Where are all the NPS users? We need to broaden our offer.

Karen Tyrell
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There is an increasing sense from many that New Psychoactive Substances (NPS) are a real and growing concern, both within local communities and in prisons. However, this hasn’t translated into people coming through our doors for NPS support. If we are going to adequately address NPS use, and what this means for a new population of drug users, we need to create a broader offer – alongside delivering services for ‘traditional’ drug users. 

I try to visit as many of our services as possible – like HMYOI Cookham Wood, where I went recently. Everywhere I go, I ask about New Psychoactive Substances. A long standing interest of mine has been to try to understand how drug use has changed from when I was a front line worker. Back in those days, I knew a sensible amount about heroin, crack, ketamine and other substances. I would even occasionally bump into a steroid user in a needle exchange and could provide some basic harm reduction advice. But NPS hadn’t made a dent back then – in fact, it didn’t exist.

These days, if you believe the papers, it’s all the rage. People are dying at a worrying rate – even though the ONS figures contest this. 

Make no mistake, NPS use is not without risk. I’ve done a bit of reading recently – what with the Chief Inspector of Prison’s damning report on drug use in prison and the new NPS toolkit for commissioners coming out –  and it does appear that people are using NPS at a higher rate inside prison than in the community. And that’s the case, even though the UK is considered to have one of the highest rates of NPS use in Europe (according to the Global Drug Survey 2015), which presumably means that issues in our prisons are proportionally worse than our European neighbours as well. Addaction works across 16 prisons in England and, having visited one or two, I can say that NPS use certainly is an issue in prison.

NPS use is an issue in our community services too, though less evident. According to Addaction’s own figures, about 2.5% of our clients report using NPS in some form with only 1% of people in treatment listing it as their main drug.  My question is ‘WHY?’ Why, if there are so many legal (or illegal) highs around, aren’t people coming forward for treatment?

The answer isn’t that people don’t need help and support – although of course, that will be true for some. The answer, it seems to me, is that services (by which I mean both community and prison drug and alcohol services) don’t necessarily look appealing to NPS users. They aren’t for them. They don’t look or sound like they have something which NPS users might need. 

The world outside of drug and alcohol services is changing – and it is changing fast so the only way to keep up? Learn, and learn fast. Make sure you have at least a ‘sensible amount’ of knowledge – for example, you could come to our upcoming conference – which brings together some of the leading lights in the field, like Professors David Nutt and Harry Sumnall. We are very lucky in Addaction to have a wealth of expertise on NPS – but I don’t think ‘potential ‘service users (i.e. people who haven’t used our services) really understand that. We all need to get better at ensuring that everyone feels able to come to services for support on NPS use – not just ‘traditional’ opiate users.

To do this we can all make sure that our early intervention and, importantly, our harm reduction services are properly equipped to cope, that there is a pathway to help people address their NPS use. We should do small things to ensure our services are attractive too – make sure there is information about all sorts of drugs available in the community, run specific sessions for NPS users, offer specialised support for those aged 18-25…. There is a long list, but much of it doesn’t take too long to do – just a bit of thinking about our services through the eyes of an NPS user, or even asking them what they think and then doing that!