst UK students
• Survey of 446 students between ages of 13 and 30 in UK (mean age 19, median 18 years) carried out online, late 2010.
• 82% said they had heard of ‘legal highs’, of which 79% offered correct definition (5% wrong)
• 31% lifetime use– 41% mephedrone, – 20% salvia, – 11% ‘spice’, – 16% “don’t know”
• Over half (51%) knew ‘some’ contain illegal or controlled components
• Three in four (74%) said they didn’t consider them safer than illicit drugs
• Of those who had used a ‘legal high’ over half (53%) said the legal status makes no difference to their likelihood of using the drugs, one in four said it would make them less likely to use, and 4% said it would make it more likely.Source: Corazza, O. et al. “Legal highs”: safe and legal “heavens”? A study on the diffusion, knowledge and risk awareness of novel
psychoactive drugs among students in the UK, Riv Psichiatr 2014; 49(2): 89-94
What do we know about young people’s use of NPS• Crime Survey for England and
Wales found young adults, aged 16 to 24:– 7.6% had taken nitrous oxide in the
last year– 1.8% had taken salvia in the last
year
• Global Drug Survey – 20.4% had taken nitrous oxide in
the last year– 10.9% had taken ‘mystery white
powder’ in the last year– c.13% said they had taken a legal
high/research chemical/synthetic cannabis & electronic THC
Photo by Flickr user Yaniv Golan
Young People in Treatment for ‘Club Drugs’
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-130
500
1000
1500
2000
2500
Ketamine Ecstasy MephedroneSource: Young People’s Statistics from the National Drug Treatment Monitoring System (NDTMS), Public Health England (2013)
DrugScope’s Street Drug Survey 2013
• Mephedrone-type stimulant drugs were popular with older teenagers;
• Younger teenagers were more attracted by the synthetic cannabinoids
substances with lurid names such as Clockwork Orange and Exodus Damnation;
• Few young people bought drugs online, but were able to buy not only from head
shops, but a range of high street outlets including petrol stations and take-away
food shops, especially in the north of England;
• While few young people were coming forward to treatment services, outreach
workers told a different story about patterns of use and of young people at risk
of serious health consequences.
NOT JUST ABOUT YOUNG PEOPLEBut remember it’s
Other groups and settings to think about:• LGBT – especially MSM• Complex needs clients (mental health,
homelessness, criminal justice• Prisons• Students• Clubs & some clubbers
WHAT SHOULD WE DO?
Photo by Flickr user Ian Page-Echols
A life course approach
Source: Davies, S.C. “Annual Report of the Chief Medical Officer, Volume One, 2011, On the State of the Public’s Health” London: Department of Health (2012)
And for NPS specifically?
• Increase our understanding of prevalence – use, harms and at risk groups
• Ensure NPS covered in wider personal social and health education
• Think beyond schools and universities– Environment, Community, Family, Workplace
• Tailored messages to reduce harms• Develop and learn from evidence• Understand routes into specialist services
And things we might want to avoid
• Messages that focus on the most extreme outcomes– May work for least likely to use, but it boomerangs
for contemplators and dabblers• Harsh and inconsistent punishment• Knowledge on its own
– Skills and character essential
Thank you
Andrew BrownDirector of Policy, Influence and EngagementDrugScope
The Club Drug ClinicDr Owen Bowden-Jones
Tackling the spread of New Psychoactive Substances
Quick tea break
Tackling the spread of New Psychoactive Substances
Working towards a safer nightline
Marc BlanchetteB Chilled – Phoenix Futures
Tackling the spread of New Psychoactive Substances
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
The B-Chilled team
Marc Blanchette - Community Health Champions Project Manager
Olivia Hemsoll – Outreach Support Worker
The project is also supported by a large group of Community Health Champion volunteers whoare selected and trained especially for the service
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
Background to B-Chilled
There has been a decline in the traditional treatment cohort of heroin and crack users, and a rise in the use of ‘club drugs’, ‘legal highs’, ‘recreational’ or ‘party drugs’.
This has highlighted fresh challenges to those involved, and working, in the night-time environment and traditional treatment services, as a result there has been a need for new approaches to tackle these changes.
In response, Phoenix Futures working in partnership with Public Health England, developed the Community Health Champion’s B-Chilled Project. The project’s aims are also supported by Birmingham City Council and the West Midlands Police.
Since the project’s commencement it’s remit has widened to include alcohol, sexual health and personal safety.
The identified areas of focus of the B-Chilled project are:
• Digbeth• Southside (Arcadian and Hurst Street)• Northside (Broad Street)
B-Chilled provide the following services:
• Club & Pub Interventions – providing harm reduction guidance to help people access information, support and advice on recreational drugs, alcohol, sexual health and personal safety.
• Superclub & Festival Work – creating ‘Chill-Out Spaces’ and providing welfare and harm reduction services to help people access drug information, advice and immediate support.
• Health & Community Fairs – providing information stalls at open days and community events.
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
B-Chilled Volunteers
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
•Volunteers are known as Community Health Champions
•We have 70 trained volunteers so far, with more coming through
•Volunteers undertake a minimum of 16 hours intensive training in drugs, alcohol, sexual health and outreach & engagement skills
• Volunteers are supported and supervised by paid staff whilst delivering outreach sessions
• Longer term volunteers are now taking on the role of Lead Volunteer and will soon be supervising teams themselves
How does B-Chilled operate?
• Outreach sessions in clubs & pubs, community events and festivals• Professional, friendly, relaxed and experienced outreach teams• Targeted interventions – drugs (particularly ‘legal highs’), alcohol, safe
sex, personal safety• Quality referrals into treatment providers & ongoing support – one to one,
telephone, via social media
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
How does B-Chilled operate? • A regular outreach sessions in NTE• ‘Chill Out’ space in venues• Works with Universities and Student Guilds • Partnerships with key NTE stakeholders• Brief interventions & quality referrals
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
• Via training and on-going support from the B-Chilled project, venue managers and event promoters can better prevent and manage drug related incidents.
B-Chilled benefits venues in Birmingham's night time economy by providing....
• Free service• Proactive approach to customer safety• Staying up to date with changing drug trends• Extra staff who contribute to monitoring and maintaining safety• Enhancement of customer experience in Birmingham's NTE• Prevention or reduction of incidents and risk• Confidentiality• Assistance in developing a bespoke and workable drugs policy• Training for door and venue staff
(Source:http://www.safernightlife.org/pdfs/digital_library/uk_safer_nightlife_guideline.pdf)
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
Training for ProfessionalsThe project offers up to date in-depth training around drug use aimed at professionals who work within the night-time economy. These include:
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
• Door supervisors
• Security Staff
• Bar and club staff
• Club and pub managers
• Event/club promoters
• Street & Taxi Wardens
Training for Professionals
The training covers:
• The rise in use of ‘Legal Highs’ and other new drugs• Descriptions of products that are used to bypass current legislation• Recent changes in legislation with regard to these emerging substances• An over view of the effects and risks posed by the use of new drugs and
other legal substances• Statistics on current usage across the UK• Developing workable drug policies to help deal with the use of these
substances in clubs and pubs• Responding to emergencies that involve the use of these substances
The training can give workers valuable information to help them understand the issues and engage with clubbers. This will help reduce the risks posed to them by their use of substances whilst out enjoying the night-time economy. Ultimately this intervention could even save lives
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
Club Drugs/NPS
• Anything used to “party” – pubs, clubs, parties, raves, festivals, events, private
• Not ‘traditional’ drug service presentations (e.g. heroin and crack)
• Established drugs: ecstasy, cocaine, ketamine, speed, crystal meth
• Newer drugs: GBL, mephedrone• ‘Legal highs’: ‘Ivory Wave’, ‘Spice’, ‘Benzo Fury’
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
Why are we concerned?• Small number experiencing significant harms• Use of NPS can result in acute toxicity and serious harm. It can
also result in people putting themselves in situations where they may be vulnerable or at risk of other harms (e.g. through collapse, intoxication, etc) including accidents and being victims of crime (e.g. sexual or physical assault).
• Numbers in treatment increasing• Concern of ‘time-lag’ between using and problematic use• ‘Legal highs’ – no evidence base• The harms of NPS are multi-faceted and may be physical (intrinsic
to the drug) or social in nature.
B-Chilled‘Supporting a Safer Nightlife in Birmingham
New challenges• New drugs, with less information• Different (greater) harms• Dependence• At risk behaviour• Delivered in club drug-specific, or club drug-
aware locations• Ever changing substances
B-Chilled‘Supporting a Safer Nightlife in Birmingham
Who are B-Chilled engaging with?• Typically different profile to traditional drug
services• Higher functioning• Less likely to have criminal record• Students & Urban clubbers• Respond well to treatment – ‘recovery capital’• Triggers include arrest & negative experience
whilst using
B-Chilled‘Supporting a Safer Nightlife in Birmingham’
Further information …..
Marc Blanchette - Community Health Champions Project Manager: 07966 874776 or [email protected] Hemsoll – Outreach Support Worker: 07817 423963 or [email protected]
Office: Phoenix Futures, 2nd Floor, Ruskin Chambers, 191 Corporation Street, Birmingham, B4 6RP. Tel: 0121 212 1122 Facebook page: B Chilled BirminghamTwitter: @BChilledBhamWeb: www.phoenix-futures.org.uk
Key actions going forward
Simon Claridge, Mentor
Tackling the spread of New Psychoactive Substances
Alcohol and Drug Prevention
Creating positive change for children and young people
Photo by Flickr user Jon McGovern
“Societies tend to make a small investment in prevention and, on average, they reap a small return.”
Drug and Public Policy Group
Drugs and Public Policy Group (2010), Drug Policy and the Public Good: a summary of the book. Addiction, 105: 1137–1145. doi: 10.1111/j.1360-0443.2010.03049.x
Why we need early interventions
Early Childhood Adulthood
Leve
l of
Pro
blem
Beh
avio
rs
Trajecto
ry of P
roblems/
Increasing C
osts
Source: PriceWaterhouseCoopers
Age 21, cost per person already = £91 - £121k
£827,000Lifetime cost of male problem drug user
between the ages of 10 to 17 years associated with:• 80,640 violent offences per year, and• 27,200 property offenses per year
between the ages of 15 to 16 years is associated with:• 195,000 accidents or
injuries per year,• 39,000 hospitalisation or
admissions to A&E per year, and
• 104,000 cases of unprotected sex per year
Young people’s drinking behaviour
57,616 14-16 year olds have truanted 5 or more times in their lifetime because of excessive alcohol consumption
39,000 15-16 year olds performing poorly or badly at school as a result of their drinking behaviours
Source: Jones, L. et al: A review of the effectiveness and cost-effectiveness of interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old (ADDENDUM Additional economic evidence prepared for the Public Health Interventions Advisory Committee (PHIAC)) (2007)
The Life Course Approach
CM
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nnu
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epor
t: 2
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‘On
the
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e of
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pu
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’s h
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’
What we do
What we knowworks
What we do that we know works
What we do that we know doesn’t work
The Olive of Prevention
Adapted from Harry Rutter, director of the National Obesity Observatory
Traditional perspective on prevention
• Emphasising the harms (health and social) will disincentivise use.
• Young people given enough information will make rational decisions about their health.
• One off interventions are enough.
• Prevention = school drug and alcohol education/posters/TV adverts.
We need to change our perspective
Research has shown• Cautionary stories• Information• Focus on harm or fear• Harsh or inconsistent
punishment
Don’t work
Case study – Scared Straight
• Programme assumes that by showing ‘reality’ of the criminal justice system young people will want to avoid it
• Unfortunately trials of the interventions have shown:
the ‘Scared Straight’ programme actually increased the risk of offending in the juveniles in the intervention group compared with juveniles in the control group
• The Social Research Unit calculated that for every child it is delivered to (£55) it costs a further £14,268 to put right.
Scared Straight and Other Juvenile Awareness Programs for Preventing Juvenile Delinquency: A Systematic Review of the Randomized Experimental Evidence, The ANNALS of the American Academy of Political and Social Science September 2003 vol. 589 no. 1 41-62
Settings
Photo by Flickr user Collin Key Photo by Flickr user adwriter Photo by Flickr user loop_oh
Environment Family School Community
Setting and SystemsEnvironment
Family
School
Community
Photo by Flickr user Australian Govt.
Universal vs. Targeted
Photo by Flickr user Collin Key Photo by Flickr user CliffMuller
Delivered to all regardless of risk.Examples include: • school prevention programmes• public health media campaigns
Photo by Flickr user Ian Freimuth
Delivered to higher risk groups. Examples include:• Family and parenting
programmes• Screening and brief intervention
Case Study – Preventure
• Two or three session targeted programme based on personality type; sensation-seeking, impulsivity, anxiety-sensitivity, and hopelessness
• Outcomes– 40% decreased risk of alcohol
consumption in the intervention group, 55% decreased risk of binge-drinking.
• Need to Treat of twoO’Leary-Barrett M, Mackie CJ, Castellanos-Ryan N, Al-Khudhairy N, Conrod PJ. Personality-Targeted Interventions Delay Uptake of Drinking and Decrease Risk of Alcohol-Related Problems When Delivered by Teachers. J. Am. Acad. Child Adolesc.Psychiatry, 2010;49(9):954 –963
Photo by Flickr user Micah & Erin
So why not just target?
Low Risk – 10% chance
Medium Risk – 40% chance
High Risk – 60% chance
Case Study – Good Behaviour Game
• Classroom strategy for 6 – 8 year olds. Programme assumes that early socialisation into school is protective.
• Outcomes:– Doing well in school– Good behaviour– Not using substances– Not depressed– No suicidal ideation
• SRU benefit to cost ratio shows for every £1 invested £26 is returned. Photo by Flickr user Philippe Put
UN Drug Prevention Model
Nuffield Foundation: The wisdom of the crowd - 65 views of the NHS at 65 (2013)
Contact Details
Mentor1st Floor, 67-69 Cowcross StreetLondon EC1M 6PU
020 7553 9920
@SiClaridge; @MentorTweets; @MentorADEPIS
www.mentoruk.org.uk
End of conferencePlease hand in your badges and feedback
forms as you leaveThank you and have a safe journey home
Tackling the spread of New Psychoactive Substances
