Michael Lawrence is NPS Development Lead at Crime Reduction Initiatives. This presentation for the ADEPIS seminar on NPS - held on Monday 19th May - is intended to introduce facts about NPS and key advices to face the challenges.

1. Novel Psychoactive Substances &
Emerging Trends
Michael Lawrence – NPS
Development Lead

2. NPS Development Lead
To co-ordinate an education and treatment response to NPS within all
service areas across CRI. The key responsibilities are to raise the
awareness amongst staff of the availability, effects and risks associated
with NPS use and to act as a focal point for collating and disseminating
information about NPS.
The lead has close links to members of the ACMD and various
universities conducting research into NPS and emerging trends (Liverpool
John Moores University and the University of Hertfordshire).
Is a member of DrugWatch.
The NPS lead is involved at a strategic level in the emerging field of NPS
awareness and development.

3. NPS? Novel WHAT?
Legal Highs? But
mephedrone is Class
B??
Herbal Highs? Is that
mystery white powder
‘herbal’??
RC’s ?! Club Drugs?

4. Prevalence
“While overall drug use has declined, the number of people needing treatment for club
drugs has risen. Club drug users make up just 2% over-18s and 10% of under-18s in
treatment.”
- Club Drugs: Emerging Trends & Risks, NTA (2012)
“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.”
- Advisory Council of the Misuse of Drugs (Oct 2011)
A 2011 report from the EMCDDA stated that novel psychoactive substances were a
“major feature of Europe's drugs problem today”.
- European Monitoring Centre for Drugs & Drug Addiction

5. Prevalence
“There is an upward trend in admissions, due to NPS drug toxicity,
for both hospital and pre hospital presentations” and “the harms of
NPS are multi-faceted and may be physical (intrinsic to the drug)
or social in nature. Health services are starting to see health and
other problems caused by regular use of NPS affecting NPS
users' employment and education.
Cases of dependence which require detoxification and psycho-
social treatment (e.g. GHB/GBL dependence) are also presenting
to specialist substance misuse and other services (sexual health
services, youth support services etc.).

6. The primary characteristics of NPS
that differentiates them from
common illicit substances:
• No clear data on measures of incidence or
prevalence
• No clear data on motivations for use
• No clear data on patterns of use
• No clear data on objectively measured adverse
drug reactions

7. Why do NPS pose a particular challenge to
policy makers, health practitioners,
researchers, drug workers, etc.?
•Large number of substances
•Rate at which new substances emerge
•Internet

8. There are thousands of substances
catalogued
New substances emerge at a rate of
approximately
1 per week

9. Dr Alexander
Shulgin –
his books
PiHKAL and
TiHKAL have
been the
starting point
for most
chemists/che
micals

10. New drugs & the art of pulling a rabbit out
of a hat!
Discovered: By trawling through scientific literature to discover existing,
but long forgotten, drugs that have similar subjective effects to common
recreational drugs. For e.g. Mephedrone and MDMA
Created: By tweaking the molecular structure of existing drugs.

11. From the hat to …
1. Internet forums
2. Promising compound identified:
- Lab commissioned
- Marketing
3. As compound becomes more widely known, other
producers and labs begin producing same compound
4. UK – buyers either source directly from the lab or from
wholesalers. Compound is branded and sold via head
shops, internet, etc.
5. Compound is controlled
6. Above process is repeated

14. First Contact & The Unknown
Mystery white powders and products that either don’t, or incorrectly, list
active compounds
They don’t know, you don’t know
How do you provide meaningful treatment in this environment?
Harm Reduction can act as the scaffolding that bridges the gap between
the unknown and meaningful treatment. In that all important first contact:
Ask questions to establish effects
Populate the scaffolding with generic HR information
Touch on the Key Issues (dose, duration, naïve users, etc.)
The importance of that first contact must not be underestimated

15. Key Issues
- Dose
- Duration of session
- Active substance often unknown
- Naïve users
- Underlying health (mental/physical) issues
- Poly-drug use

16. General NPS Harm Reduction
- Advice around ROA (route of administration)
- Test dosing and dosage information
- Avoid poly-drug use including alcohol
- Consider ‘set’ and ‘setting’
- Have a ‘sitter’
- Thinking about safe sex
- Getting home safely
- Consider sleep and nutrition

17. Key Issues
Main harms
“Arguably the greatest harm to YP from legal highs is to their
education and relationships, not to their health”
– Prof. Harry Sumnall (Professor in Substance Use, LJMU;
ACMD)
Social: CJS; social exclusion; relationships; family/children;
education; debt;
Health: dependence; anxiety; psychosis; ROA damage;
acute intoxication; OD; accidents; suicide;

18. So ….
Don’t focus on the chemistry and the
seemingly never-ending list of new
drugs –
focus on
the Effects & Presenting Issues

19. Interventions & Treatment
Interventions
Motivational Interviewing
CBT
SMART
Fellowships
Other counselling/psychotherapy (Person Centred, Solution Focused;
etc.)
Treatment (prescribing)
GBL – Chlordiazepoxide and baclofen
Benzodiazepines
Anti-anxiety medications-SSRI’s; beta blockers
Anti-psychotics
Zopiclone and other sleep-aid medication

20. Useful Techniques
Harm reduction
Goal setting – SMART
Tracking patterns of use – drug diaries
Identifying and developing strategies
for managing triggers
Looking at pros and cons of change
Motivational Interviewing
Brief interventions
Focus on clients strengths and skills

21. What is being done? Legislation
MoDA (Misuse of Drugs Act) – over 600 drugs listed with more being added
end Feb 2013
Medicines Act – largely avoided due to being advertised as ‘not for human
consumption’
TCDO (Temporary Class Drug Order) – nBOMe compounds and 5 & 6-APB
added on 10th June 2013
Consumer protection legislation – “The powers available in the Consumer
Protection from Unfair Trading Regulations (2008) (CPRs) and General
Product Safety Regulations (2005) (GPSRs) should be fully utilised to control
the trade in NPS” - Consideration of the Novel Psychoactive Substances,
ACMD (Oct 2011)
Advertising Standards Authority – investigate claims made by NPS
websites

22. Monitoring
European Monitoring Centre on Drugs & Drug Addiction: EMCDDA
Early Warning System - for new synthetic drugs
FEWS – UK Home Office Forensic Early Warning System
DrugWatch - an informal network of organisations, charities and
individuals working in the UK drug treatment field. From the mission
statement, “It was set up as a bottom up initiative in response to the lack
of any systematic, accurate or practically useful warning system during
the 2010 heroin drought and in response to the new psychoactive
substances now on the market. DrugWatch covers both the more
traditional illegal drugs as well as ‘newer’ substances that may still be
legal, as in reality drug users use both, often at the same time.”

23. Critical Thinking
What exactly is novel about Novel Psychoactive Substances?
Simply by asking this question we are prompted to think critically by:
setting the context
framing the challenge
recognising our own assumptions and values
Answering the question has the impact of:
reducing anxiety
reducing alarmism
reducing complexity
formulating an appropriate response
empowers staff

24. Michael Lawrence
NPS Development Lead
CRI
07880 357282
michael.lawrence@cri.org.uk