tag:theconversation.com,2011:/us/topics/new-psychoactive-substances-20378/articlesNew psychoactive substances – The Conversation2022-09-28T10:46:37Ztag:theconversation.com,2011:article/1911752022-09-28T10:46:37Z2022-09-28T10:46:37Z‘Gutter water’, ‘monkey tail’ and smoked faeces: new dangers on Nigeria’s drug scene<figure><img src="https://images.theconversation.com/files/486064/original/file-20220922-15282-eqedpv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some people take the new drugs to prolong sex.</span> <span class="attribution"><span class="source">PIUS UTOMI EKPEI/AFP via Getty Images</span></span></figcaption></figure><p>New, unconventional drugs are <a href="https://www.emerald.com/insight/content/doi/10.1108/DAT-02-2020-0003/full/html">becoming popular</a> in Nigeria, designed by dealers and users to replicate the effects of illegal substances like cannabis, cocaine, and ecstasy. They affect how the brain works and cause changes in mood, feelings and behaviour. Policymakers have labelled them as “new psychoactive substances” because they’re not recognised under international conventions. </p>
<p>These psychoactive substances are found all over the world, and they’re growing in popularity. But little empirical research has been conducted on the uptake of these new drugs in many non-western contexts, especially in Africa. More information is needed because using substances like these is harmful to health. Policymakers need proper evidence regarding their availability, use, and effects to provide evidence-based interventions.</p>
<p>It appears that people in Nigeria are creating new drugs either because they can’t afford more traditional narcotics, or because they’re not controlled (and therefore difficult to detect), or because they’re strong.</p>
<p>As my colleagues and I documented in <a href="https://www.sciencedirect.com/science/article/pii/S2667118221000064">a mini review of recent insights on the topic</a> in Nigeria, most new psychoactive substances are extremely potent. Some drug users prefer them to conventional narcotics because they want to experience a more intense and longer high. </p>
<p>We also found that some people will take these substances – such as tramadol – to give them more energy for hard labour. Others use them because they want to last longer during sex. </p>
<p>These new psychoactive substances pose a public health threat, but because they’re new and not easy to detect, they are not controlled – for instance, by the <a href="https://www.unodc.org/unodc/en/treaties/single-convention.html?ref=menuside">1961 Single Convention on Narcotic Drugs</a> or the <a href="https://www.unodc.org/unodc/en/treaties/psychotropics.html?ref=menuside">1971 Convention on Psychotropic Substances</a>. </p>
<p>Traditional drugs – like cannabis, cocaine, and ecstasy – are controlled under these conventions, making them easier to detect, categorise and regulate internationally. </p>
<p>Studies that reveal more about the substances being used in Nigeria and their effects on users will help inform public health interventions.</p>
<h2>Types of drugs</h2>
<p>New psychoactive substances exist all over the world, and they’re growing in popularity. The United Nations Office on Drugs and Crime identified <a href="https://www.unodc.org/LSS/Announcement/Details/eff8dc38-7ab0-42b0-8cd9-753b89953fcc">almost 900</a> new substances between 2009 and 2018. These were found across 119 countries and territories, in all regions of the world.</p>
<p>In western countries, people use synthetic opioids, like tramadol and fentanyl, and synthetic cannabinoids. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2667118221000064">Our mini-review</a> of empirical studies conducted in different parts of Nigeria mapped the types, availability, and motivations for taking these new psychoactive substances.</p>
<p>In Nigeria, aside from a few imported new psychoactive substances like tramadol, most of them are locally sourced and can be obtained free of charge or at a low cost. </p>
<p>There’s a cocktail called “gutter water”, which is made from a mix of tramadol, cannabis, codeine and vodka. Other popular cocktails include “monkey tail” – a combination of homemade spirit, cannabis and psychoactive plant roots, seeds and stems – or a mixture of sodium hypochlorite solution (bleach) and carbonated soft drinks. </p>
<p>There are also pure plant-based substances. Some people will chew or smoke dried cassava and pawpaw leaves or seeds, zakami (<em>Datura metel</em>) seeds, and moringa (zogale) leaves.</p>
<p>Other popular ways to get psychoactive effects involve sniffing burnt tyres, hydrogen sulphide gas (sewer gas), or nail polish. </p>
<p>There are other new substances that people who are desperate or very poor try to use, but it is unknown whether these produce psychoactive effects that can get them high. These include smoking the whitish elements of lizard dung or human faeces. Others will drink 10-day-old human urine for the same reason. </p>
<h2>Addressing the issue</h2>
<p>Although research on the harms caused by using new psychoactive substances is at an early stage in Nigeria, <a href="https://www.tandfonline.com/doi/abs/10.1080/10911359.2020.1790462">one study</a> found that some tramadol users experienced seizures or convulsions after taking the substance, and a few users died from a drug overdose.</p>
<p>Because drug availability <a href="https://www.tandfonline.com/doi/abs/10.1080/10911359.2020.1790462">often correlates</a> with high drug use, it’s logical to say that without strategies to address the new drugs, their use may continue to rise. </p>
<p>Therefore, there is a need to initiate a strategy to address the issue. This must be underpinned by sound research. There must be comprehensive data that maps the availability, types, patterns, and motives for taking these new drugs among Nigerians.</p>
<p>A nationwide campaign will be essential. It must give young people the information they need on the dangers of substance use. </p>
<p>Credible government sources like the National Orientation Agency of Nigeria and the Ministry of Health should champion this effort. Campaigns should aim at deterring people from ever trying new psychoactive substances. Efforts must also be made to reorient those who already use the substances without stigmatising them. </p>
<p>For the campaign to be successful, the Nigerian police and other law enforcement agencies that often use intimidation and <em>war on drug</em> approaches to enforce laws should be distanced. This is primarily because brutalising drug users <a href="https://www.tandfonline.com/doi/abs/10.1080/09687637.2021.2004998">has not</a> reduced drug availability and use in Nigeria. </p>
<p>Finally, official corruption – blamed <a href="https://www.unodc.org/documents/data-and-analysis/bulletin/2019/19-11671_ebook.pdf#page=39">for fuelling</a> the availability of tramadol – must be tackled immediately.</p><img src="https://counter.theconversation.com/content/191175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emeka Dumbili received funding from the Tertiary Education Trust Fund (TETFUND) in 2012. </span></em></p>People in Nigeria are creating new drugs either because they can’t afford more traditional narcotics, because they’re not controlled or because they’re strong.Emeka Dumbili, Lecturer, Nnamdi Azikiwe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1020662018-09-06T10:29:29Z2018-09-06T10:29:29ZMonkey Dust mayhem: the English city reportedly at the centre of a drug-fuelled ‘epidemic’<figure><img src="https://images.theconversation.com/files/235043/original/file-20180905-45175-vkin8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1056695408?src=KK0Tn2yONOLBLeCfjwT9eA-1-50&size=medium_jpg">DedMityay/Shutterstock</a></span></figcaption></figure><p>The English city of Stoke-on-Trent in the West Midlands is reportedly suffering from an “epidemic” of people using a synthetic drug known on the street as Monkey Dust. One police officer interviewed in a recent <a href="https://news.sky.com/story/hooked-on-monkey-dust-warning-of-city-wide-epidemic-11468071">Sky News report</a> described the process of restraining Monkey Dust users as “dealing with someone who thinks they are the Incredible Hulk”. </p>
<p>But our ongoing research raises questions about how widespread and localised use of the drug really is. </p>
<p>Monkey Dust is a type of <a href="https://www.drugwise.org.uk/new-psychoactive-substances/">new psychoactive substance</a> (NPS) that had already been banned in the UK prior to a 2016 blanket ban of all NPS products. It is made from a chemical known as a cathinone called MDPHP and has a stimulant affect. It is often likened to other cathinones such as <a href="http://www.wnfo.org.uk/drugs/mdpv/">MDVP</a>.</p>
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<a href="https://theconversation.com/monkey-dust-krokodil-nyaope-why-new-drug-concoctions-keep-appearing-101916">Monkey Dust, Krokodil, Nyaope: why new drug concoctions keep appearing</a>
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<p>In early September, the negative and addictive effects of Monkey Dust led the Staffordshire police and crime commissioner <a href="https://www.bbc.co.uk/news/uk-england-stoke-staffordshire-45387640">to suggest</a> that it should be reclassified as a Class A rather than Class B drug. However, changing the classification is unlikely to address user levels, or the current behaviour associated with the drug that is causing concern. It would simply enable a longer prison sentence for possession and supply. And prisons are not without drug problems, with 60-90% of inmates thought to be using <a href="https://www.justiceinspectorates.gov.uk/hmprisons/wp-content/uploads/sites/4/2015/12/Substance-misuse-web-2015.pdf">NPS</a>. </p>
<p>In August, Staffordshire police <a href="https://www.theguardian.com/society/2018/aug/17/surge-in-monkey-dust-drug-use-linked-to-social-media-police-say">said</a> they were getting around ten calls per day related to Monkey Dust issues. These calls may be about the same situation, rather than separate incidents, and it’s unclear whether the incidents actually involved Monkey Dust, or whether other substances were being used that could have exacerbated the situation. </p>
<p>The 2016-17 Crime Survey for England and Wales <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/642738/drug-misuse-2017-hosb1117.pdf">highlighted</a> an overall decrease in NPS users immediately following the 2016 ban, and shows that other drugs, such as heroin, have higher user levels. But the ban may have impacted honesty levels on whether people disclosed NPS usage that year, and young people under 16, homeless people and those in prison are not included in the survey. Internationally, it’s believed that <a href="https://www.unodc.org/wdr2017/index.html">NPS use is on the increase</a>, but is still less of an issue than other drugs such as cocaine and heroin. </p>
<h2>Who is using Monkey Dust?</h2>
<p>As levels of Monkey Dust use are based on self-reported information, rather than forensic drug testing, it’s hard to tell if people are taking MDPHP or another NPS product. There are <a href="http://www.re-solv.org/nps/">hundreds of NPS products</a> and they mimic a range of drugs. </p>
<p>A small-scale research study my colleague Em Temple-Malt and I did with student researchers in Stoke asked homeless people, young people at college and professionals working to tackle drug issues about their knowledge and usage levels of NPS. We saw little evidence of an epidemic – <a href="https://en.oxforddictionaries.com/definition/epidemic">defined as</a> as a “widespread occurence” across the city. Our study was small, with a total of 41 participants and aimed to give a snapshot of what was happening in Stoke-on-Trent to help inform future drug service development.</p>
<p>Less than 7% of the homeless people and college students we chatted to reported using NPS regularly. However, they talked about friends who used and concerns about aggressive behaviour and other effects of NPS drugs that they had witnessed. A small group of professionals also told us that vulnerable groups in society were likely to be using NPS and the negative effects of some of the drugs.</p>
<p>One homeless hostel user we spoke to reported being “done” for “breach of the peace” by the police after taking Monkey Dust and being caught “arguing with a garden gnome”. While on the surface this might sound like a low level offence, some of those we spoke to said they had witnessed concerning behaviours by people who had used NPS.</p>
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<p>In Stoke-on-Trent, the <a href="https://www.stokesentinel.co.uk/news/stoke-on-trent-news/monkey-dust-zombie-drug-epidemic-1886540">police have said</a> strains of Monkey Dust are causing some users to become “extremely agitated and paranoid”, with some climbing up onto buildings or running into traffic. But this is only the case for some users and not all. Such chaotic drug usage usually affects a small group of the population who often require resource intense interventions, inclusive of assistance from emergency services. </p>
<p>Nationally, first responders and the police are reporting aggression and violence provoked by NPS. Research in <a href="https://eprint.ncl.ac.uk/237991">police custody suits</a> in the northeast of England found that staff were concerned about how to deal with aggression and unpredictable behaviour from NPS use. </p>
<h2>Help for those addicted</h2>
<p>In my own experience of working with drug and alcohol users, being intoxicated can become a form or escapism. And for homeless people, there are lots of traumatic experiences which may lead them to use drugs and alcohol as a coping mechanism. </p>
<p>One of the recommendations emerging from our research is for better addiction support for vulnerable people within homeless hostels, such as an on-site drop-in service. Still, underlying issues that trigger people to use drugs also need addressing, including reducing negative experiences in the family home, such as child abuse, unemployment and poverty. </p>
<p>But there have been national <a href="https://www.kingsfund.org.uk/blog/2018/01/local-government-spending-public-health-cuts">funding cuts</a> to the health and public health sector and to drug support services <a href="https://www.bbc.co.uk/news/uk-england-44039996">run by the voluntary sector</a>. Given the role police play in tackling drug issues, <a href="https://www.theguardian.com/uk-news/2017/nov/09/britains-police-budgets-to-lose-700m-by-2020-amid-rising">cuts to their budgets</a> are also a concern. It could be considered that an epidemic of austerity has left police, emergency services, public health and support organisations with inadequate resources to handle drug-induced violence and aggression.</p><img src="https://counter.theconversation.com/content/102066/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Page does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The synthetic drug Monkey Dust is causing mounting concern in Stoke-on-Trent – but how widespread is its use?Sarah Page, Senior Lecturer Sociology and Criminology, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1019162018-08-24T09:56:53Z2018-08-24T09:56:53ZMonkey Dust, Krokodil, Nyaope: why new drug concoctions keep appearing<figure><img src="https://images.theconversation.com/files/233435/original/file-20180824-149469-1h4ruh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reaching out.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/trying-grab-syringe-heroine-overdose-648581206?src=xkrNWz93-ROm5-8EfxQDqw-1-4">Shutterstock</a></span></figcaption></figure><p>The globalisation brought about by the internet means that recreational drug use is now a worldwide issue. And for legislators, drug taking is a rapidly moving target. Over past decades, we have seen changes in how <a href="https://www.talktofrank.com/drugs-a-z">drugs </a>are being used, with new combinations of drugs being used together. But why does this happen? </p>
<p>It has long been known that street samples of heroin often contain a mixture of drugs. In <a href="https://doi.org/10.3109/14659891.2011.592898">some cases</a> different drugs are added to counter the effects of the drug which has been taken. </p>
<p>Heroin is manufactured from the morphine contained in the latex of the field poppy, <em>Papaver somniferum</em>. The morphine is extracted, reacted with acetic anhydride and turned into diamorphine – the desired drug. This is then mixed with an acid, rendering the drug water soluble, heated and then injected. </p>
<p>Street samples of heroin are often mixed with benzodiazepines (commonly temazepam or diazepam) and barbiturates (often phenobarbitone). Benzodiazepines, <a href="https://www.healthline.com/health/anxiolytics">anti-anxiety drugs</a>, are added to reduce the stress of taking the heroin. When the body clears the heroin from the system the process can induce a pseudo-epileptic fit. Some barbiturates, particularly phenobarbitone, have been used to control epilepsy and they are added to reduce the risk of fitting after taking heroin.</p>
<h2>New trends</h2>
<p>Sometimes taking drugs or drug mixtures can be part of a trend. What causes these trends is not always understood. </p>
<p>Despite an overall decline in the use of recreational drugs <a href="https://www.bbc.co.uk/news/uk-45036469">an increase has been reported</a> in cocaine use among younger people, while another recent reported trend is the growth in the use of so-called <a href="https://www.independent.co.uk/news/health/monkey-dust-hulk-drugs-synthetic-addict-uk-crime-police-stoke-staffordshire-midlands-a8486391.html">Monkey Dust</a> in the UK. This is a synthetic stimulant related to <a href="https://www.talktofrank.com/drug/cathinones">the cathinones</a>, which has similar effects to cocaine and amphetamines.</p>
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<p>Sometimes a trend is caused because a drug or drug mixture is sought which has a similar effect to drugs which have become difficult to obtain or which have become too expensive. For example, in 2009 the number of seizures of cathinones increased in Cambridge, UK, when the world supply of sassafras oil, a precursor of MDMA, <a href="http://arro.anglia.ac.uk/id/eprint/701011">dried up</a>. When the supply of the precursor was reestablished, MDMA use returned and the use of cathinones fell. </p>
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<span class="caption">Seizures of Cathinones and Ecstasy recorded in Cambridge, UK, between 2003 and 2013.</span>
<span class="attribution"><a class="source" href="https://arro.anglia.ac.uk/701011/">Alexandra Turner, 2015.</a></span>
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<p>In Russia, Krokodil – <a href="https://linkinghub.elsevier.com/retrieve/pii/S0955395913000510">a homemade version</a> of the synthetic opioid <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Desomorphine">desomorphine</a> – provides a cheap alternative to heroin. It is readily manufactured from codeine <a href="https://www.independent.co.uk/news/world/europe/krokodil-the-drug-that-eats-junkies-2300787.html">but its use</a> can result in terrible physical injuries as well as the harms associated with drug abuse itself.</p>
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<p>A legislative change can sometimes cause a change in the use of drug mixtures. For example, mixtures of <a href="https://www.ncbi.nlm.nih.gov/pccompound?term=piperazines">piperazines</a>, compounds which cause similar effects to ecstasy, emerged on the drug market as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.02934.x">a legal alternative to methamphetamine</a> in New Zealand. As a consequence, mixtures of these drugs emerged as different effects were realised. Some mixtures are still commonly encountered, including benzylpiperazine (BZP) and 1-(3-trifluoromethylphenyl)piperazine (3-TFMPP). Other drugs in this family have been reported <a href="https://pubs.rsc.org/en/content/articlelanding/2014/ay/c3ay41020j#!divAbstract">to be mixed with</a> cocaine, ephedrine and caffeine.</p>
<p>Such changes, in response to legislative control, have been observed in older, “more established” drugs as well as the novel psychoactive substances. In addition, “cheaper” drug mixtures may be developed for socioeconomic reasons. For example, in South Africa there has been an the emergence of a drug named Nyaope. We have found this <a href="https://linkinghub.elsevier.com/retrieve/pii/S037907381830481X">to contain a mixture</a> of low-grade heroin, cannabis and the antiretrovirals: efavirenz and nevirapine. </p>
<p>The effects of cannabis and heroin are well known. What is less well known is that some antiretrovirals, including those found in this drug, are hallucinogenic and cause dissociative effects. As a consequence of this, and the low cost (30 Rand or £1.60 per dose), it is finding widespread use in the poor communities where its use is rife. The problem with this drug is that it is also highly addictive and causes extra problems as users resort to crime to finance their habit. In addition, it poses particular challenges to the forensic science community as the mixture of drugs found in Nyaope have chemical properties which make them problematic to analyse and profile.</p>
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<p>Some people take drug mixtures because they are looking for a new, or more intense high. The National Forensic Laboratory System in the US indicated that in Pennsylvania, for example, there was a trend to mix heroin with <a href="https://www.ncbi.nlm.nih.gov/pccompound/?term=fentanyl">fentanyl</a> which declined from 2006 to 2010 (when no such mixtures were observed). This decline then reversed and there was <a href="https://www.dea.gov/sites/default/files/2018-07/BUL-065-18%20Heroin%20Cocktail%20--%20An%20Analysis%20of%20Pennsylvania%20Laboratory%20Drug%20Seizure%20Data%20UNCLASSIFIED.pdf">a steady resurgence</a> in this drug mixture between 2011 and 2016, with 65% of heroin cases reported to contain fentanyl in 2016. When the percentage of fentanyl decreased there was an increase in other drugs – benzodiazepines, cocaine, and “other non controlled drugs”.</p>
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<span class="caption">Composition of heroin/fentanyl mixtures reported in Pennsylvania 2006-2016.</span>
<span class="attribution"><a class="source" href="https://www.dea.gov/sites/default/files/2018-07/BUL-065-%2018%20Heroin%20Cocktail%20--%20%20An%20Analysis%20of%20Pennsylvania%20Laboratory%20Drug%20Seizure%2%200Data%20UNCLASSIFIED.pdf)">Data drawn from the DEA Bulletin, February 2018.</a></span>
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<p>This is a worrying increase. <a href="https://theconversation.com/uk/topics/fentanyl-28070">Fentanyl</a>, which is 50-100 times more potent than morphine and up to 50 times more powerful than diamorphine (both found in heroin), is particularly dangerous because it does not need to be ingested – it is readily absorbed through the skin or through inhalation of the drug powder. Not only does this present a risk to anyone using the drug but also anyone attending a victim as a first responder or, indeed, forensic scientists analysing the drug. </p>
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Read more:
<a href="https://theconversation.com/the-war-on-fentanyl-the-drug-linked-to-60-deaths-in-the-uk-since-2016-81981">The war on fentanyl, the drug linked to 60 deaths in the UK since 2016</a>
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<p>The drug is mixed with heroin, or cocaine, leading to potent cocktails of drugs which are dangerous in the extreme. One mixture, Grey Death, contains fentanyl, carfentanil (<a href="https://www.independent.co.uk/life-style/health-and-families/health-news/carfentanil-drug-so-deadly-it-is-a-chemical-weapon-available-for-sale-on-internet-a7350186.html">a synthetic opioid</a> used by vets to treat very large animals), heroin and a synthetic opiate, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741271/">U-47700</a>. U-47700 is itself seven times more potent than morphine and carfentanil is a staggering 10,000 times more potent than morphine. Two milligrams (a teaspoon of sugar weighs 2,500 times this much) of carfentanil can be fatal. A similar mixture, <a href="https://www.phsd.ca/alerts/drug-alert-purple-heroin-in-espanola-and-area">Purple Heroin</a>, is a combination of heroin, morphine, fentanyl and carfentanil. Very little drug is required to have an effect and even small amounts can cause seizure, arrhythmia, breathing difficulties and death.</p>
<h2>Warning label</h2>
<p>So what are the consequences of taking drug mixtures? The effect of any drug will depend upon such factors as the age, gender, health status, drug taking history and mood of the user. No two people will be affected in the same way by a drug or drug mixture. Drugs do not simply counteract each other, and alcohol often makes the effect or problem greater – in addition to rendering the user liable to forget how much and which drugs they have taken. While taking drug mixtures may be driven by curiosity or other reasons, given what we do know, the safest bet perhaps is to avoid them altogether.</p><img src="https://counter.theconversation.com/content/101916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cole has received funding from the EPSRC, EU (Framework V), EU AGIS programme, Botswanan Government and South African Police Service for carrying out research on the analysis and profiling of controlled substances.</span></em></p>Many people aren’t just taking one drug but a combination of drugs.Michael Cole, Professor of Forensic Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/910882018-02-08T11:41:40Z2018-02-08T11:41:40ZHow labels like ‘addict’ and ‘junkie’ mask class contempt for people who use drugs<figure><img src="https://images.theconversation.com/files/204454/original/file-20180201-123843-12y1khf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dose-syringes-scattered-on-floor-372789226?src=Bypsa6EhAZkVEUAEZfmYAw-1-24">Shutterstock</a></span></figcaption></figure><p>Terms such as “drug user”, “addict” or the blatantly pejorative “junkie”, “dope head” or “stoner”, are loaded with moral bias. They suggest that people who consume psychoactive substances are mentally weak and dangerous – when in fact chemically altering the mind (the natural drive for <a href="https://books.google.co.uk/books/about/Intoxication.html?id=6_nd2DZ-h-UC&redir_esc=y">“intoxication”</a>) has long been a part of human biology and culture, most of which does not lead to any harm or crime.</p>
<p>A recent <a href="http://www.globalcommissionondrugs.org/wp-content/uploads/2018/01/GCDP-Report-2017_Perceptions-ENGLISH.pdf">report</a> by the <a href="http://www.globalcommissionondrugs.org/about-usmission-and-history/">Global Commission on Drug Policy (GCDP)</a> – a group of drug policy reformers including political and business personalities such as Kofi Annan, Richard Branson and Nick Clegg – challenged the stigma surrounding widely held preconceptions about problematic substance use. Many prejudiced views are embedded in the <a href="http://www.bbc.co.uk/news/uk-42630131">everyday language</a> we use around drugs. </p>
<p>Unpacking language and popular rhetoric might help us see that clean <a href="https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes">needle and syringe provision</a>, <a href="https://www.youtube.com/watch?v=F0A_6r3D--w">opiate substitution treatment</a>, <a href="http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms">drug consumption rooms</a> and other interventions that mitigate the potential harms of drug use (<a href="https://www.hri.global/what-is-harm-reduction">“harm reduction” approaches</a>) are more effective than futile, prohibition-focused <a href="http://www.tdpf.org.uk/resources/war-drugs">wars on drugs</a>. </p>
<p>The report was a much needed intervention for channelling the debate towards more rational ways of discussing drug problems, policy and programmes. In cases where people do develop drug-related problems, using neutral terms such as “a person who uses drugs” or “a person with drug dependence/problematic drug use/substance use disorder” can help dispel some of the myths and damaging stigma. </p>
<p>But tempting as it might be to hope that a cultural shift alone will ensure meaningful change, we needn’t forget that stigma is often rooted in unjust material conditions and power relations that societies must also address.</p>
<h2>Classifying substances – and users</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205315/original/file-20180207-74479-11ealxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Baggy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-dealer-offers-cocaine-dose-another-734845696?src=2tTvx08Qa7pmCW1RXbB6PQ-1-44">Shutterstock</a></span>
</figcaption>
</figure>
<p>Much of the stigmatising language that equates drug use with moral failure is disseminated through the conservative parts of the <a href="https://www.thesun.co.uk/tvandshowbiz/5348410/oasis-liam-gallagher-drugs/">mainstream media</a>. However, as <a href="http://www.tandfonline.com/eprint/M6SEV79GVyKtTcMDRckI/full">my recent research indicates</a>, drug news reporting is not only a reflection of moral bias held against people who use drugs, but also of moral bias held against the lower classes.</p>
<p>I looked into over 800 news articles on new psychoactive substances (NPS), formerly known as “legal highs”, published by Romanian (two broadsheets and two tabloid dailies) and British (four tabloid dailies and a regional one) newspapers stretching from 2009 to 2017. Aiming to compare media stories in a postcommunist, relatively young democracy in Eastern Europe, and a more traditionally liberal society in the West, both cases revealed differences in the symbolic frames used to depict who the users were, and what drugs and the ways of taking them were understood to be.</p>
<p>NPS is quite <a href="http://www.drugwise.org.uk/new-psychoactive-substances/">a broad and fluid category</a>, comprising existing and new, naturally-occurring and laboratory-processed classes of substances <a href="https://theconversation.com/why-new-law-banning-all-psychoactive-substances-will-be-just-another-war-on-drugs-disaster-55478">that could be used recreationally</a>. But the associated harms were defined differently depending on the class connotations various NPS evoked.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205314/original/file-20180207-74506-dcfwkb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Spice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bag-weed-sign-spice-582918595?src=mT_CZ3oaBNdGhpD237h8Uw-1-0">Shutterstock</a></span>
</figcaption>
</figure>
<p>In Romania, NPS were labelled “ethnobotanicals” or “ethnobotanical plants” – terms first used by <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/410961/Guidance_for_local_authorities_on_taking_action_against_10.03_15.pdf">head-shop</a> entrepreneurs claiming to be selling for “research purposes”, widely picked up by journalists. When at first (2009-2011) this was perceived to mean synthetic cannabinoids (“Spice” products) used by otherwise “normal”, educated youths, media narratives mostly referred to the dangers these drugs posed to the user, as they gambled their future: drug-induced “self-harm”, “dependence” or “addiction”.</p>
<p>When later on (2012-2013), “ethnobotanicals” came to mean <a href="http://www.emeraldinsight.com/doi/full/10.1108/DAT-09-2015-0056">amphetamine-type stimulants</a> (ATS) injected by poor, unemployed, sometimes ethnic minority (Roma) users, the narrative focused more on their increased visibility within public spaces, violent and antisocial behaviour, along with rising HIV-infection rates recorded on the side of <a href="https://drogriporter.hu/en/the-not-so-balanced-approach-policy-responses-to-new-psychoactive-substances/">unsanitary injecting practices</a>. This was more about a potential contagion risk posed to wider society.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205312/original/file-20180207-74482-18k753f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Synthetics.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/666_is_money/5548568082/in/photolist-haKVUD-6C4ptY-pUbbhY-k36zt-9siRYW-5GNkj-33fGbC-8GBQUj-H43vF2-YUvXL7-ZtfotA-38qmHi-ebzMUx-BJGL7-egsPjE-evbbK1-BJGLd-6rV4fU">Raquel Baranow</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In the UK, mephedrone (a synthetic <a href="http://www.talktofrank.com/drug/cathinones">cathinone</a> used as a stimulant party drug by what the media deemed “carefree”, “innocent”, “aspiring” and generally unsuspecting teenagers) went mainstream around 2009-2012. Newspapers framed it in terms of a game of <a href="http://www.dailymail.co.uk/news/article-1258759/Schools-mephedrone-Meow-Meow-ban-teenage-deaths.html">“Russian Roulette”</a> that not only threatened users’ own lives but also wider society whose future they represented.</p>
<p>When later (2016-2017) media attention moved from middle-class youths and mephedrone on to synthetic cannabinoids or Spice <a href="http://metro.co.uk/2017/03/11/shocking-images-show-people-turning-into-zombies-after-taking-drug-spice-6502676/">turning rough sleepers into “zombies”</a> and wreaking havoc among <a href="https://www.dailystar.co.uk/news/latest-news/650694/Prisoner-UK-jail-Spice-Zombie-drug-video-cannabis-substitute-food-alcohol">prison inmates</a>, headlines pointed to the abject spectacle of disorder displayed by such groups – “pale, wasted people”, “defecating in the middle of the day”, “swaying about” in “dystopian” settings. “Like a horror movie,” as described in <a href="https://www.manchestereveningnews.co.uk/news/greater-manchester-news/spice-nightmare-manchester-city-centre-12870520">one report</a>.</p>
<h2>Drugs, injustice and austerity</h2>
<p>The concepts of “drugs” and “addiction” obscure the reality of social distinctions and deep inequalities; young, middle-class use is depicted as problematic because it threatens its subjects and the continuity of the “valuable” (and dominant parts of) society they represent, and low or underclass use because of its potentially polluting and contagious nature.</p>
<p>Changing the language of drugs alone might do little to ease the brutally felt <a href="https://www.plutobooks.com/9781786800633/the-violence-of-austerity/">violence of austerity</a> and cuts in unemployment or housing benefits. Many of the homeless <a href="http://volteface.me/features/spice-real-problem-poverty/">“Spice zombies”</a> ridiculed in the media will have been the victims of the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499083/mortgage-and-landlord-possession-statistics-october-to-december-2015.pdf">close to 120 landlord evictions</a> carried out on an average day in England and Wales, in 2015. Close to half of the ever rising numbers of homeless people in the country <a href="https://www.homeless.org.uk/sites/default/files/site-attachments/The%20unhealthy%20state%20of%20homelessness%20FINAL.pdf">use drugs and alcohol</a> to cope with mental health problems, while accommodation and support services have been reporting massive reductions in funding.</p>
<p>Focus on language but not political action also diverts attention from the impact of prohibitionist legislation such as the <a href="http://www.legislation.gov.uk/ukpga/2016/2/contents/enacted">Psychoactive Substances Act 2016</a>, effectively a blanket ban on all NPS and head shops. This might have pushed products like Spice into street markets where they’re adulterated with other drugs and fuel overdoses and aggression, as <a href="http://www.ijdp.org/article/S0955-3959(15)00313-8/fulltext">academics</a> and <a href="https://www.manchestereveningnews.co.uk/news/greater-manchester-news/spice-illegal-has-manchester-drug-12880278">charity workers</a> have <a href="https://www.theguardian.com/society/2017/aug/06/spice-zombie-drug-devastating-communities">warned</a>.</p>
<p>In the absence of specific training and educational resources, <a href="http://blogs.bmj.com/bmj/2018/01/17/ian-hamilton-language-alone-cannot-reduce-the-stigma-that-people-who-use-drugs-experience/">health workers</a> might just learn what is acceptable to say without changing long-held beliefs about patients who use drugs. But training is not a priority in an <a href="https://www.theguardian.com/society/2018/jan/15/desperate-measures-in-an-underfunded-nhs">overstrained</a> and <a href="http://www.bbc.co.uk/news/health-42653542">understaffed</a> NHS.</p>
<p>Aiming to change language alone without addressing the structural disadvantages and political issues that hide behind it might provide a narrative of action, but it could achieve next to nothing in improving the condition of the most vulnerable of people who use drugs. The widespread use of derogatory language shows it is naive to aim for fairer drug policies without aiming for fairer societies. One without the other is simply impossible.</p><img src="https://counter.theconversation.com/content/91088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liviu Alexandrescu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fighting prejudice against people who use drugs should lead to a larger interrogation of society and inequality – not only a change of vocabulary.Liviu Alexandrescu, Lecturer in Criminology, Oxford Brookes UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/763662017-05-10T10:33:51Z2017-05-10T10:33:51ZSpice and police custody: there must be a better way<p>A string of shocking videos showing users of the drug “<a href="https://theconversation.com/what-is-spice-and-why-is-the-drug-so-dangerous-60600">spice</a>” in frozen and catatonic states on Britain’s streets and in prisons have sparked a national debate about how to deal with the substance and its users. But these disturbing images are just a snapshot. The true cost is yet to be counted and it is frontline police staff who are bearing the brunt at a time when they are least prepared to face such a worrying phenomena.</p>
<p>Reports from Greater Manchester Police highlight the impact that this synthetic cannabinoid is having on public services. As part of Operation Mandera (the police crackdown on the supply of the drug), 58 spice-related incidents were recorded as taking place in Manchester city centre over one weekend. The <a href="https://www.theguardian.com/uk-news/2017/apr/10/manchester-police-calls-linked-zombie-drug-spice">police operation resulted in various actions</a>: eight people were arrested and taken to police custody, a further 23 were taken to A&E and a 48-hour dispersal order was imposed with 18 people directed to leave the city centre.</p>
<p>While policing tactics were primarily aimed at the dealers and distributors of the drug there is no question that users of spice were also arrested and it could be argued that once they are under its influence they are particularly vulnerable. The effects of these substances can result in displays of extreme and worrying behaviour. A <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/spice-nightmare-manchester-city-centre-12870520">Manchester Evening News special report</a> on the effect of spice on the city described users as “zombies”. Yet labelling users of spice in this way is unhelpful and misdirects attention away both from the fundamental <a href="https://www.theguardian.com/commentisfree/2017/apr/20/spice-terrifying-drug-panic-wont-make-go-away">long-term issues of appropriate support, care, and prevention</a> and the short-term issues of how best to treat, care and/or contain someone whose behaviour is causing them to present a danger to themselves or others. The problem is not just confined to Manchester. There have been <a href="http://www.dailyrecord.co.uk/news/scottish-news/horror-lethal-spice-zombie-drug-10339888">similar reports</a> all over the <a href="http://www.standard.co.uk/news/london/spice-should-be-made-a-class-a-drug-says-westminster-council-boss-a3486346.html">country</a>.</p>
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<p><a href="http://whatworks.college.police.uk/Research/Research-Map/Pages/ResearchProject.aspx?projectid=490">Our research at Newcastle University</a> explored the impact that new psychoactive substances (NPS), including synthetic cannabinoids such as spice, had on a busy city-centre police custody suite in the north-east of England. Speaking to detention officers about their experiences, we found that spice users were considered high risk due to the unpredictability of their behaviour, potential poly drug use and the unknown effect these substances may have on their physical and mental health. NPS users also took part in our study and gave us an insight into their motivations for using (homelessness, mental health problems, poverty, experimentation) and what they saw as their addictive potential, describing the pain of trying to withdraw from certain kinds of NPS as being similar to heroin.</p>
<h2>‘You don’t know who you’re getting’</h2>
<p>The custody environment and the role of police staff working within it is unlike any other. Staff are challenged to handle some of the most volatile, vulnerable and demanding members of society while administering their duties. Unlike other police positions their the key role of custody officers is the welfare of those in their care as they either enter into the criminal justice system or are released back into the community. Staff in the custody suite described to us the additional stress and strain they faced when dealing with people who they believed had taken these substances. One officer said: </p>
<blockquote>
<p>It seems that every night shift we do, there’s an ambulance called. It’s the fear that we don’t know what they’ve taken … And then they start exhibiting, crying one minute, very aggressive the next. You don’t know who you’re getting.</p>
</blockquote>
<p>Staff spoke of the difficulties in providing a good quality of care to people when the effect of the substance was relatively unknown. Users require a high level of monitoring and checks, thereby placing a large demand on resources when in custody. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"852196198207410177"}"></div></p>
<p>A critical question is whether custody is the right place for users still experiencing the effects of spice. Staff described those in their care as often having severe hallucinations or as exhibiting behaviour similar to that of “excited delirium” whereby detainees could be incredibly strong, exhibiting aggressive behaviour, trying to fight staff and often requiring restraint. Police staff were limited in how they could care for users, beyond constant monitoring and offering reassurance. </p>
<p>Staff within the custody suite are not medically trained beyond being able to administer first aid. Further medical support, including having a qualified nurse permanently based within the custody suite 24/7, was viewed as a critical resource. Yet custody nurses are only in place across some police forces in England and Wales and are subject to local funding arrangements. Equally hospitals are not necessarily the right place for spice users: while paramedics and A&E staff are able to provide the medical care potentially needed they require further resources to handle and restrain users acting in dangerous and erratic ways.</p>
<p>Caring for people when they have taken any substance can be a challenge. As police custody staff become more used to the behaviours exhibited by spice users and the novel aspect fades they are able to build a knowledge bank of experience in how to provide care and offer support. Yet to properly address the needs of NPS users and relieve some of the pressure on police resources, there needs to be appropriate strategic care pathways put in place. </p>
<p>The crackdown by Greater Manchester Police may have provided some form of temporary respite for the city centre with spice users removed from public view but the situation is complex and further holistic multi-agency approaches are needed to provide users with the care and support they need. With cuts to support for substance users and homeless populations frontline services are left dealing with the immediate problem of caring for and containing users and their complex behaviours.</p><img src="https://counter.theconversation.com/content/76366/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research project was funded by a N8 Policing Research Partnership (N8 PRP) Catalyst Project Small Grant Award.</span></em></p>The new psychoactive drug Spice is taking its toll on frontline policing.Kelly J. Stockdale, Research Associate, Teesside UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/708892017-01-10T14:42:25Z2017-01-10T14:42:25ZEarly signs show legal high ban is pushing sales from the high street to street dealers<p>In the first six months after a new law banned the sale and production of psychoactive substances in Britain, over <a href="https://www.gov.uk/government/news/psychoactive-substances-ban-6-months-on-almost-500-arrests-and-first-convictions">31 shops have been shut</a> and four people convicted. But there are early indications that the law could actually be increasing the street market for synthetic cannabinoids – commonly known as “spice” – but at higher costs. </p>
<p>The main goal of the <a href="http://services.parliament.uk/bills/2015-16/psychoactivesubstances.html">Psychoactive Substances Act</a>, introduced at the end of May 2016, was to shut down shops and websites trading in psychoactive substances – formerly referred to as “legal highs”. The new law makes it an offence to produce, import or supply any psychoactive substance if it is likely to be used for its psychoactive effects, regardless of its potential for harm. Possession of a psychoactive substance is not an offence. </p>
<p>To enforce the Act, tough sentences for offenders were introduced, including up to seven years in prison for the supply, production, possession with intent to supply, importation or exportation of a psychoactive substance. New powers have also been given to the police, who can use prohibition and premise orders to shut down shops that sell drugs paraphernalia, known as headshops, and online dealers.</p>
<p>According to <a href="https://www.gov.uk/government/news/psychoactive-substances-ban-6-months-on-almost-500-arrests-and-first-convictions">a press release</a> from the Home Office at the end of December, since the Act came into force, the police have stopped 332 shops across the UK from selling psychoactive substances, and 31 headshops have closed down.</p>
<h2>Spice for sale</h2>
<p>From these figures, it would appear that the new Act is having the desired impact. But although the police may be stopping sales on the high street, as our research predicted before the introduction of the new law, the prevalence of synthetic cannabinoids – commonly known as “spice” – shows no sign of decreasing. </p>
<p><a href="http://theconversation.com/what-is-spice-and-why-is-the-drug-so-dangerous-60600">Our study</a> – which is not yet publicly available – conducted in Manchester in early 2016, found that synthetic cannabinoids were by far the most commonly used psychoactive substances in the city. This was particularly the case among the <a href="http://www.homeless.org.uk/">homeless</a>. As noted by one of those we interviewed for the study, synthetic cannabinoid use was “really rife” in the homeless community at the time the new law came into force, with an estimated 80 to 95% of the homeless in the city dependent synthetic cannabinoid users.</p>
<p>We found that the undetectable nature of synthetic cannabinoids (both in public spaces and in mandatory drug tests), their potency (when compared to skunk cannabis) and low cost – £10 for a 1.5g packet that could make up to 20 joints – made them particularly appealing for an economically disadvantaged group such as the homeless. These substances are also highly addictive, and many of those interviewed had replaced problematic use of other substances – typically heroin and crack cocaine – with just synthetic cannabinoids.</p>
<p>Regular users reported increased tolerance that led to many dependent synthetic cannabinoid users spending around £50 a day on their habit prior to the new law being introduced. So it was unsurprising that dependent users of synthetic cannabinoids were resorting to theft, begging and prostitution to fund their habit. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/152173/original/image-20170109-3627-15blv42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A homelessness protest in Manchester, 2015.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/10413717@N08/17266355662/in/photolist-oizYYg-4HyqYt-3RzsJ-3VSowq-siLzZh-akrkkG-9Cx6KH-4FY1tV-c1yaMw-vR9q3-hiT4ig-hiUg72-hiTBMf-e7QzGg-3VNcWx-hiTxGw-2WoLM-4hLTVK-rE4vxj-fgEn8H-4Fxdg8/">Smabs Sputzer/flickr.com</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Prior to the new law, there was an already well-established street-level synthetic cannabinoid market in the area with users <a href="http://www.huffingtonpost.co.uk/2016/02/11/legal-highs-stockpiled-in-led-up-to-april-ban_n_9210812.html">stockpiling</a> them in preparation for the closure of shops selling psychoactive substances.</p>
<h2>Market for homeless users</h2>
<p>All of those we interviewed predicted that this market would simply increase following the implementation of the new law. As was the case in <a href="http://ec.europa.eu/public_opinion/flash/fl_401_en.pdf">Ireland</a> and <a href="http://www.cinn.gov.pl/portal?id=15&res_id=656250">Poland</a>, which both introduced a blanket ban on new psychoactive substances in 2010, <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/teenager-arrested-manchester-piccadilly-gardens-12256899">early indications</a> from Manchester are that this has indeed been the case. </p>
<p>We are about to begin research in Manchester on a new project tracking the impact of the Act. But it’s already clear that pushing the synthetic cannabinoid market underground has impacted upon homeless synthetic cannabinoid users in a number of interrelated and detrimental ways. First, there are rumours that street level dealers are mixing synthetic cannabinoids with crack cocaine to get users increasingly addicted. </p>
<p>Second, as <a href="https://www.globaldrugsurvey.com/mephedrone-quality/">was the case</a> when mephedrone was banned in the UK in 2010, our ongoing research is showing that prices of synthetic cannabinoids have started to increase with users reportedly paying twice as much for street deals compared to previous purchases from shops. And third, a shift from shops to street level dealing has led to people getting less than they used to: a street level gram can actually range from 0.5g to 0.8g. Instead of paying £10 for 1.5g of synthetic cannabinoids, users are now paying £40 for the equivalent amount.</p>
<p>We’ve seen that this has resulted in an increase in violence and robbery within the homeless community, and believe it’s likely to lead to an increase in theft, begging and prostitution as users now require more money to fund their regular and dependent use. </p>
<p>The new law has largely achieved its aim of preventing high street shops from selling these substances. But for those who persist in using them, these drugs remain easily accessible and the Act has led to further problems for users and in particular, the homeless.</p><img src="https://counter.theconversation.com/content/70889/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The market for sythnetic cannabinoids, or spice, shows no sign of decreasing.Paul Gray, Senior Lecturer in Criminology, Manchester Metropolitan UniversityRobert Ralphs, Senior Lecturer in Criminology, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/606002016-09-23T15:33:47Z2016-09-23T15:33:47ZWhat is Spice and why is the drug so dangerous?<p>Synthetic cannabis, of which Spice is an example, is linked to serious health issues ranging from difficulties breathing to psychotic episodes. But, despite well-known issues, these drugs are still in demand and homeless people, particularly, are at risk of mental health issues from their use. So what exactly are these drugs made of and why do they cause such violent reactions.</p>
<p>Spice is not a single drug, but a range of laboratory-made chemicals that mimic the effects of tetrahydrocannabinol (THC), the main psychoactive component of cannabis. <a href="http://ki.se/en/research/spice-a-hundred-times-more-potent-than-cannabis">Research suggests</a> that Spice and other forms of synthetic cannabis are capable of producing much more intense and prolonged effects at much lower doses than natural cannabis. This is because, while the THC in natural cannabis only partially reacts with the body, synthetic cannabis reacts far more fully. </p>
<p>To understand the biology behind the intense reaction to Spice we need to look at the parts of the body’s central nervous system that react to cannabis – the cannabinoid receptors – and the chemical part of the drug that reacts with the body – the “agonist”. </p>
<p>While THC is a “partial agonist” (it only partially reacts with cannabinoid receptors), synthetic cannabis is often a “full agonist”. In this way, the more adverse effects observed with synthetic cannabis use stem from its ability to completely saturate and activate all of the body’s cannabinoid receptors at a lower dose. </p>
<p>Although the consequences of long-term regular use are not well defined, <a href="http://onlinelibrary.wiley.com/doi/10.1002/jcph.827/epdf">experts believe</a> that synthetic cannabis has the potential to develop, or cause a relapse of mental illness, especially if there is a family history of mental disorders.</p>
<h2>Where does Spice come from?</h2>
<p>In 2008, the first synthetic cannabinoid – which reacts with the body in the same way as cannabis – was identified on the recreational drug market. JWH-018 was an aminoalklindole originally developed by <a href="http://pubs.rsc.org/en/Content/ArticleLanding/2015/AN/C5AN00797F#!divAbstract">John Huffman of Clemson University</a> in the US and sold under the brand name: Spice. Aminoalkylindoles – the most common sub-family of synthetic cannabinoids –- are produced, in kilogram quantities, through quick and simple chemical reactions using legal substances. These substances are produced on a large-scale by chemical companies based in China and then shipped, as bulk powders, to Europe by air or sea. Once in Europe, the synthetic cannabinoids are mixed with (or sprayed onto) plant material using solvents such as acetone or methanol to dissolve the powders. The combination is then dried, packaged and sold as either incense or smoking mixtures. </p>
<p>JWH-018 is now a controlled substance in many countries under narcotics legislation. But the prevalence of next-generation synthetic cannabinoids – now known colloquially as Spice or Mamba – continue to be the largest group of new psychoactive substances (NPS) in common usage. As of December 2015, 14 different sub-families of cannabinoid agonists have been identified – indicating that there are potentially hundreds of these types of substances circulating via the internet and often across international borders.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125590/original/image-20160607-7438-1yw2w1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Spice – a particular problem among the homeless.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=Q1owmDE5ORIXMQV19XaSJg&searchterm=homeless%20london&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=301238456">Elena Rostunova/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Why is it so dangerous?</h2>
<p>Different brands of smoking mixtures can have very different effects, but the strength of a specific brand appears to owe more to the ratio of cannabinoids to chemically inactive plant material in the mixture, rather than the variation in the <a href="https://www.unodc.org/documents/scientific/NPS_2013_SMART.pdf">chemical structure of compounds</a> themselves. In other words, the specific type of chemical in the mixture is less important than how much chemical there is compared to what has been put in to provide bulk. </p>
<p>Due to the high potency of some synthetic cannabinoids, the amount needed for each “hit” can be as little as a few tens of milligrams (about the size of a match head). The intoxicating effects of more potent brands – such as Clockwork Orange, Pandora’s Box and Annihilation – can be quite overpowering. Some people experience difficulty breathing, rapid heart rate, and shakes and sweats, all of which can lead to a severe <a href="http://dx.doi.org/10.3109/15563650.2015.1110590">panic attacks</a>. At higher doses, balance and coordination can be severely affected. Users can experience a loss of feeling and numbness in their limbs, nausea, collapse and unconsciousness. </p>
<p>Continued use of synthetic cannabinoids can cause psychotic episodes, which in extreme cases can last for weeks, and may exacerbate existing mental-health illnesses in susceptible users. But most reports of severe mental health, addiction and acts of violence as a result of regular use tend to be among <a href="https://www.theguardian.com/society/2015/nov/07/cheap-spice-strengthens-grip-northern-towns-blackpool-synthetic-cannabinoid">prisoners and homeless people</a>. These groups are much more likely to report high rates of drug dependency, self-define as having addictive personalities and disclose a range of diagnosed mental-health issues including “dual diagnosis” (drug dependence and at least one mental-health disorder, or at least two personality or psychotic disorders) and existing offences for violence. </p>
<p>Because of the substantial risks of synthetic cannabinoids, many countries have already outlawed their production, possession and distribution. But it is unlikely that the “war on drugs” will show any sign of relenting, given the <a href="https://theconversation.com/fast-market-for-legal-highs-poses-challenge-for-scientists-17709">rapidly evolving nature</a> of the recreational drugs market and the lack of globalised drug-control legislation. Only by working collectively can scientists, medical professionals and law makers help to stem the flow of these dangerous compounds before they pose a serious threat to health of vulnerable groups in society.</p><img src="https://counter.theconversation.com/content/60600/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New psychoactive substances, same problematic users.Oliver Sutcliffe, Senior Lecturer in Psychopharmaceutical Chemistry, Manchester Metropolitan UniversityRobert Ralphs, Reader in Criminology, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/426472015-06-02T15:00:27Z2015-06-02T15:00:27ZWhy the government is right to blanket ban new psychoactive substances<figure><img src="https://images.theconversation.com/files/83667/original/image-20150602-6990-hjdp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Legal highs' to become defunct.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-161639954/stock-photo-drug-dealer-taking-money-for-heroine-and-ecstasy.html?src=TsONsjDlB3Y9RyiOM88R0A-1-1">Dealing by Shutterstock</a></span></figcaption></figure><p>The proposals in the Queen’s Speech to introduce a general ban on “legal highs” has given all the usual suspects another opportunity to restate previously held positions. </p>
<p>Legalisers across the political spectrum, such as Release and the Adam Smith Institute, tell us that if only cannabis and ecstasy were legal there would be no market pressure to create drugs which mimic their effects in laboratories in China – and therefore legal highs would not exist. Meanwhile Julia Hartley Brewer <a href="http://www.telegraph.co.uk/news/general-election-2015/politics-blog/11638124/Some-highs-are-more-legal-than-others.html">in The Daily Telegraph</a> tells us that “the ban on legal highs is a good thing and will undoubtedly save lives”.</p>
<h2>What the experts said</h2>
<p>The sober, evidenced, and persuasively argued <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/368583/NPSexpertReviewPanelReport.pdf">report of the expert panel into New Psychoactive Substances (NPS)</a> – on which the proposed legislation is based – lacks both the certainty and rhetorical flourish of the commentators.</p>
<p>The expert panel began by contextualising the use of NPS. They acknowledged that measuring use precisely is impossible but all the evidence pointed to levels of use much lower than those implied by newspaper headlines: 1.3% of all adults; 1.9% of the 16-24 age group; 0.4% of schoolchildren – all small fractions of the use of more traditional drugs among the same groups. </p>
<p>Furthermore, the majority of NPS users are also users of illegal drugs (98% of those who had used mephedrone in the last year had also used another illicit drug) which suggests that the number of new users being introduced to the risks of drug use is negligible. All told the panel concluded that “NPS appear to be less used and associated with less harm than traditional illegal drugs.”</p>
<h2>Less harm not harmless</h2>
<p>Less harm however does not equate to harmless. The European Monitoring Centre for Drugs and Drug Addiction in Lisbon <a href="http://www.emcdda.europa.eu/publications/2015/new-psychoactive-substances">reported an unprecedented increase</a> in the number, type and availability of new psychoactive substances in Europe that “is also responsible for the
increase in serious harms reported to the EMCDDA in
recent years”. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=654&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=654&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83663/original/image-20150602-6960-1tt2l2l.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=654&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Number of new psychoactive substances reported to the.
EU Early Warning System 2005-14.</span>
<span class="attribution"><a class="source" href="http://www.emcdda.europa.eu/publications/2015/new-psychoactive-substances">EMCDDA</a></span>
</figcaption>
</figure>
<p>In England there is evidence of an increase in mephedrone treatment need from 839 adults in 2010-11 to 1,630 in 2012-13, with a similar pattern for under 18s. Deaths associated with NPS have also been increasing, from 29 in 2011 to 52 in 2012 – still dwarfed by the 1,500 deaths associated with illicit drugs, but far too many to ignore and an alarming rate of increase.</p>
<p>The overall picture is of a small but growing problem with use concentrated among existing drug users. This can lead to the intensification of pre-existing problems such as <a href="http://www.beigeuk.com/2014/02/chem-sex-revealed-part-one/">unsafe sexual practices</a> between men who have sex with men, and dealing and bullying in custody, <a href="http://www.ppo.gov.uk/wp-content/uploads/2015/03/PPO-self-inflicted-deaths-publication-press-release.pdf">particularly among vulnerable young prisoners</a>. To these problems we need to add the continuing concern that the next wave of substances to arrive may have much greater potential for immediate and long-term harm. </p>
<h2>Other attempts at legislation</h2>
<p>Much of the media comment has focused on the shift in the legal basis for enforcement towards what the expert panel describe as a “precautionary principle” rather than responding to evidence of harm as the Misuse of Drugs Act (1971) does. </p>
<p>The panel recognised the significance of the shift but also painstakingly reviewed the attempts over the past few years to use existing legislation to <a href="http://www.theguardian.com/society/2015/may/01/chinese-labs-legal-highs-west-drugs">keep up with the labs in China</a> who could easily tweak the chemistry more quickly than the Advisory Council on the Misuse of Drugs (ACMD), which makes recommendations to government on the control of dangerous or otherwise harmful drugs, could assess the harm for each slightly different formulation. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83658/original/image-20150602-6990-15aow0w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frog ‘e’: available at local head shops.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/666_is_money/5548568082/in/photolist-9siRYW-83p8yy-88dVNJ">Raquel Baranow</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>There have been various attempts across the world to overcome this problem, including <a href="http://content.time.com/time/health/article/0,8599,1918675,00.html">the outlawing of analogues</a> (substantially similar) in the US in 1986, which has proved cumbersome, expensive and not very effective, and the currently stalled attempts to introduce regulation <a href="http://tvnz.co.nz/national-news/legal-highs-could-make-comeback-onto-nz-shelves-6230151">in New Zealand</a>. There have even been attempts by local authorities in the UK <a href="https://www.gov.uk/government/publications/action-against-head-shops">to use consumer protection legislation</a> to disrupt sales. Of all the models available, the expert NPS panel concluded in its report that the legislation introduced in Ireland in 2010 offered the most practical way forward. </p>
<p>In essence, under the new UK Psychoactive Substances Bill, any substance delivering a drug-type experience to the user will be illegal to manufacture or supply, but not to possess – unless it is already illegal, in which case it will remain subject to the Misuse of Drugs Act. Exemptions will be given by the Home Office to include foodstuffs and our current culturally sanctioned drugs, such as alcohol, tobacco and caffeine.</p>
<p>Some see this as the thin end of the wedge: the state taking to itself unprecedented powers to declare activities to be unlawful by default. The panel saw it as a proportionate pragmatic response to a market which seeks to profit from selling products which are inherently dangerous by sheltering behind the technical legal requirements to prove the harmfulness of each very slightly different variant.</p>
<p>There are no expectations that this approach will solve the problems with NPS overnight. While the panel believed that on balance it has the potential to reduce use and may save lives, critics have argued that it will have no effect at all, merely driving the domestic market into the hands of existing illegal drug dealers and leaving foreign-based websites to ship NPS into the UK at will. My own best guess is that it does have a reasonable chance of yielding some benefit.</p>
<h2>The exclusion of possession</h2>
<p>There are real advantages in driving activity underground. The panel identified 250 “head shops”, where legal highs are sold in high streets, and 120 UK-based online retailers. NPS are also increasingly being sold in petrol stations, newsagents, and market stalls. Closing down the visible points of sale will tend to deter novice users and, just as importantly, will prevent the normalisation of NPS use which the presence of open sales promotes.</p>
<p>The government deserves credit for following expert advice. Successive governments have ignored the advice of the ACMD over <a href="https://theconversation.com/david-nutt-i-was-sacked-i-was-angry-i-was-right-19848">a range of issues</a>. In this instance it has followed the advice of the panel in most key respects, setting a helpful precedent.</p>
<p>One of the key recommendations that has been accepted is that, although the offences related to NPS largely shadow those of the Misuse of Drugs Act, there will be no offence for recreational possession. This opens up opportunities to reflect again on the utility of the current offence of possession within the act itself – and, in particular, the vexed issue of imprisonment which looks to many observers, even those who do not favour legalisation, to be disproportionate. Presumably the <a href="https://www.sentencingcouncil.org.uk/">Sentencing Council</a> will at some stage be asked to advise on the sentencing guidelines for the offences within the new act. Perhaps this will create an opportunity for them to give guidance to judges which will avoid too great a discrepancy in the response to those using very similar substances.</p><img src="https://counter.theconversation.com/content/42647/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Hayes is a former CEO of the National Treatment Agency. As such he was responsible to ministers and parliament for the funding and delivery of treatment for drug addiction in England between 2001-13. He currently chairs the Northern Inclusion Consortium, a collaboration between five third sector organisations providing integrated responses to social and economic exclusion</span></em></p>Successive governments haven’t always followed expert advice, but they have in the new bill to end ‘legal highs’.Paul Hayes, Hon. Professor Drug Policy, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/229622014-02-12T06:41:51Z2014-02-12T06:41:51Z‘Legal highs’ linked to more deaths as officials struggle to track new substances<figure><img src="https://images.theconversation.com/files/41172/original/vn77d8xg-1392048748.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1024%2C672&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">2CB, 2CE? Let's call the whole thing off. </span> <span class="attribution"><span class="source">Psychonaught</span></span></figcaption></figure><p>The number of deaths caused by a group of mind altering drugs, including mephedrone, has increased over the past three years. And while toxicology reports also link the use of these substances to deaths from other causes, the speed at which new substances are created is making it difficult for authorities to keep up. </p>
<p>At the National Programme on Substance Abuse Deaths (NPSAD) at St George’s, University of London, we’ve been monitoring the rise of new psychoactive substances (NPS), including benzofurans, MDAI and methoxetamine, since 2005. According to our <a href="http://www.sgul.ac.uk/research/projects/icdp/our-work-programmes/substance-abuse-deaths/?searchterm=drugs%20deaths">latest report</a> the deaths from these substances rose six-fold from 10 in 2009 to 68 in 2012. The presence of the substances identified in post-mortem toxicology tests has also increased, from 12 cases in 2009 to 97 in 2012.</p>
<p>From information collected from forensic scientists, law enforcement, and other agencies, it’s clear that people are increasingly using these drugs. But even as misuse becomes more recognised, the authorities are one step behind in trying to stop it; just as new psychoactive substances become regulated, new molecules appear on the market and the cycle repeats. </p>
<p>Physical and psychological problems reported by health professionals from psychoactive substance use include dependence, psychoses, paranoia, as well as risky behaviour like injecting mephedrone, overdosing and poisonings that result in hospital admissions. </p>
<p>The worst case scenario is death by overdose (accidental or intentional), suicide (induced by psychiatric conditions including depression, anxiety, psychoses, caused or triggered by the drugs), and accidents resulting from impaired judgement, including traffic accidents, falls from heights and drowning.</p>
<h2>Psychoactive substances</h2>
<p>Although the composition of many new psychoactive substances is largely unknown, they may be derivatives of controlled or regulated psychoactive substances. We found many consumers use the internet to obtain or exchange psychoactive drug-related information. And despite the risks, advertising these drugs as “legal” and of “high purity” can make them more attractive because it suggests they are therefore safe. </p>
<p>But most of these chemicals have never been subject to proper scientific investigation or evaluation in laboratory or animal experiments, let alone human trials. This lack of knowledge and practical experience causes problems not only for potential consumers but also health and other professionals who may have to deal with consequent harmful effects. </p>
<p>Undertaking a risk assessment usually includes evaluating what acute or chronic effects it might have, along with medical or psychopathological features associated with use, such as increased blood pressure, cardiac problems and seizures. </p>
<p>Technical knowledge about recreational compounds appearing in the drug market in recent years is rarely obtained through reference books and scientific journals because basic research on them hasn’t taken place. Instead, information is often only gained after such substances have started causing harms to users. So despite increasing use, drug policy makers, EU regulators, drug enforcement agencies and individual health professionals have clear gaps in their knowledge. </p>
<p>We need more regular data and information to be collected from a range of sources to understand trends, how they are used, who is using them, and who is suffering adverse health consequences. Our report is the most comprehensive look at the world of new psychoactive substances involved in deaths. We collect information on individual fatalities from forensic toxicology laboratories and associated informal networks, pathologists, coroners and their staff, the Scottish Crime and Drug Enforcement Agency, Drug and Alcohol Action Teams – who all voluntarily supply information – and media reports. This requires regular communication and co-operation. </p>
<h2>More clued up</h2>
<p>But it’s clear that more information is needed to keep up with emerging and continuing drug trends, and if health professionals and the government are to be more clued up and ahead, rather than behind. </p>
<p>The way information is collected and when is also hugely important. Logging admissions to Accident & Emergency departments will pick up adverse outcomes quickly, but the full extent of their causes may not become evident until the conclusion of an inquest into any resulting deaths. These investigations may not be completed until six months, or longer, after the event. This means that some key information, which could inform treatment options and education, isn’t available until some time after the substances have appeared. So building a full picture will require effort and working across different boundaries.</p>
<p>Monitoring drug-related deaths will help us to contribute scientific data to the pool of knowledge to help inform potential users of the potential dangers, and help the health professionals who look after them if they become unwell. Deaths have gone up so we must find a way of reducing the number.</p><img src="https://counter.theconversation.com/content/22962/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Corkery is affiliated with the National Programme on Substance Abuse Deaths at St George's University, the Department of Pharmacy, University of Hertfordshire, and is an expert on drug-related deaths for the UK Focal Point on Drugs (based in Public Health England)</span></em></p>The number of deaths caused by a group of mind altering drugs, including mephedrone, has increased over the past three years. And while toxicology reports also link the use of these substances to deaths…John Corkery, Research Co-ordinator, Department of Pharmacy, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.