First in-depth qualitative study
Important new research from a team based in Manchester has found that use of synthetic cannabinoid receptor agonists (SCRAs more commonly known as Spice) remains popular with vulnerable populations, in particular homeless people.
The research, formally titled “The use of synthetic cannabinoid receptor agonists (SCRAs) within the homeless population: motivations, harms and the implications for developing an appropriate response” by Paul Gray, Rob Ralphs and Lisa Williams can be downloaded for free here.
The research was undertaken in Manchester and is based on interviews with 53 homeless users of Spice and 31 stakeholders, mainly those working in homelessness services.
The researchers found that the use of Spice was widespread and had not been affected by the 2016 Psychoactive Substances Act which led to most High Street shops selling New Psychoactive Substances (NPS) to close.
The research explores the specific motivations of homeless people associated with their use of Spice and found three main themes:
- Their non-detectable nature
- Their ability to provide an escape from the reality of life on the streets
- The need to use to prevent the onset of unpleasant withdrawal symptoms
Mirroring the findings of prison research, Spice appeal to the homeless people interview for this report because of its non-detectable nature. Users discuss being able to openly consume Spice in public settings and hostels while still being able to avoid detection (and therefore sanctions) despite zero tolerance substance use policies.
You see, in here now [bail hostel], to be honest, I can’t drink or smoke weed and get away with it. You get breathalysed when you come back in and they can smell the skunk in your room. So instead of smoking weed, … I smoke Spice [SCRAs].
Another commonly cited motivation for using SApice by the homeless people interviewed for this research was that it provided an escape from the reality of their daily lives. People described how Spies offered respite from the day-to-day experience of life on the streets, helping users to keep warm, forget problems and/or pass the time.
I know this might sound daft yeah, but when you are on the streets and you smoke Spice, it makes you feel warm, like you’ve got a warm blanket around you.
In addition, those living on the streets recounted the difficulty they experienced in getting to sleep in public spaces due to feelings of vulnerability. In this context, SCRAs functioned to facilitate sleep.
It helps you sleep. [The] amount of times I’ve done that in the car park I used to sleep in. Spice knocks you to sleep.
In addition to the practical and functional reasons for SCRA use outlined above, for many interviewees, their continued use of SCRAs was also motivated by a desire to avoid the acute and unpleasant symptoms associated with withdrawal. These included loss of appetite, hallucinations and paranoia, excessive sweating, severe stomach cramps, diarrhoea, and vomiting.
The risks of Spice use
The physical and mental health risks of taking SCRAs are well established. Alongside the dependency and acute withdrawal symptoms, weight loss and losing consciousness and having to receive emergency medical treatment of common. In England and Wales, deaths related to synthetic cannabinoids have more than doubled from 24 in 2017 to 60 in 2018. Most of the homeless people interviewed for this research were able to think of at least one person they knew whose death they thought was caused by their use of Spice.
Many interviewees also spoke about how their use of Spice had triggered a range of mental health problems.
The researchers conclude that further enforcement legislation or activity is unlikely to reduce the use of Spice amongst this very vulnerable population.
Instead, the researchers call for medically supervised community detox and inpatient rehabilitation to be readily available to homeless Spice users. They also argue that it is vital that existing treatment services have the capabilities to address mental health problems alongside drug and alcohol issues.
In practice, given the relatively low levels of Spice use among those presenting to mainstream drug and alcohol treatment services,my view is that there is an urgent need for specialised SCRA outreach services targeted at the homeless population.