Novel psychoactive substance use by mental health service consumers: an online survey of inpatient health professionals’ views and experiences

Purpose: There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The aim of the study was to undertake a scoping survey to explore inpatient mental health workers' perceptions of NPS use by consumers. Design/methodology: A cross-sectional online survey of mental health professionals. Participants were opportunistically recruited through social media and professional networks. Findings: A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90% of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. Participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with. Research Limitations/Implications: Whilst we are cautious about the generalizability (due to methodological limitations), our findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding impact on mental and physical health, as well as ease of availability and a need for specific training and guidance. Practical Implications: Mental health professionals require access to reliable and up to date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included. Originality/value: To the best of our knowledge this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS.The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems

Reducing drug related deaths : a pre-implementation assessment of knowledge,barriers and enablers for naloxone distribution through general practice

Peer reviewedPublisher PD

Drug policy constellations: A Habermasian approach for understanding English drug policy

Background: It is increasingly accepted that a view of policy as a rational process of fitting evidence-based means to rationally justified ends is inadequate for understanding the actual processes of drug policy making. We aim to provide a better description and explanation of recent English drug policy decisions. Method: We develop the policy constellation concept from the work of Habermas, in dialogue with data from two contemporary debates in English policy; on decriminalisation of drug possession and on recovery in drug treatment. We collect data on these debates through long-term participant observation, stakeholder interviews (n=15) and documentary analysis. Results: We show the importance of social asymmetries in power in enabling structurally advantaged groups to achieve the institutionalisation of their moral preferences as well as the reproduction of their social and economic power through the deployment of policies that reflect their material interests and normative beliefs. The most influential actors in English drug policy come together in a ‘medico-penal constellation’, in which the aims and practices of public health and social control overlap. Formal decriminalisation of possession has not occurred, despite the efforts of members of a challenging constellation which supports it. Recovery was put forward as the aim of drug treatment by members of a more powerfully connected constellation. It has been absorbed into the practice of ‘recovery-oriented’ drug treatment in a way that maintains the power of public health professionals to determine the form of treatment. Conclusion: Actors who share interests and norms come together in policy constellations. Strategic action within and between constellations creates policies that may not take the form that was intended by any individual actor. These policies do not result from purely rational deliberation, but are produced through ‘systematically distorted communication’. They enable the most structurally favoured actors to institutionalise their own normative preferences and structural positions

Drug Policy Governance in the UK: Lessons from changes to and debates concerning the classification of cannabis under the 1971 Misuse of Drugs Act

Background Drugs policy is made in a politically charged atmosphere. This is often not seen to be conducive to the ideals of evidence-based policymaking. In the UK over recent years the efficacy of the 1971 Misuse of Drugs Act (MDA) has been one of the most widely discussed and debated areas of UK drug policy. Since inception, the MDA 1971 has remained relatively stable with very few drugs moving up or down the scale and until recently, and with very few exceptions, there has been little public debate on the nature of the system. This changed in the run up to the cannabis reclassification in 2004 from class B to class C, through the reverse of this decision in 2009 and the fallout between the Government of the time and leading members of the Advisory Council of the Misuse of Drugs. Methods Based on wide-ranging survey of the literature and secondary analysis of various official publications and academic commentaries, this paper considers what the cannabis episode can tell us about the current state of UK drug policy governance. Results Previous research on drug policy governance has suggested that policy goals should be clearly articulated so as to avoid confusion over what constitutes evidence, decision-makers should be ‘evidence-imbued’ and there should be widespread consultation with, and transparency of, stakeholder engagement. The interpretation here is that recent changes to cannabis legislation reveal that these aspects of good governance were called into question although there were fleeting moments of good practice. Conclusion The use of evidence in drug policy formulation continues to be bedevilled by political stalemate and reluctance to countenance radical reform. Where evidence does play a role it tends to be at the margins. There are, however, potential lessons to be learned from other policy areas but this requires a more pragmatic attitude on behalf of decision-makers