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Coalition pledges P12 Council outcomes CO10, CO25, CO26 Single Outcome Agreement SO2, SO4

Health, Social Care and Housing Committee

10am, Tuesday 27 January 2014

New Psychoactive Substances

Executive summary

At the Full Council meeting on 20 November Cllr Ricky Henderson raised a motion to in regards to the challenges and concerns presented by New Psychoactive Substance (NPS) use and requesting a report to the next meeting of the Health, Social Care and Housing Committee detailing work undertaken to date and examining further action that can be taken including any enforcement options available to the Council and/or the Police.

Item number Report number

Executive/routine

Wards All

3516363New Stamp

Health, Social Care and Housing Committee 27 January 2014 Page 2

New Psychoactive Substances

Recommendations

That the Committee:

1. notes the current challenges and progress across the partnership to address the issue of NPS, including the on developing enforcement options.

2. supports the existing response coordinated through the CIP process and acknowledge that the CIP need to allocate time to scoping the challenge and developing a clear plan of action.

3. requires regular progress reports in relation to this issue.

Background

New Psychoactive Substances (NPS) are legal drugs, which have similar properties to other illegal drugs but are yet to be classified under the Misuse of Drugs Act. They are sold in specialist head shops1 and over the internet; there are some reports that they are being sold in newsagents, petrol stations and off-licenses in Edinburgh.

The NPS causing the most concern in Edinburgh are stimulants (mainly (ethylphenidate) and are sold in a powder form with brand names such as Burst or Blue. The main concerns are an increase in risky injecting behaviour amongst existing problem drug users, the limit to enforcement action due to the legal status and the link to mental health problems, antisocial and violent behaviour.

At present, the problems experienced by Edinburgh are not reflected in other areas of Scotland.

Main report

1. A Summary of the Challenges

Stimulant NPS are being used by a group known drug users who are choosing these drugs instead of, or as well as, heroin and other dependency forming drugs. Although the effects are intense, they are short-lived and this has led to a rapid increase in injecting amongst this population. Medical professionals have reported an increase in distribution of injecting equipment and wound infections; staphylococcus and a rare strand of streptococcus have been identified amongst injecting drug users in a small

1 These are shops specialising in selling these substances; they may also sell nicotine vaporisers and other legal drug related paraphernalia.

Health, Social Care and Housing Committee 27 January 2014 Page 3

area of the city. An investigation is underway led by NHS Lothian Public Health to identify the source of these infections. There is minimal risk to the general population of transmission, but this is a significant concern for injecting drug users.

Concerns have been raised about by environmental wardens and others about an increase in needle discards.

The chart below shows the increased use of needle exchange programmes by people using NPS during the course of 2014. The dip in August is likely to be linked to a reduction in supply following Operation Redwall.

This group of problem drug users tend to experience a range of difficulties, such as homelessness and poor physical and mental health. The heavy use of stimulant NPS can have a significant impact on mental health and wellbeing, and the Royal Edinburgh Hospital has identified an increased use of its resources as a direct result of NPS. The continued use of these substances impacts significantly on peoples treatment programmes and their ability to recover from episodes of poor mental health.

Between March August 2014, there were 835 admissions to the Toxins Unit at the Royal Edinburgh Hospital. 114 of these have been confirmed as being for NPS use (A further 26 are as yet unconfirmed). 74 of confirmed cases were for a single substance called Burst. This is a stimulant NPS which appears to be used by the existing group of drug users described above.

Police Scotland reports an increase in anti-social and bizarre behaviour, as well as violence amongst people who are using these substances. In the past 4 months, there have been a number of instances of the police dealing with individuals exhibiting aggressive and unpredictable behaviour, the most serious of these resulted in an

Health, Social Care and Housing Committee 27 January 2014 Page 4

officer being stabbed, a siege and a suicide. In addition, the police are investigating a number of drug-related deaths where NPS are implicated. Research suggests that the use of stimulants drugs can result in a greater propensity for violence and other anti-social behaviour.

Local evidence suggests that between January October 2014

39 incidents where the Police were called and the person was taken to A&E 6 deaths linked to NPS use (pending investigation) A number of incidents of violent linked to extreme behaviour

These drugs are legal and therefore traditional approaches to reducing their supply are not available to the police, other than confiscation through current Stop and Search powers.2 Retail outlets are able to sell these substances despite a common understanding amongst partners of the risk of users experiencing significant harm as a direct result.

Finally there are concerns being raised by some residents associations about the impact on the local neighbourhood. This has mainly been in the city centre where there are outlets selling these substances in close proximity to pharmacies that supply injecting equipment. This is resulting in complaints about public injecting and concerns around the risks associated with discarded needles.

The Developing Response

The developing response to this situation is being coordinated through a multi-agency Community Improvement Partnership (CIP). This model replaces Tasking and Coordinating (TAC) groups between the Council and Police Scotland. For the approach to NPS, it also involves NHS Lothian.

The City-wide CIP has developed a draft framework which covers the areas set out below.

Enforcement

Operation Redwall was a national Police Scotland initiative to disrupt the supply of NPS, held on 22 August 2014. In Edinburgh, a partnership approach was developed between the Police Scotland, Trading Standards and Environmental Health. In total, 11 shops were visited and 160 NPS products were seized for analysis using Trading Standards General Product Safety Regulations 2005 (GPSR) powers. A full report on

2 Seizure is based on the fact that police have no way of identifying the chemical composition of the substance; police use the Misuse of Drugs Act 1971 (Section 23) to test for controlled substances. Seizures are not returned to those stopped and searched, even if they are legal.

Health, Social Care and Housing Committee 27 January 2014 Page 5

the outcomes of the operation is pending and future actions depend on the analysis of the products seized.

Partners are exploring the following options for future activity which include using General Product Safety Regulations, with a lead from Trading Standards. Alongside this, Police are leading on work to identify whether a charge of reckless conduct can be brought against retailers selling these substances

All options may be amended in light of guidance from the Procurator Fiscal.

Developing a Treatment Response

Further work is underway to develop the skills of staff in treatment and recovery services, including the development of clinical guidelines.

A needs assessment is being considered to understand better the challenges, from a treatment perspective. This includes identifying the prevalence, the associated problems faced by users, and a user perspective on the solutions.

If the problems associated with the problem use of these drugs continues to grow and treatment services cannot find an effective way to engage this population, other options will need to be considered which focus on reducing harm.

A needs assessment is being planned and funding sought through NHS Lothians Health Foundation to better understand the challenges around engagement.

NHS Lothian Public Health has established an Incident Management Team to identify the source of the staphylococcus and streptococcus infection. It is believed that the infection is related to the injecting of NPS, and further investigation may help to identify its source and reduce the risk of further infection. This may offer an opportunity for an evidence-based link between certain NPS and the risk of significant harm.

A protocol is being developed for engaging with the media on this issue.

2. Conclusions

There are two major partnership concerns:

a) The problematic use of these drugs by a small group of people who are known problem drug users; and the frequency of injecting and link to mental health problems and other antisocial behaviour and violence are creating problems for individuals their families and the local community. Existing services are experiencing challenges in engaging this group and alternative approaches need to be found. These may become contentious if this problem continues to grow.

b) The link between anti-social and/or violent behaviour and the use of these drugs.

Health, Social Care and Housing Committee 27 January 2014 Page 6

The legal status of these drugs presents particular challenges in terms of managing their availability. The use of Trading Standards powers and other legislation detailed in this report need to be explored with the COPFS to identify whether local availability can be reduced.

Different approaches may need to take to reducing the demand for these drugs and engaging people into treatment services.

Measures of success

Success measures are yet to be developed, however they could include:

Reduction in the number of outlets selling these substances Number of needle exchanges for NPS use Reduction in the number of drug deaths where NPS are identified as a

contributing factor

Financial impact

There are currently no plans to invest further money in prevention, treatment and recovery services to address NPS use. Solutions will need to be found within existing resources.

Risk, policy, compliance and governance impact.

N/a

Equalities impact

Any needs assessment work and developments in responses need to include an equalities impact assessment.

Sustainability impact

N/a at this stage

Consultation and engagement

A Framework to address NPS use is being developed. This will involve key stakeholders.

Health, Social Care and Housing Committee 27 January 2014 Page 7

Background reading/external references

None

Peter Gabbitas Director of Health and Social Care

Contact: Nick Smith, EADP Manager

E-mail: nicholas.smith@edinburgh.gov.uk | Tel: 0131 529 2117

Links

Coalition pledges P12 Work with health, police and third sector agencies to expand existing and effective drug and alcohol treatment programmes

Council outcomes CO10 Improved health and reduced inequalities CO25 - The Council has efficient and effective services that deliver on objectives CO26 The Council engages with stakeholders and works in partnership to improve services and deliver on agreed objectives

Single Outcome Agreement

SO2 Edinburghs citizens experience improved health and wellbeing, with reduced inequalities in health SO4 Edinburghs communities are safer and have improved physical and social fabric

mailto:nicholas.smith@edinburgh.gov.uk

New Psychoactive SubstancesHealth, Social Care and Housing Committee10am, Tuesday 27 January 2014Executive summary

New Psychoactive SubstancesRecommendationsBackgroundMain reportMeasures of successFinancial impactRisk, policy, compliance and governance impact.Equalities impactSustainability impactConsultation and engagementBackground reading/external referencesNonePeter Gabbitas

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New Psychoactive Substances