NPS come of age

Timed to coincide with the 26 May 2016 government ban on all legal highs (AKA “New Psychoactive Substances” or “research chemicals”), a new publication from DrugWise: “NPS Come of Age: A UK overview” provides a very helpful brief history of legal highs.

Authored by Harry Shapiro (long time stalwart of DrugScope – and the Institute for Study of Drug Dependency, for those with very long memories), the report provides a very useful overview of legal highs, tracing their evolution and summarising what we currently know about levels of  use and treatment responses.

The road to NPS

The period since 2008-2009 has seen a significant increase at least in interest and probable use of a new breed of drugs. The genesis of this development in the UK can probably be traced back to the increasing control of precursor chemicals under the 1988 UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. During the 1990s so-called ‘herbal highs’ came onto the market, promoted as a more ‘natural’ route to intoxication and including psychoactive (often psychedelic-like) plants such as salvia and morning glory and more indeterminate products such as ‘herbal ecstasy’.

If there was a tipping point for the exponential growth of NPS, it would arguably be the global sale of Benzylpiperazines (BZP) from a base in New Zealand. The 1990s saw a heroin drought in the region caused by the eradication of much of the opium growing capacity in Thailand.

However, this was quickly replaced by methamphetamine labs, causing significant problems in Australia and New Zealand. BZP’s stimulant properties were promoted as a safer alternative to methamphetamine – which they were. The market place opportunities provided by the burgeoning internet allowed the supplier to easily fulfil the orders that started coming in from across the world. In the UK, BZP was promoted as a safe alternative to MDMA – which it wasn’t.

The growth of the internet was another vital step along the way to the manufacture and sale of NPS. It allowed for:

• A global information exchange between users about the drugs and their effects.
• The search for patents by those looking for compounds which had been the subject of experimentation by pharmaceutical companies, but since discarded.
• The wholesale ordering and dispatch of both the raw chemicals and finished product usually from the Far East, using encryption technology.
• Retail ordering and dispatch from globally dispersed websites using payments through third parties such as PayPal.
• The development of a so-called ‘Dark Web’ in which resided such operations as Silk Road (and subsequently many similar sites) and which demands a higher level of technical knowledge to access, and the use of virtual currency such as the bitcoin.

Legal highs

From 2006 until 2016, many of these substances have been legally available on the high street, both from ‘head shops’ and a range of other retail outlets such as petrol stations and fast food outlets. However, the Psychoactive Substances Act which came into effect on 26th May 2016, bans the manufacture, sale and distribution of any and all psychoactive substances accompanied by a list of exemptions including tobacco and alcohol.

Difficulties in establishing levels of use

The citing of NPS patterns and prevalence of use in official datasets remains patchy, not least because those groups most affected are least likely to be identified by official surveys like the Crime Survey for England and Wales. But from what exists plus a growing body of anecdotal evidence and unofficial reporting – a picture is emerging of NPS use in the UK in 2016.

Interestingly, Harry Shapiro argues that this picture is not dissimilar to the emergence of crack cocaine in the UK: much sensational media reporting and dire predictions for the future, but ultimately finding a level in the drug scene with regular use primarily concentrated among those with existing serious drug problems and other vulnerable groups.

Types of NPS

The main group of drugs are the synthetic cannabinoid receptor agonists (SCRAs) which are currently presenting serious problems in prisons and young offender institutions, among the homeless and existing service users.

Still thought of as an NPS, mephedrone is the other main source of problems across a range of user cohorts, from young people, to those on the ‘chem sex’ party scene, through to traditional service clients.

Treatment

Relatively few people are coming forward to treatment services in the community citing an NPS as their primary drug problem in 2016. Workers see more of the problem out in the community with clients who are not accessing treatment, for example homeless and rough sleepers.

While NPS have been mentioned in a number of fatalities, very few deaths appear to have been as a direct result of taking an NPS in isolation. The issue of providing up to date and credible information in such a new and rapidly developing scenario is problematic – and there is a danger of over-reacting to the situation.

For drugs workers, the key message from this DrugWise report is to ‘deal with the problem in front of you’ rather than being overly concerned about the substance that is alleged to have been taken. Useful clinical guidance has been published under the auspices of Project Neptune with more targeted care bundles to come.