Earlier this week, the National Assembly's Health & Social Care Committee published their inquiry report (pdf) into new psychoactive substances (aka. NPS, "legal highs"). It was an extensive and wide-ranging inquiry which took evidence from a huge list of witnesses and focus groups around Wales.
- Wales on Drugs I : Drugs & Modern Wales
- Wales on Drugs II : Why do people take drugs?
- Wales on Drugs III : Where do drugs come from?
- Wales on Drugs IV : The Welsh War on Drugs
- Wales on Drugs V : The Prohibition Question
- Wales on Drugs VI : Why don't we legalise drugs?
I rarely cover committee inquiries when the reports are significantly more than 50 pages long, but this is one of those exceptions. I'm obligated to cover it, as I said this last year :
"....they (AMs) avoid the topic altogether, despite it (drugs) being something that affects every part of Wales. As is typical here, despite having reservations on current policy, many don't want to take responsibility over it. To an extent you could call that moral cowardice."They're talking about it at least; so kudos. I'll assume they were going to look at the issue anyway and the above didn't influence that decision. The Health Committee are also undertaking a separate inquiry into substance abuse generally, and I'll come back to that once they publish a report.
I know I keep saying this but reducing 80-90 pages of text to under 2,500 words is harder than it looks (and massively under-appreciated), but I'm warning you from the start that this is a long read.
When I looked at drugs, one of the main areas I would've liked to do more on was legal highs but there's little info out there. This post could, therefore, be considered complementary to the Wales on Drugs series, hence why I linked to them above if you're interested.
The Committee made 14 recommendations, summarised as :
- Working towards a pan-UK effort to come up with a method to conclusively determine the usage levels of legal highs.
- Welsh Government public awareness campaigns should ensure they're targeted at young people and their means of communication, parents too, and should emphasise that "legal does not mean safe". An evaluation should be undertaken to determine the effectiveness of this campaign.
- Welsh Government should determine if the All Wales School Liaison Core Programme is providing value for money and properly educating school pupils about legal highs. They should also work with interested parties to improve drugs education, including updated literature for parents and pupils.
- Welsh Government should roll out a legal high training programme for public-facing staff, starting with the NHS.
- Welsh Government and NHS should work to see how current substance abuse programmes can be adapted to take legal highs into account.
- Welsh Government and UK Home Office should collaborate to crack down on the use of legal highs in Welsh prisons.
Legal Highs : The Scale of the Problem
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| Examples of typical legal highs. (Pic : wimps.tv) |
They're often low-cost and provide massive profits to sellers, but as they're appearing at a rate much quicker that they're being controlled under the Misuse of Drugs Act 1971, the UK is "struggling to keep up". Between 2005-2012, it's said some 230 legal highs have been picked up by the European Monitoring Centre for Drugs alone.
The Home Office asked an expert panel to look in to the UK response to legal highs in 2013, and while this is acknowledged as a pan-European issue – and drugs policy is non-devolved - the Welsh Government have their own substance abuse strategy running until 2018.
Office of National Statistics (ONS) figures from September 2014 said 60 people died from the use of legal highs in EnglandandWales in 2013 (2,955 deaths from substance abuse overall), and this rate is significantly lower than that for other drugs like heroin. However, the rate is increasing rapidly.
One key problem is a lack of data on legal high use. The systems used to collect and collate information in the public sector were described as "poor and inconsistent". The Wales Ambulance Service said that the variety of ingredients used in legal highs often meant paramedics didn't know what they were dealing with, and patients have different reactions to different NPS.
As the majority of legal high users don't access substance abuse services, it's said they were unaccounted for in monitoring systems. Drugs charity Turning Point said lack of data was directly impacting their ability to deliver services the people need as they don't have an idea what services are needed and where.
It's also unclear who is using legal highs and why, though DrugScope say they're mainly used as recreational drugs in their own right or as alternatives to illegal drugs.
Tarian – the regional organised crime unit covering southern Wales – said legal highs get in to Wales via Bristol, Liverpool and London, making their way to Newport and Cardiff, meaning legal high use is much higher in south Wales than the north. They also said use was higher amongst 18-24 year olds, though there are reports of children as young as 11 using them. Music festival audiences and university students were picked out as vulnerable to experimenting with NPS.
Public Health Wales outlined three "types" of NPS user :
- Recreational users – Self-explanatory. Mainly teens and young adults.
- "Psychonauts" – People who actively experiment with mind-altering substances, but who aren't considered addicts.
- Poly-drug users – People with a history of drug-taking or a history of using "hard" drugs.
All evidence points towards increased use of legal highs, however Cwm Taf University Health Board said that while it's a growing problem, some 80% of substance abuse service patients are there because of alcohol (Vice Nation : Alcohol I, II, III) and NPS use was "small in comparison". Other witnesses say cannabis and alcohol remain the top two problem drugs.
NPS can be bought online, through known dealers, friends or even on high-street "head shops", so they're not as hard to find as hard drugs like heroin. Low prices and easy access (as they're sold legally) were cited as reasons for their growing popularity.
Health Minister, Mark Drakeford (Lab, Cardiff West), acknowledged the lack of data, but the Welsh Government had put resources into identifying legal highs, like the controversial WEDINOS scheme (The reason why there's no grown up drugs debate). Public Health Wales have also been tasked with producing a 10-year estimate of problematic drug use. He cautioned that NPS use is low with "relatively low harms occurring from it", so there needed to be a balance between recognising the problem but not over-exaggerating it.
Awareness
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| People are now aware of former legal highs like mephedrone, but there's still little information out there on the risks associated with them. (Pic : Spin 1038 Dublin) |
Many witnesses believe the term "legal high" is unhelpful as it gives the impression they're safe to consume (by the way, I'm using it because it's easier to understand than the more wonkish, jargon term "NPS"). It was therefore important to underline that "legal does not mean safe".
The Committee say one of the key themes that came out of their focus group visits was the low level of awareness on the risks associated with NPS amongst users, their families and professionals. The chair of WEDINOS added that as substances are new, there's little information on their toxicity and safety.
Some short-term problems associated with legal highs include paranoia, psychosis and seizures – in some cases said to be as severe as those experienced by class A drug users. Other associated problems include blood-borne diseases like hepatitis and sexually transmitted diseases due to "risky behaviour". SANDS Cymru were also concerned that legal highs were acting as a "gateway drug", with other witnesses saying that legal highs had "broken down the taboo of injection".
There are two main state-backed awareness programmes :
- WEDINOS – Established in 2013, this scheme identifies NPS sent in by the public or professionals by testing them and noting the symptoms users experience. Information is published online. They have systems in place to prevent abuse (i.e. drug dealers using the service to test purity) and 11.5% of samples have been rejected as illegitimate.
- DAN 24/7 – A 24-hour bilingual helpline and website for people concerned with substance abuse, and is a Welsh equivalent of England's Talk to Frank. Their work has been praised, in particular use of social media.
Many witnesses called for information tailored to certain audiences. Public Health Wales said there was "no single way to raise awareness for people who use NPS", but the focus groups said there was a clear need for targeted information, in particular in the wider media.
The Health Minister accepted the need for targeted information, but without glamorising legal highs or drug use generally.
Education
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| There were arguments for an increase in the amount of drugs education in schools, but also for parents, GPs and other professionals who come into contact with legal highs. (Pic : National Assembly via Flickr) |
Many teachers delivering PSE haven't had any training in drugs education, and subsequently "lacked confidence" to deliver lessons, leading to an "information vacuum". The Health Minister flatly disagreed with this, saying £3million had been made available by the Welsh Government and Police & Crime Commissioners to train police officers to go into schools as part of the All Wales School Liaison Core Programme, which reaches "99% of schools". The Committee say awareness of the programme's existence was low.
The need to educate parents was described as a "key theme". Health boards said parents, although more than aware about alcohol and illegal drugs, are often unaware of legal highs – a 2012 survey suggested 86% don't know anything. Health board witnesses said educating parents delivers "more bang for buck" in influencing teenage behaviours.
It's a similar picture for professionals like social workers and GPs. DrugScope said GP training only briefly touches on substance abuse generally, and even less so when it comes to legal highs. The need to train police officers, probation officers and prison officers was also highlighted because of particular problems with legal highs within the criminal justice system generally.
Dealing with the Problem
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| New laws in the Republic of Ireland have (reportedly) ended the "head shop" trade. (Pic : Leinster Express) |
Public Services
Health – There were concerns over capacity issues within substance abuse treatment programmes - as well as the range of available services - to deal with legal highs; however it was argued that the rate of treatment referrals for legal highs was low enough not to seriously impact capacity. Focus groups said there was a stigma attached to substance abuse services, and it would be better if they were located alongside other health care services, or drop-in clinics in hot spots for legal high use.
Local government – Trading standards officers play a key role in the clampdown on legal highs, but the WLGA say they've seen a 30% cut to their services which means they've become "reactive" rather than "proactive". There's also limited capacity within youth services due to budget cuts.
The criminal justice system – Again, there was an emphasis on cuts with a net loss of 800 police officers in Wales since 2010. The police have had to prioritise activity which means intelligence on NPS might not be followed up on. Similarly, the prison service are unable to carry out as many cell searches as they used to due to the loss of prison officers. They called for a "whole prison approach" to stop drugs coming in, reduce the demand and reduce harm.
The Law
It's said there's a consensus that current laws are "unclear, inadequate and too inflexible" to deal with legal highs – in particular a failure to keep up with the changing legal high market, where manufacturers can "stay one step ahead of the law" by simply changing the ingredients so they're no longer classed as illegal.
Some witnesses called for a debate on the decriminalisation of drugs (Wales on Drugs VI : Why don't we legalise drugs?) or a shift in focus to harm reduction; others wanted an outright ban on NPS use, or at the very least their supply – supported strongly by trading standards officers in particular.
DrugScope, the police and charities supported a ban on the sale of legal highs by high-street "head shops". However, the British Psychological Society warned that an outright ban on legal highs might drive the market underground when it's at least visible at the moment. The police admitted that the criminalisation of mephedrone (aka. "meow-meow") had done little to stem demand, and simply driven sales underground and increased the price.
The UK Home Office are currently considering a blanket ban on the sale of legal highs – whether online or in "head shops" - based on similar measures in the Republic of Ireland, which has pretty much ended the "head shop" trade. The EU are proposing a directive to govern criminal law in terms of legal highs, but the UK has an opt-out which they are considering using – though the EU Commission argue they can't.
It was also said authorities – like the police and trading standards - currently "lack powers" to deal with the issue decisively, meaning their often "behind the curve". There's a particular problem in prisons, where inmates see legal highs as "an attractive alternative to more traditional drugs", mainly as a cannabis substitute. Since the inquiry, however, the law has changed and prisoners can now be tested for drugs not classified by the Misuse of Drugs Act....the trouble being there's no definitive test for legal highs.
Conclusions
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| It's a solid report with a lot of common sense recommendations, but on the ground, dealing with the problem is largely out of the Welsh Government's hands. (Pic : National Assembly via Flickr) |
The rise in the number of deaths resulting from the use of legal highs has been described as "massive", but the actual numbers dying or coming into serious harm are very small indeed. If the completely unregulated nature of the market and the ingredients weren't a major concern in their own right, you could even argue legal highs are statistically safe.
Of course, it's worth reiterating that they're not safe. No drug is.
As I've pointed out previously (Wales on Drugs IV :The Welsh War on Drugs), in 2012, 55 people were killed by helium - itself considered a legal high – while theres a growing problem with the recreational use of nitrous oxide ("laughing gas"). Also, many prescription drugs, in particular anti-depressants and opioids like morphine, can be lethal in certain circumstances.
The response to this will have to be led at a UK, even EU, level because drugs policy and trading standards are non-devolved. I'll maintain that prohibition doesn't work – backed by evidence given in this inquiry about markets being pushed underground. Decriminalisation is a step in the right direction but wouldn't address the regulation of the market. We'll have to consider alternatives.
New Zealand passed a law – the Psychoactive Substances Act 2013 – which controlled the import and manufacture of legal highs. All psychoactive products would require approval from a regulatory authority and extensive testing before being sold, and retailers required a license to sell them. Research showed the number of legally-available NPS fell from over 200 to under 50, though there were criticisms of lack of hard evidence on the impact. The number of retailers also reportedly fell from over 4,000 to around 160.
Due to a public backlash, the New Zealand Ministry of Health started to suspend licenses and put a halt on the sale of legal highs, as provisions within the Bill governing the responsibilities of local councils in terms of licensing were poorly implemented. New regulations are set to be introduced some time this year to enable them to be sold again, as the New Zealand Government maintain that a blanket ban wouldn't work.
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