This week the Chief Inspector of Prisons warned that the soaring use of misleadingly-called ‘legal highs’ has fuelled increasing levels of aggression and bullying inside prisons. It’s not the only indicator that things are changing, perhaps radically, in the UK.
The National Poisons Information Service (NPIS) advises primary care and hospital medics on potential harms from drugs and chemicals. In a report just published they report a worrying trend around New Psychoactive Substances (NPS):
For these drugs there were more than 130 phone queries, a 13-fold increase, from clinicians treating users in the past year. There was also a 2-fold increase in queries from NHS health professionals through the NPIS online database TOXBASE, over the same period.
Gambling with health
In the NPIS press release, the director of their unit in Newcastle said:
“Synthetic forms of cannabis have been used increasingly in recent years and pose users a particular problem as some appear considerably more toxic than traditional cannabis and many are now controlled as class B drugs. Those who use these substances are taking a real gamble with their health.”
One new drug a week
All over the UK, services are seeing a rise in problem use of NPS and club drugs. The Royal College of Psychiatrists published a report recently titled ‘One New Drug A Week’. This paper highlights that demand cannot be met with current approaches and highlights six steps for improvement:
- Put NPS/Club drugs on an equal footing with other drugs and ‘widen the door’ in established services
- Support the front line – give staff knowledge and skills
- Connect the front line – join the dots between all health settings where NPS users present and specialist drug treatment services.
- Watch all horizons for harm – gather intelligence and data from a wide variety of services
- Promote research
- Educate users to empower them
Meg Fluharty over on The Mental Elf, has a nice summary of the RCPsych guidance which is worth a look.
Meantime clinicians are expecting some comprehensive guidance on management of problem NPS use when the Neptune Project publishes its evidence base review and guidelines early in 2015. The UK National Clinical Guidelines (Orange Book) will also include updated information on NPS, though this is still some distance away.
For the moment management is pragmatic and empirical. Solid harm reduction advice is available. NHS Greater Glasgow and Clyde has teamed up with Scottish Drugs Forum to provide guidance on safer injecting. And our own Crew in Edinburgh has useful advice focussed on reducing harm.
Services are seeing more people who fulfil the criteria for dependence and who are in despair over the harms and chaos that NPS have brought to their lives. They will need a more intensive approach with regard to treatment. Treatment services will need to be more confident in managing clients and it’s hard to see how we can address the problem without increasing resources for psychological and psychosocial interventions.
Recovery from legal high dependence
There are growing numbers of people who consider themselves in recovery from legal high dependence. One of the greatest favours we can do for clients seeking help is to connect them up to such people. They can be found in SMART meetings and in the rooms of NA, CA and AA. Doing so engenders hope, provides practical peer support and can create a pathway to recovery that will change things for the better. Legal highs may be soaring but recovery soars too.