From triple helix - winter 2015 - Legal Highs': Lawful But Not Helpful [p14-16]
(Right click and choose 'save as...' to download a printable version of this article)
News stories about 'legal highs' are an increasingly common sight in the UK, and more of these substances are coming into circulation all the time. Figures for 2013-2014 show that in England, 'legal highs' were the primary drug for only a small proportion of adults in contact with drug treatment (0.07%). Data for those under the age of 18 shows that 0.63% had legal highs as their primary drug. (1) This, however, does not reflect the higher level of use for those not accessing treatment, as, for example, a Europe-wide poll found 8% of 15-24 year olds in EU member states reported using NPS (10% for the UK). (2)
Although this group of drugs, more properly known as Novel Psychoactive Substances (NPS), form a minority of those being misused, they are causing considerable and growing concern. In response to this, the Psychoactive Substances Bill was introduced to Parliament in May 2015, aiming to prohibit and disrupt the production, distribution, sale and supply of NPS in the UK. The bill is currently awaiting its second reading in the House of Commons. But what exactly are these drugs, and what risks do they carry with them?
The different terms for these substances (legal highs, herbal highs, party pills, novel psychoactive compounds, designer drugs etc) can all be unhelpful in different ways but the Home Office's expert review panel, whilst recognising some of the difficulties, used the term 'New Psychoactive Substances', which they defined as 'Psychoactive drugs, newly available in the UK, which are not prohibited by the United Nations Drug Conventions but which pose a public health threat comparable to that posed by substances listed in these conventions'. (3)
Although termed 'new' or 'novel', many of these drugs have been produced in the past, but have only recently started to be misused. This had occurred previously, for example although ecstasy (MDMA) arrived on the drug scene in the UK in the mideighties, MDMA had been discovered as far back as 1912. (4) The difference now is the large numbers of new drugs available and a rapidly changing picture.
The emergence of NPS has introduced a range of new and exotic sounding drugs that people report using, such as Black Mamba, Bliss, Clockwork Orange, Mary Jane and Spice. Indeed the number of NPS identified in Europe each year has increased during the current decade - 41 (2010), 49 (2011) 74 (2012), and 81 (2013) (5) - although it is felt that most of the substances identified by early warning systems are not widely used.
Within NPS there are three main groups of drugs, Cathinones, Synthetic Cannabinoids and Piperazines:
They are often taken in association with other drugs, particularly alcohol, which increases the health risks. Episodes of intoxication will often require supportive care based on the symptoms described above. This may include acute medical care.
Links to crime: Drug-related crime seems most closely linked to heroin and crack cocaine use, and at present there is insufficient evidence to link NPS use to acquisitive crime, but with the development of opioid NPS this could become more of an issue. (23)
The root of the challenge of NPS is their legal status. When the sale of these substances is not controlled by laws, they can be sold online or from 'headshops' (shops specialising in the sale of NPS; 250 are estimated to exist in the UK). (24) When any of these drugs are made illegal, people may switch to buying them from drug dealers, as with other illicit substances.
The Misuse of Drugs Act 1971 aimed to prevent the non-medical use of certain drugs, putting them into classes A, B and C, with varying sanctions for the different classes. Where drugs are not specifically included in these lists they may be viewed as not illegal, and hence legal, and often then viewed in some way as being safe, despite the Advisory Council on the Misuse of Drugs (ACMD) in 2011 stating that 'Just because a substance is termed "legal" this does not make it safe, nor may it be legal'. (25) This seems to be in line with Paul's advice in 1 Corinthians 10:23, where he indicates that some actions, although not breaking the law, may hinder Christian living.
This has led to other legislation seeking to close loopholes but the producers of the drugs change the synthetic compounds and people using the drugs adjust what they are taking. An example of this was seen with GHB which was classified as a class C drug in 2003, after which some users switched to taking GBL (which has a faster onset of action than GHB). GBL itself became a class C drug six years later. With new drugs being produced each year, the UN reports: 'the international drug control system is floundering, for the first time, under the speed and creativity of the phenomenon known as new psychoactive substances'. (26)
As stated above, the UK government is now seeking to introduce legislation specifically to address this area, the Psychoactive Substances Bill.
NPS appear to present a number of challenges, some of which can be addressed by politicians, some by health and other professionals, and some by individuals, including church-goers. It is clear these drugs, despite the 'legal' part of their name, can have serious consequences and should be viewed in a similar way to other drugs. For the Christian they may hinder their ability to live as God intended.
For health professionals, the Royal College of Psychiatrists report, referred to earlier, proposes six areas of action. (27)
Widen the front door: Addressing the previously narrow focus of drug services.
Support the front line: Help staff to become more knowledgeable about the issues and management of NPS. As health professionals become informed, they should be able to recognise the drug use and offer appropriate help. As with other drugs, single sessions of motivational interviewing can be helpful, but if there is a poor response or accompanying mental health problems are found then referral to specialist services should follow. (28)
Connect the front line: Enhance links between drug specialist services and the non-specialist services where people are presenting; eg Aamp;E, acute physical and mental health services, primary care and sexual health clinics.
Watch all horizons for harm: Ensure people are up to date with changing patterns of us.e
Promote research into NPS and club drugs.
Empower users through education: for drug users and the general public.
Some of these - such as 'widening the front door' and being contemporary - seem good principles for churches to adopt, (both generally and specifically in relation to NPS), as we seek to follow the Lord's mandate: 'To proclaim good news to the poor. He has sent me to bind up the brokenhearted, to proclaim freedom for the captives and release from darkness for the prisoners'. (29) We need to be aware of the emergence of these substances so that as we come across people who use them, whether in our clinics or our churches, they feel understood and open to help.
1. Young people's statistics from the National Drug Treatment Monitoring System (NDTMS) 2013-2014. (PHE gateway 2014638)
2. European Commission. Flash eurobarometer 401: Young people and drugs. 2014
3. Stephenson G, Richardson A. New Psychoactive Substances in England: A review of the evidence. Crime and Policing Analysis Unit, Home Office Science, October 2014
4. Drug facts: Research chemicals. KFx: Learning of Substance
5. Stephenson G, Richardson A. Op Cit
6. 1 Corinthians 10:23 (ESV)
7. 1 Corinthians 6:19
8. Wyatt J. Matters of life and death (Revised edition), Leicester: IVP, 2009:61
10. Wills S. Drugs of abuse. Pharmaceutical Press, 2005:69-71
12. Winstock AR, Barratt MJ. Synthetic cannabis: a comparison of patterns of use and effect profile with natural cannabis in a large global sample. Drug Alcohol Depend 2013;131(1-2):106-11
14. Royal College of Psychiatrists. Faculty report: One new drug a week. FR/AP/02, 2014
15. New Psychoactive Substances Review - Report of the expert panel. September 2014
16. Drugs in prison. Centre for Social Justice, 2015
17. Mixmag. Global drug survey 2014
18. New Psychoactive Substances Review - Report of the expert panel. September 2014
19. Stephenson G, Richardson A. Op Cit
20. Binks S, Hoskins R, Salmon D et al.Prevalence and healthcare burden of illegal drug use among emergency department patients. Emerg Med J 2005; 22:872-3
21. Stephenson G, Richardson A. Op Cit
22. Royal College of Psychiatrists. Op Cit
23. Stephenson G, Richardson A. Op Cit
25. Advisory Council on the Misuse of Drugs. Consideration of the Novel Psychoactive Substances (Legal Highs). ACMD, 2011
26. United Nations Office on Drugs and Crime. World drug report 2013.
27. Royal College of Psychiatrists. Op Cit
28. Winstock AR, Mitcheson L. New recreational drugs and the primary care approach to patients who use them. BMJ 2012 Feb 15;344:e288.
29. Isaiah 61:1