Consideration of the novel psychoactive substances (‘legal highs’)

Original report can be found at: http://www.homeoffice.gov.uk/ Crown Copyright, the Advisory Council/ The Home Office. This work is published under an open government license.The Advisory Council on the Misuse of Drugs (ACMD) committed to providing the Government with advice on novel psychoactive substances (often colloquially termed „legal highs‟). This is a relatively recent phenomenon, exemplified by the drug known as mephedrone. The actions by the ACMD and subsequently by the Government on this drug have gone some way to reducing the potential harms caused by this substance. However, there is more that can be done. The advent of novel psychoactive substances has changed the face of the drug scene remarkably and with rapidity. The range of substances now available, their lack of consistency and the potential harms users are exposed to are now complex and multi-faceted. In light of this we have pleasure in enclosing the Council‟s report. This report provides advice on high level issues that ACMD believe the Government should give careful consideration to in addressing legally available psychoactive substances. The report does not purport to provide a single solution to the problem, but rather a number of practicable options that, in combination, seek to tackle the on-going sale, supply and consequential harms. It is important that the Government recognises that each and every department, that has a locus of responsibility in drug issues should both take personal ownership and share collective responsibility of the recommendations in this report. Tackling the issues that are raised by novel psychoactive substances requires a co-ordination of efforts that can only be realised by a strategic and co-operative approach. The ACMD has identified lead departments for each of the recommendations that should assist and guide the Government in this aim. The ACMD provides key recommendations in this report on legislation, public health, education and research. The key legislative measures are primarily concerned with tightening the enforcement of existing legislation and moving the responsibility for the supply of novel psychoactive substances to the vendors, such that the burden of proof falls to them. The ACMD believe it is for vendors to prove that such substances are neither analogues of current medicines nor products harmful to consumers in their intended form. The ACMD also makes key recommendations around public awareness from local to international initiatives.Final Published versio

Characteristics of drug users who do or do not have care of their children

Aims - To compare the relative frequency of eight indicators of problem drug use and potentially adverse social circumstances in drug using parents and non-parents and to explore whether a profile based on these characteristics differs according to whether or not dependent children live with their drug-using parent. Design – The study utilises a 5-year national UK treatment monitoring system dataset. Sample – 61,425 users with, and 105,473 without dependent children accessing drug treatment services in England and Wales between January 1996 and December 2000. Measurements – Information about parenthood and children’s residence was routinely collected. Drug use and social circumstance indicators were daily heroin use, daily alcohol use, regular stimulant use, sharing of injecting equipment, living with another user, living alone, unstable accommodation, and criminal justice referral. Findings – There were clear differences between drug using parents according to where children live. Parents with children at home and non-parents showed fewer of the indicators than parents with children in care or elsewhere. Sixty-five percent of parents with none of the indicators lived with their children, compared to only 28% of those with three indicators and 9% of those with six or more indicators. Parents with children in care or living elsewhere showed the highest prevalence for each individual indicator. Conclusions – Drug using parents demonstrate a range of potentially unfavourable drug use behaviours and social circumstances but those whose children live with them use drugs less frequently and live in more favourable conditions than those whose children live elsewhere. Protective factors may operate in family situations while severe drug use and adverse social circumstances may result in a breakdown of family structures

Factors predicting drop out from, and retention in, specialist drug treatment services: A case control study in the North West of England

<p>Abstract</p> <p>Background:</p> <p>In the United Kingdom (UK), the National Treatment Agency for Substance Misuse (NTA) considers retention to be the best available measure of drug treatment effectiveness. Accordingly, the NTA has set local treatment systems the annual target of retaining 75% of clients for 12 weeks or more, yet little assessment of this target or factors that improve retention has occurred. This study aims to quantify the proportion of people retained in treatment for 12 weeks in the North West of England and to identify factors associated with premature drop out.</p> <p>Methods:</p> <p>The North West National Drug Treatment Monitoring System (NDTMS) was used to identify treatment durations for everyone beginning a treatment episode between 1^stApril 2005 and 31^stMarch 2006 (N = 16626). Odds ratios, chi-square and logistic regression analyses compared clients retained for 12 weeks to clients whose discharge record showed they had prematurely dropped out before 12 weeks. Individuals with other outcomes were excluded from analyses.</p> <p>Results:</p> <p>75% of clients (N = 12230) were retained for 12 weeks and 10% (N = 1649) dropped out prematurely. Multivariate analysis showed drop out was more likely among Asian drug users (adjusted odds ratio 1.52, 95% CI 1.12 to 2.08) than their white equivalents. Drop out was more likely among residents of Cumbria and Lancashire (adjusted odds ratio 1.80, 95% CI 1.51 to 2.15) and Greater Manchester (adjusted odds ratio 2.00, 95% CI 1.74 to 2.29) than Cheshire and Merseyside and less likely among alcohol users (adjusted odds ratio 0.73, 95% CI 0.59 to 0.91). A significant interaction between age and deprivation was observed. For those aged 18 to 24 years and 25 to 34 years, drop out was significantly more likely among those living in affluent areas. For those in the older age groups the converse effect was observed.</p> <p>Conclusion:</p> <p>In combination, the drug treatment systems of the North West achieved the Government's retention target in 2005/06. A number of factors associated with drop out were identified; these should be considered in strategies that aim to improve retention. Drop out and retention are measures that capture the joint effect of many factors. Further work is required to evaluate the effect of deprivation.</p

"Spice", "Kryptonite", "Black Mamba": An overview of brand names and marketing stragtegies of Novel Psychoactive Substances on the Web

Novel Psychoactive Substances (NPSs) are often sold online as “legal” and “safer” alternatives to International Controlled Drugs (ICDs) with captivating marketing strategies. Our aim was to review and summarize such strategies in terms of the appearance of the products, the brand names, and the latest trends in the illicit online marketplaces. Methods: Scientific data were searched in PsychInfo and Pubmed databases; results were integrated with an extensive monitoring of Internet (websites, online shops, chat rooms, fora, social networks) and media sources in nine languages (English, French, Farsi, Portuguese, Arabic, Russian, Spanish, and Chinese simplified/traditional) available from secure databases of the Global Public Health Intelligence Network. Results: Evolving strategies for the online diffusion and the retail of NPSs have been identified, including discounts and periodic offers on chosen products. Advertisements and new brand names have been designed to attract customers, especially young people. An increased number of retailers have been recorded as well as new Web platforms and privacy systems. Discussion: NPSs represent an unprecedented challenge in the field of public health with social, cultural, legal, and political implications.Web monitoring activities are essential for mapping the diffusion of NPSs and for supporting innovative Web-based prevention programmes.Peer reviewedSubmitted Versio

Excess overdose mortality immediately following transfer of patients and their care as well as after cessation of opioid substitution therapy

Aims: To investigate clustering of all-cause and overdose deaths after a transfer of patients and their care to alternative treatment provider and after the end of opioid substitution therapy (OST) in opioid-dependent individuals in specialist addiction treatment. Design, Setting and Participants: Mortality data were identified within a sample of 5,445 patients with opioid use disorder who had received OST treatment between 1st April 2008 and 31st December 2013 from a large mental healthcare provider in United Kingdom. We investigated the circumstances and distribution of the 332 deaths identified within the observation window with a specific focus on overdose deaths (n=103) after a planned discharge, drop-out and transfer between services. Measurements: Crude mortality rates for overdose mortality 7/14/28/180 days after the end of treatment/transfer for overdose mortality. Findings: Of 47 individuals who died from overdose after having been transferred between services, 9 died in the first 2 weeks (crude mortality rate [CMR] 136.4, 64.3 – 243.1 95% CI) and a further 5 died in the first month post-transfer (CMR 79.5, 44.2 – 129.7 95% CI). Of the 32 individuals who died from overdose after planned OST cessation, 5 died in the first 2 weeks (CMR 151.5, 51.1 – 319.0 95% CI) and a further 4 died in the first month post discharge (CMR 82.6, 38.4 – 151.0 95% CI). Conclusions: In the UK, opioid-dependent people who are transferred to an alternative treatment provider for continuation of their opioid substitution therapy experience high overdose mortality rates, with substantially higher rates in the first month (especially first 14 days) following transfer

A Qualitative Study of an Integrated Maternity, Drugs and Social Care Service for Drug-using Women

Background: The care of drug-using pregnant women is a growing health and social care concern in many countries. A specialist clinic was established offering multidisciplinary care and advice to pregnant drug users in and around Aberdeen (UK) in 1997. The majority of women stabilise and reduce their drug use. By determining the needs and views of the women more appropriate services and prevention strategies may be developed. There has been little research conducted in this area and none in Scotland. Methods: This is a qualitative study that aimed to gain an understanding of the experiences of women drug users, seeking and receiving prenatal care and drug services from a specialist clinic. Twelve women participated in semi-structured one-to-one interviews. Results: The women preferred the multidisciplinary clinic (one-stop shop) to traditional prenatal care centred within General Practice. The relationships of the clients to the range of Clinic professionals and in hospital were explored as well as attitudes to Clinic care. The study participants attributed success in reducing their drug use to the combination of different aspects of care of the multi-agency clinic, especially the high level prenatal support. It is this arrangement of all aspects of care together that seem to produce better outcomes for mother and child than single care elements delivered separately. Some women reported that their pregnancy encouraged them to rapidly detoxify due to the guilt experienced. The most important aspects of the Clinic care were found to be non-judgemental attitude of staff, consistent staff, high level of support, reliable information and multi-agency integrated care. Conclusion: There is an impetus for women drug users to change lifestyle during pregnancy. The study highlighted a need for women to have access to reliable information on the effects of drugs on the baby. Further research is required to determine whether positive outcomes related to clinic attendance in the prenatal period are sustained in the postnatal period. Early referral to a specialist clinic is of benefit to the women, as they reported to receive more appropriate care, especially in relation to their drug use. A greater awareness of needs of the pregnant drug user could help the design of more effective prevention strategies

The ‘drug policy ratchet’: why do sanctions for new psychoactive drugs typically only go up?

It has been much more common for drugs to be subjected to tighter rather than looser control as drugs and evidence about their effects have has emerged. We argue that there is in place a drug policy ratchet which subjects new psychoactive substances (NPS) to increasing control through the continuation of historical patterns that involve the attribution to emerging drugs of guilt by three different kinds of association: guilt by deviant association; guilt by lunatic association; and guilt by molecular association. We use our contemporary ethnographic experience of drug policy-making to show how these processes continue to be applied to policy on NPS, alongside selective, narrative use of evidence and the ‘silent silencing’ by absorption of the concept of evidence-based policy. We show that the drug policy ratchet cannot be justified as an example of the precautionary principle in action, as this principle is itself not rationally justified. We conclude that recognition of the drug policy ratchet and its mechanisms may help researchers and policy-makers to improve regulation of NPS

Deaths of individuals aged 16-24 years in the UK after using mephedrone

Objective: Mephedrone is a stimulant drug chemically related to amphetamine, with effects similar to those of amphetamine and cocaine. This study aims to analyse fatalities following ingestion of mephedrone in the UK amongst 16-24 year olds in 2009-13, providing an update on data presented at the 2nd International Conference on Novel Psychoactive Substances. Methods: A literature search was undertaken to identify published information on pharmacology, toxicity, and fatalities associated with mephedrone. Fatalities involving mephedrone were extracted from the National Programme on Substance Abuse Deaths database, which receives information on drug-related deaths from Coroners in the UK and Islands and other data suppliers. Selection criteria: deceased aged 16-24 at time of death; mephedrone directly implicated in the cause of death and/or mentioned in the Coroner’s verdict. Results: Thirty cases met the study criteria and, when known, all were of White ethnicity, most (85%) had a history of drug use and 73% were male. Two-thirds (63%) were accidental poisonings. Mephedrone was used with other substances in most cases (87%); other substances were implicated in 60% of deaths. Conclusions: Mephedrone use can have potentially fatal consequences, especially in combination with other substances. Deaths in the 16-24 years age-group continue to occur from its use in the UK, despite it being a controlled drug. Health professionals and potential consumers should be alert to this risk.Peer reviewe

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.

We examined intervention effectiveness of strategies to prevent image- and performance-enhancing drug use. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow-up times. However, studies with components in addition to information provision may be more promising. Interventions outside of sport settings are required to reflect the transition of this form of substance use to the general population