Side event: Health responses to New Psychoactive Substances

Organised by the Governments of the United Kingdom and New Zealand, and the UNODC Laboratory and Scientific Section.

Opening Remarks from HE Leigh Turner – UK Permanent Representative to the UN Vienna

Thank you and welcome. There is growing evidence of the impact of these substances. The UK has been working with its partners to adapt the international field – this includes initiating the Global Early Warning System at the UNODC, Law Enforcement Taskforce in tackling NPS trafficking. Series of concrete recommendations. We are happy with our progress, but more needs to be done, as expressed in the outcome document.

Moderator: Justice Tettey – Chief, Laboratory and Scientific Section, Research and Trend Analysis Branch, UNODC

Thank you. It’s been 7 years since NPS first came up at CND. In that time, our only concern was synthetic cannabinoids. No they cover every drug you can think of. Over this periods, we’ve had 7 CND resolutions on this issue. We have made some progress, as HE Turner mentioned. Look at the international drug control conventions, and look how far we’ve come. We’ve achieved a lot in bilateral and multilateral meetings, but there’s still a long way to go. Fatalities, violence related to fentanyl, synthetic cannabinoids and NBOmes are increasing. It is a good time to deal with this from a health perspective.

Hon Peter DunneAssociate Minister of Health, New Zealand

“New Zealand’s experience of and response to NPS (thoughts from and island nation)”

Good afternoon, and welcome to this event cohosted by New Zealand. I want to talk about New Zealand’s health based approach to NPS. New Zealand’s particular focus on NPS has been on strengthening intra-government links and collaborating with civil society. We are establishing strong links between government and non-government organisations. We are working on establishing an early warning system to coordinate integrated responses across the country, and associate with the UN’s Global SMART program. NZ specific system working on identifying gaps on the availability and adverse reactions to NPS, and the barriers to accessing services regarding this issue. The Ministry of Health is taking the leading in this initiative. If unapproved NPS are detected, information is passed to the police to investigate. The NZ government is working towards monitoring adverse health effects closely, through working with emergency departments.

The unique part of NZ policy is the Psychoactive Substance Act in 2013. The old drugs – the risks could be judged – but the new substances are not understood. We have to identify substances, and then legislate to control them. This process takes at least 6 months for each substance, in which time, 10 new substances could be developed. We adopted a similar regulatory approach to the one we have for medicines. Then a product could not be solved until it is approved by a regulator. But then we had to find a way in which to approve these products. They would be approved if they posed a low risk to public health. The Act is not intended to be a blanket ban, but used as a response to review products – new products are automatically unapproved, until the approval process. The Act was amended in 2014, to not be able to have NPS tested on animals. This means that we cannot approve any products, as we cannot test them. I have been informed that we now will not be able to approve a product for at least 5 years. The Act also restricts the sale of these products to those over the age of 18, and from certain premises. I do not believe the restrictions of animal testing will be prevalent for a long time. The Act enables sensible controls to be put on products. The definition of NPS is very broad, which means there can be no delay in approving products. The Act is also squarely health focused, in which to reduce the harms posed by NPS. The Act is in line with our national drug strategy. We believe this is the most appropriate way to deal with NPS around the world.

Dima AbdulrahimNEPTUNE (Novel Psychoactive Treatment UK Network), Club Drug Clinic, Central and North West London NHS Foundation Trust

“The Neptune Project: Spreading Improvement”

Project NEPTUNE started in 2013. Aim: to increase the confidence of clinicians in meting the challenges in addressing NPS harm. We have done this by convening a multidisciplinary group of experts, undertook a systematic review of treatment literature, developed evidence-based clinical guidance. We also had the evidence peer-reviewed.

We focused on three areas – screening of harms, assessment of harms, management of harms.

Guidance addressed – acute NPS toxicity; harms from chronic use; reduction of harms, patient safety and public health.

Guidance target audience – Emergency Care, Primary Care, Drug Treatment, Sexual and Mental Health.

We developed a two-pronged approach to address the four major groups: stimulants, depressants, hallucinogens, synthetic cannabinoid receptor agonists (SCRAs). Wanted to focus most commonly used drugs. We developed a number of very large guidance documents. – on clinical management, LGBT people, and SCRAs. The documents have been very well received, for which we are very grateful. Unfortunately clinicians do not seem to have time to look at the guidance. So we are working on tools that can be easily used by clinicians – including 7 e-learning modules; divided into: all clinical settings (1), acute harms and management (3), and chronic harms and management (3). They are currently being tested/piloted in a number of health/drug treatment services. We have been lucky it is now being independently evaluated. This is all available free of charge online: www.neptune-clinical-guidance.co.uk/resources

Paul Griffiths Scientific Director, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

“EMCDDA work on New Psychoactive Substances (to date)”

NPS and public health responses –

We’re still seeing a high number of substances being identified, but speed of innovation may be slowing down. Legal high street market seem to be coming less important, and interactions are becoming more important. More harms are being detected. Consumer perceptions may have changed – now used by more marginalised groups. Much more aggressive regulatory and legislative responses. Most worrying – more opioid drugs being identified.

Responding to highly potent substances – such as acryloylfentanyl – posing new harms.

Health responses to new psychoactive substances (EMCDDA) – resource available in this room.

Challenges of responding to NPS – skills appropriate to illicit drugs in general are also appropriate to NPS – but: some differences, sexual health risks, multiple injections, psychiatric comorbidity, drug interactions.

We need knowledge transfer, interagency cooperation, and coordination. Identifying and responding to acute harm remains a poorly developed area – with the challenge of identification and forensic testing. We need to develop protocols and methods for effective risk communication to both professionals and potential users. This presents a new dimension in harms – including the risk of accidental exposure to workers.

Vladimir PoznyakManagement of Substance Abuse (MSB), Department of Mental Health and Substance Abuse, WHO

“Perspectives from the WHO on New Psychoactive Substances: direction and plans”

Thank you. Three major areas:

  • Activities to support NPS assessment by the WHO Expert Committee on Drug Dependence (ECDD)
  • Activities to support health system responses to NPS use and health consequences
  • Activities to integrate NPS in the current WHO surveillance mechanisms and tools

I will focus on the second and third areas.

  • Building health capacities – it’s a different group that we see in clinical practices. It encompasses primary health care, STIs, trauma centres, mental health, specialised addiction services.
  • WHO guidelines on NPS are needed – to be developed in line with WHO procedures for guideline development
  • Training of health professionals (including on-line and apps)
  • Many areas covered by WHO guidelines, but there are many gaps – and NPS is one of them.

Classes of psychoactive substances in the draft International Classification of Diseases (ICD-11) – there are now categories for NPS, including synthetic cannabinoids, synthetic cathinones and other specified psychoactive substances.

We need to make the second step – from early warning, to quantify and specify relationships been risk relationships of substances. We are thinking of implementing a service-based sentinel surveillance system for NPS, with a focus on non-fatal health effects. This is well documented in Europe, but not in other regions throughout the world.

I want to highlight the role of NPS in road traffic injuries/accidents – feasible ares of assessment of NPS impact on public health. NPS are described as substances that are synthesised and consumed for non-medical purposes with the expectation of the effects of illicit drugs.

We have 5 minutes for questions:

Ayesha – Youth Organisations for Drug Action – we recognise the efforts made in reducing harms from NPS. Are you working directly with youth organisations on the ground in developing surveillence, and how are you helping these key affected populations?

Dima Abdulrahim: NEPTUNE was developed by clinicians – we are in touch with NPS users everyday. People think they are using traditional drugs, but that’s not what they’re being sold.

Thomas – to Dunne – do you have evidence (surveys) that there was a reduction in NPS use?

Dunne – after the Act was amended in 2014, I sought advice from hospital emergency rooms – periodic reports show small, sporadic incidents, and we believe NPS is no longer as big a problem as previously.

Dr Judith Yates – my patients would like to use drugs safely, like alcohol. With prohibition, my patients don’t know what substances they’re consuming. I’d love to see the NZ model working – is there any chance we can speed it up in some way?

In 2013 we allowed 60 products to stay on the shelves, down from 300. Suddenly we had to take them all off. I expect an alternative to emerge.

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