No longer novel: Addaction NPS conference 15th March 2016

March 21st 2016

Speakers rattle the cage of the Psychoactive Substances Act (PSA)

By Harry Shapiro

The conference was timed for the run-up to the enactment of the PSA originally due to come into force on 6th April. However according to a notice sent round to Constabularies, this is now slated for “the Spring” with 21 days notice of the Act coming into force.

Not since the decision to regrade cannabis from Class B to C has a piece of drug legislation created such a furore. Back in 2006, it was the tabloids, some mental health charities and moral minority campaigners who were outraged. Now it is those who campaign more generally for law reform who regard the new Act as not only another doomed tactic in the drug war, but one with more far reaching consequences.

At the conference and in one of his more grandstanding moments Professor David Nutt declared the PSA the worst piece of legislation in the history of bad legislation, although maybe being hung for sheep stealing or burnt as a witch probably tops that. But he had important points to make, such the side-lining of the ACMD. Their involvement in determining drug law is enshrined in the Misuse of Drugs Act (MDA), yet they were not consulted initially as a group about any future legislation and, moreover, MPs will decide on any future exemptions to the Act. The PSA itself is a substantial departure from the MDA in that for a drug to be controlled, it has to be demonstrated that it would cause significant  harm to the wider community. The operative word here is  harm. As David Nutt pointed out, under the PSA any and all current and future substances that can be classified as ‘psychoactive’ will be covered by the Act whether they are harmful or not. The issue of proving psychoactivity remains contentious in itself and has not been resolved in Ireland where a ‘blanket ban’ has been in force since 2010. In a later presentation Dr Mark Piper, Head of Toxicology for conference sponsors Randox said that the accuracy of future testing for NPS was assured, but that testing for psychoactivity was another matter entirely.

Professor Nutt was joined in his disdain for the PSA by Dr Ben Sessa who unashamedly used the platform to state his view that if we had been more liberal in our approach to cannabis, we would not be faced with the problems of synthetic cannabinoids (SCRAs) – a point also made by David Nutt referring to Holland which so far has escaped the scourge of SCRAs. Ben went to cite his personal experience of head shop owners resolutely refusing to give him harm reduction advice for fear of prosecution. Looking into the future of the drug scene, Dr Sessa said that the days of the dark web were numbered, suggesting that any drug could be bought these days on the ‘clear’ or ‘open’ net and that maybe one day, you could use a home 3D printer to summon up your drug of choice.

More measured, but no less critical of the drug laws, is Professor Harry Sumnall, but his focus here was on how to respond to young people at risk because of NPS. Interestingly, his points about what does and doesn’t work in communications were  reiterated by the last speaker (see below) especially when high risk groups are involved. For  example, there needs to be a recognition that drugs are often a vehicle for social bonding and that hearing about risk from the usual suspects, like the police, will cut no ice. The evidence suggests that work with young people whether in or out of school, needs to be targeted, as 90% of UK teenagers say they have never tried an NPS. Universal education and prevention work is likely to be ineffective, but there is a place for harm reduction interventions with those already using or at risk of using, including children and young people in care, young offenders and other vulnerable young people.

David Nutt and Ben Sessa garnered the most applause – yet the room was full of staff who have to deal with these problems every day and who, the person on the Clapham Omnibus might think, would be very anti-reform. We hear regularly from celebrities, academics and other commentators about the iniquities of the’ war on drugs’. Maybe it is about time that somebody surveyed all those various professionals who are actually in the trenches. That voice could be quite powerful.

By contrast were the presentations from Simon Bray, the Metropolitan Police NPS lead and Andrew Selous MP, the prisons minister. The main thrust of the Conference was the devastating impact that SCRAs were having in prisons to the extent that unlike in the community, possession of an NPS “in a custodial institution” will be an offence. After taking the delegates through a list of the main provisions and almost as an aside, Simon Bray mentioned that the offence would not only apply to inmates, but also to staff (not surprisingly) and visitors. Maybe it was obvious to the audience, but it did strike me that services working with inmate families should warn them that an NPS carried inadvertently into a prison could have serious consequences.

In a display of Great British sang frois, the Minister refrained from commenting on criticism of the Act, but instead announced that mandatory drug testing for SCRAs was being trialed in 34 prisons with a roll-out expected in a few months. The inability to test for SCRAs has been a key driver in their popularity in prisons. Speaking on behalf of the Prisons Inspectorate, Majella Pearce could muster little enthusiasm for MDT saying simply that it is “with us”, but primarily reiterated the findings of the Inspectorate thematic review published last December on the changing nature of substance misuse in prisons with recommendations both to NOMS and Ministers.

Getting closer to the ground, delegates heard from Addaction’s Fern Hensley whose centre piece was a video interview with an inmate from Lincoln prison who stated how much NPS had affected prison culture from his one spell in prison to the next. He spoke of how strong SCRAs were with a concomitant increase in violence and self-harm. Fern explained the four week structured Trans4orm programme which one inmate described as “a bright light in a dark place”.

In line with other speakers, Rick Bradley also from Addaction, made the point about media misreporting of NPS, either coming up with ridiculous scaremongering slang like ‘hippy crack’ for nitrous oxide (and the infamous ‘meow meow’ for mephedrone, made up by red top journalist after spotting mention of MCAT on Bluelight) and more problematic, the constant reference to ‘legal highs’ as if they were all the same drugs which presents problems for drug workers trying to engage with young people who have no sense of relative harms say between nitrous oxide and SCRAs. The PSA itself makes no distinctions to the extent that the Home Affairs Select Committee recommended that the Sentencing Council take on the job of constructing a tariff based on relative harms. Nobody should be holding their breath on that one.

Both Rick and Harry Sumnall agree that while the PSA will curb high street sales of NPS (and in the process probably deter the casual and curious user), the overall balance of harms will not be prevented because the most serious use takes place among the most vulnerable groups who will most likely continue to access NPS from the same street dealers from whom they have always sourced their drugs.

Like an Oscar winner ‘who couldn’t be with us tonight’ and instead speaking via video link from his island hideaway in the Caribbean (OK, actually Darlington), Dr Owen Bowden-Jones majored on the clinical challenges of NPS and how these were being addressed by Project Neptune. The initial guidance document was a massive tome which surveyed nearly 2000 articles on club drugs and NPS which by Owen’s own admission,  and like so much published guidance, ran the risk of just sitting on a shelf. So he gathered a further team of experts to produce much briefer, more targeted guidance coupled with e-learning modules and care bundles. All of this will be available in the coming months. For more information go to:

The event closed with a presentation from Addaction’s Medical Director, Dr Kostas Agath. He took as his theme, “NPS: a new paradigm for prevention and early intervention.” To be honest, at first, I wasn’t sure where this was going. But then Dr Agath introduced the German philosopher, Jurgen Habermas who developed a specific theory of communication with its unlikely genesis in the philosopher’s own speech impediment caused by a cleft palate.

In what I am sure was a greatly simplified summary, Kostas set out the theory that effective communications needed three key elements which if drawn as a Venn diagram would intersect at a ‘sweet spot’. The first element was Facts – but facts or in modern parlance, ‘the evidence base’ is not enough. There has to be a realisation of  and engagement with the social Norms that the recipients operate in, whether that’s an individual, a community or society at large. They have to be able to relate to the narrative. And the third key element is Authenticity – in other words, who is delivering the message? Are they credible with the audience?

For me, this was quite thought-provoking (even if obvious when you think about it) and can be applied right through a whole range of (in this case) drug issues, from delivering effective drug education and prevention in schools, working with vulnerable people in any setting, right through to influencing policy at the highest level. And if I’ve got that totally wrong, I’m hoping that Dr Agath will communicate effectively with me to put me right.