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May 2013 |
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Novel psychoactive compounds
llenge
substance in question wasn’t X but contained Y, then
we can also brief the field to say that the substance
sold and packaged as X was found to contain Y and
had these effects.
If tests do show that substance X did, in truth contain
X, then we now know a bit more about X than we did
before – that it may be linked to these side effects.
Importantly, all such information cascades must be
clear as to the evidence underpinning assertions, mindful
that they may be of limited geographic relevance, and
that they are time limited and can become obsolete.
4. Cluster drugs…
A model that I have found useful in training sessions
has been to provide a detailed framework of drug
families, so that people can locate newer drugs against
more familiar comparisons. If we then at least start
from the basis that our new drug shares the same
risks as its nearest neighbours, we can start to engage
with the substance and refine the information as more
knowledge emerges. So by locating newer compounds
such as etizolam or ethylphenidate alongside more
familiar compounds such as diazepam or
amphetamine, you can provide common sense advice
on tolerance, overdose, mixing and withdrawal.
5. …but use caution
Having extolled the virtues of clustering by drug families,
there are of course limits to it. This includes the
dramatic differences in dose range between older,
adulterated drugs and newer drugs that may be stronger
and purer. It can only provide a foundation. Newer drugs
may turn out to be safer, or more hazardous and this
should be acknowledged. A key area where a ‘clustering’
approach works less well is general drugs education
literature. Saying, for example, that ‘6-APB is similar to
ecstasy’ is something of a double-edged sword. While it
could inform useful harm reduction, it also runs the risk
of popularising and effectively advertising a new drug.
6. Keep sight of skill sets
One of the key benefits of locating newer compounds
within a comprehensible framework is that it allows
workers to see how their existing knowledge and skills
can be applied. In the face of a flurry of new drugs, some
people seem paralysed by abbreviations and slang
names. But those same workers were skilled at working
with people who had cravings, were bingeing on cocaine,
or who were experiencing bad ecstasy-related
comedowns. Reinforcing that their skills are transferable
to newer compounds can leave workers empowered and
more confident in engaging with them.
7. Review popularity
Not everything becomes popular. It is certainly the
case that there’s been a veritable slew of new drugs
coming to market as reported by international and
European monitoring, but very few of those drugs will
ever appear on the UK market and fewer still will gain
popularity. So time and energy can be wasted
researching and preparing for some NPCs that will
never become an issue.
Throughout the distractions of the new, the less
new is becoming more and more popular. Mephedrone
has become a fixture of some regional drug markets,
but elsewhere the most widely reported newer
compounds have been gabapentin and pregabalin. So
amid the coverage of NPCs, we need to be aware of
less high profile compounds that are gaining ground.
8. Keep sight of fundamentals
It’s important not to lose sight of some fundamentals
here. NPC use rose in part and peaked because the
‘right drug’, 4-MMC, arrived at the right time – pre-
austerity, with a market typified by poor quality cocaine
and MDMA.
We don’t have a good evidence base in relation to
use, but there is some evidence that while a small
number of people are dabbling with NPCs, the majority,
given a choice, will gravitate back towards the ‘classics’
of cocaine, MDMA, cannabis and speed.
Those who are experiencing the biggest problems
and need targeted interventions are:
•
multiply vulnerable people, including young
people for whom NPCs are just the latest,
most available ways to be altered
•
young naive users who are able to source
potent compounds with little information or
skills for harm reduction.
9. Get tech savvy
The internet plays a critical role in the emergence of
NPCs and in changes to existing drug markets. It is
therefore essential that workers keep their knowledge
of evolving technologies as up-to-date as their
awareness of new drugs. This includes being
confident and familiar with undertaking primary
research online in a number of arenas (such as drug
discussion forums), and able to critically assess the
value of the information.
It is no longer enough to rely on one or two
authoritative sources of information as they are all too
often woefully behind the curve. In turn, the need to
be able to roam the web means that organisations
that restrict access to websites based on catch-all
search terms (such as ‘drugs’) must review and
change their policy. Expecting workers to stay abreast
of NPCs while restricting net access is akin to
expecting someone to navigate from London to
Glasgow with only a sextant and a mappa mundi.
Beyond pragmatism
There are of course many interventions beyond these
pragmatic suggestions that need to be explored in
relation to NPCs. The way substances are analysed and
tested and how this information is shared with the
wider field and end users is a significant challenge and
the legislative framework and regulation of sale needs
wholesale review. Retaining outreach, educative and
harm-reduction interventions for people using NPCs is
essential, even while other parts of service align
themselves with delivering recovery-orientated services.
While these greater systemic issues will get
addressed slowly, there is much that we can do now,
with what we do know and the skills we do have.
DDN
Kevin Flemen runs KFx, a drugs information and
training services and has delivered training sessions
about NPCs around the UK. For more information and
resources go to www.kfx.org.uk