tag:blogger.com,1999:blog-361446632024-03-05T23:38:11.911+00:00KFx Drugs BlogThe KFx Blog is part of the KFx Website. It includes news, views discussion, ideas and musings on drug use in the UK and further afield. Its aim is to contribute to informed debate to drug use in the UK.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.comBlogger122125tag:blogger.com,1999:blog-36144663.post-23453536098702115552021-04-09T11:31:00.001+01:002021-04-10T08:46:14.322+01:00 No NICE answers on Pain and Prescribing<p><br /><br />Here at KFx Towers we've been offering a course about the non-medical use and diversion of Prescription and Pharmacy medicines for a couple of years. While interest and use of Novel Psychoactives abated, there had been a steady increase in questions and concerns about prescription medication.<br /><br />A lot of course participants are prison health workers, alongside community drugs workers and hostel staff. Prisons have long been a "canary in the coalmine" for drugs of necessity. If prisoners are unable to access drug-of-choice X, what other medication becomes sought-after?<br /><br />A long time ago, it was prisons in the North of England that were flagging up Pregabalin and Gabapentin as the go-to medications. Clamping down on these has seen an increase in demand for other medication including mirtazapine and quetiapine. And when access to these is reduced, there's always the illicit fall-back drugs such as synthetic cannabinoids, with all the attendant risks.</p><p>The non-medical use of POMs is of course nothing new. Experienced drug users in the 80s and early 90s knew their way around the BNF better than most trainee pharmacists. Growing concern about the diversion and misuse of key medications was noted in the 2016 ACMD report "t<a href="https://www.gov.uk/government/publications/diversion-illicit-supply-of-medicines">he Diversion and Illicit Supply of Medicines</a>" <br /><br />At the same time the <a href="https://www.theguardian.com/science/2016/may/25/opioid-epidemic-prescription-painkillers-heroin-addiction">American Opioid crisis </a>had been causing huge concern. The emergence of "pill mills" dispensing high-strength opioids had created a new generation of dependent users. Action was required but as is often the case the path to hell is paved with good intentions. Clamping down on the pill-mills - without the requisite treatment and support for those the casualties they created - drove dependent opioid users in to the arms of the illicit drug market - as availability of fentanyl was increasing.</p><p>The death toll and headlines caused concern on this side of the Atlantic, with articles such as this in the <a href="https://pharmaceutical-journal.com/article/feature/a-crisis-hidden-in-plain-sight-prescription-opioid-misuse-in-the-uk">Pharmaceutical Journal</a> saying "<i>The United States is in the grip of an opioid misuse epidemic, with 142
opioid-related deaths every day. Could prescription painkiller misuse
reach crisis levels in the UK too</i>?"</p><p>While there was every reason to be watchful and vigilant for the over-prescribing of medicines associated with diversion, misuse or dependency, we were in truth very far from the US situation. Since the Shipman Enquiry, the scrutiny applied to stronger opioids in the UK was higher than ever. <br /><br />We still had an issue with long-term prescribing of benzodiazepines and related compounds despite decades of guidance cautioning against their use on an ongoing basis. Likewise the willingness to prescribe codeine-based compounds, tramadol and weaker opioids on a liberal basis was a cause for concern. But we were still far from the American experience. And worse we were looking at only one aspect of that experience - what happens when over-prescribing takes place, not looking at what happens when you rapidly clamp down on this prescribing.</p><p>NICE released a draft set of guidelines on the management of Chronic Pain in August 2020 and the <a href="https://www.nice.org.uk/guidance/ng193/chapter/Recommendations#managing-chronic-primary-pain">final guidance was released in April 2021</a> It has colossal ramifications for those experiencing pain or those already prescribed the drugs mentioned.</p><p>The key guidance on pharmacological interventions is as follows:<br /> </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRvt84v8eUu83EYmW9iI9vTLgt3Js3DLN0e9LTaslh8VGWcH2wF0iierkkLzdolDXD9q_HooA_lAk54NQLqzp99ySspl3osuUOQ0-DgB-1HOyMqL3twFiwWCd6faPgOnc6vHKqhw/s846/2021-04-09_10-30-45.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="818" data-original-width="846" height="386" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRvt84v8eUu83EYmW9iI9vTLgt3Js3DLN0e9LTaslh8VGWcH2wF0iierkkLzdolDXD9q_HooA_lAk54NQLqzp99ySspl3osuUOQ0-DgB-1HOyMqL3twFiwWCd6faPgOnc6vHKqhw/w400-h386/2021-04-09_10-30-45.jpg" width="400" /></a></div><br /><br /><br />Locally, over the past few years we have already seen what happens when attempts are made to withdraw patients with long histories of sedative or opioid prescription without adequate preparation of support. <br /><p></p><p>- too often patients are advised by their prescriber that their prescription will be reduced and stopped with little or no prior warning or discussion;<br />- when the patient is distressed or resistant to this change some are then referred straight to Drugs Services without any further support intervention, their anxiety with change being viewed as an addiction issue rather than unmanaged fear of symptoms recurring or withdrawal issues.<br /><br />The NICE guidance is heavily predicated on the timely availability of high quality, non-pharmacological interventions such as talking therapies, alternative models of pain attenuation and physical therapies. But in many parts of the country access to such interventions have waiting lists, have limited availability or simply don't exist.<br /><br />So what happens when people find that their prescriptions are being reduced, the promised non-pharmacological interventions aren't available and the local drug services isn't the right place for them? Predictably people turn to self medicating. And thanks to legitimate on-line pharmacies, dubious overseas suppliers and wholly illicit dark-web sources there is no limit to what people seeking relief from pain can obtain - without recourse to the street drug dealer.<br /><br />The downside of course is that by pushing people away from NHS-managed pain management to less legitimate channels is fraught with additional dangers.<br />- the drugs may be fake, of unknown strength or composition;<br />- the patient no longer gets product information, dose guidance or any other advice;<br />- there's no scrutiny of dosage, meaning this can escalate without any oversight to levels way outside recommended doses<br />- the former patient is at risk of criminalization<br />- if the prescriber is unaware of the purchase of these products, they cannot record and watch for side effects or avoid known drug interactions;<br />- the stability of patient supply is uncertain, dependent on websites or suppliers that may cease to be available at short notice.<br /><br />We have already seen the devastating consequences of this in relation to benzodiazepines. Attempts to reduce over-prescribing were well-intentioned. But people seeking relief from anxiety, stress, insomnia or trauma had ready access to benzodiazepines - first from overseas pharmacies, then from the NPS market and finally from the dark web and street dealers. Far from reducing dependency on diazepam we saw the emergence of a cohort of people dependent on - and dying from - the non-medical use of stronger "street" benzos such as etizolam or flualprazolam.<br /><br />There is undoubtedly a need to question the need to explore prescribing for chronic pain, and improve non-pharmacological offerings. But to do so without ensuring that these offerings are in place, that GP training to support and reassure people when their prescriptions are reduced and stopped, and without appropriate joint working with drug services is a recipe for disaster.<br /><br />The intention may well be good but without great care with the implementation we will end up closer to the American experience. While it is far from ideal for people to be prescribed opioids or other medication which may be ineffective from within the NHS it is far safer to do so than for people to source similar, stronger drugs illicitly outside of the NHS. <br /><br /><br /></p><p><br /><br /><br /></p>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-22710449642769704292018-08-22T11:30:00.001+01:002018-08-22T15:04:58.317+01:00Monkey Business<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Stoke
on Trent and Staffordshire have been contending with "monkey-dust" for
years. The rest of the UK and the media have just caught up.</span></span></h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">There have been numerous reports in the UK media of a "new" drug hitting the streets - "Monkey Dust." The <a href="https://www.vice.com/en_uk/article/pawwq7/monkey-dust-the-uks-latest-nightmare-drug-is-not-what-media-says-it-is">Daily Mirror from 16th Augus</a>t
is as representative as any of the hyperbolic media reporting: "Monkey
Dust: Terrifying new drug on UK streets 'that turns users into the
Hulk'"</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">The
wall-to-wall media coverage will undoubtedly drive interest and demand
for products sold as "monkey dust." And it has already generated lots of
email questions. Hence this short article.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><b>"Monkey Dust" is not slang for a single substance.</b>
Most of the media reports say that "Monkey Dust" is slang for MDPV
[methylenedioxypyrovalerone.] Substances sold as "monkey dust" may
indeed contain MDPV. But they have also been found to contain other
related compounds such as a-PVP, MDPHP and other hallucinogenic
stimulants.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Hostel workers in Stoke routinely report that the "monkey dust" has changed again as they see different emergent behaviours.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">This same confusion as to what is in "monkey dust" can be found in reports and discussions dating back a number of years. </span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">A <a href="https://www.briefreport.co.uk/news/drug-importer-jailed-for-importing-monkey-dust-from-china-2083413.html">2013 report</a> notes a person in Hanley arrested for importing 40g of "Monkey Dust" from China: the drug in question was MDPV.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">A <a href="https://www.briefreport.co.uk/news/pair-jailed-after-importing-monkey-dust-from-china-off-an-internet-site-4030167.html">2016 report </a>notes a similar case in Normacot, but the "monkey dust in question was a-PVP.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">The <a href="https://www.bbc.co.uk/news/uk-england-stoke-staffordshire-45144531">BBC</a> cites Public Health England and describes Monkey Dust as being "Methylenedioxy-α-pyrrolidinohexiophenone or MDPHP. </span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">A (confused) <a href="https://staffslive.co.uk/2016/04/stoke-trent-crown-court-judge-slams-rise-monkey-dust-drug/">Staffs Live</a> report in 2016 worked on the basis monkey dust was PCP and also made reference to alpha-PVP. </span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"> <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=32&cad=rja&uact=8&ved=2ahUKEwjCqKyWvoDdAhWPF8AKHag2Daw4HhAWMAF6BAgJEAE&url=https%3A%2F%2Fwww.briefreport.co.uk%2Fnews%2Fpolice-recovered-cannabis-and-monkey-dust-after-raid-on-teen-s-home-in-meir-4397172.html&usg=AOvVaw1VTrRhbGwpniZ7posZPLlm">A 19 year old arrested in 2016</a> again in Stoke was found to have a-PVP which the media report referred to as "monkey dust." <br /><br />The <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwi90_6yvoDdAhXFCsAKHZzYBIsQFjAAegQIABAC&url=http%3A%2F%2Fwebapps.stoke.gov.uk%2Fuploadedfiles%2FStoke-on-Trent-Strategic-Assessment-2015-V2.pdf&usg=AOvVaw0e_j5fnYZGaCe-fhcJfoCh">Stoke on Trent Community Safety Assessment</a> from 2015 makes explicit reference to the uncertain composition of "Monkey Dust" saying:</span></span><br />
<blockquote class="tr_bq">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Information provided by ‘Drugs Expert Witnesses via the Staffordshire Police Drugs Liaison/Controlled Drugs Liaison/Chemical Liaison Officer suggests that Cannabis, Cocaine, Mephedrone and ‘MonkeyDust’ (MDPV/Alpha PVP) are common amongst problematic drug users (PDUs) in Stoke-on-Trent and across North Staffordshire as a whole.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"> ... In the case of Monkey Dust the uncertainty surrounding ingredients is enhanced,hence the effects may not be what the user expects. This can then cause erratic drug users to commit public order offences unwittingly.</span></span></blockquote>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br />So, rather than thinking of Monkey Dust as being MDPV, it is safer and more accurate to view "Monkey Dust" as an "unknown white powder." From batch to batch it may be strong or weak, short or long acting, more or less hallucinogenic.</span></span><br />
<h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">"Monkey Dust" is not a new term. MDPV is not a new drug.</span></span></h3>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><b>Monkey Dust </b>has
been used as a slang term in Stoke/Stafford for over five years. As a
trainer i have delivered sessions for the Local Authority and third
sector agencies in Stoke for over ten years. The term "monkey dust"
started to emerge after 4-mmc (mephedrone) and related compounds were
prohibited and became more widespread after the PSA came in to force.<br /><br />Stoke
on Trent had a very significant issue with Synthetic Cannabinoids
legally sold via local smoking shops. These sources were restricted,
initially by Community Protection Orders and later as a result of the
Psychoactive Substances Act.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Levels
of 'monkey dust' use became more common and amongst homeless and
vulnerably housed clients became as widespread and subsquently more
widespread than synthetic cannabinoids.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><b>MDPV</b>
and relatives such as a-PVP are not new drugs. MDPV emerged at the same
time as Mephedrone (MCAT) and was banned in 2010. However it MDPV along
with a host of other cathinones were <a href="https://www.ncbi.nlm.nih.gov/pubmed/20687197">showing u</a>p being sold as "new" "legal" highs when they were neither new nor legal.</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><b>Zombies, Hulks, Cannibalism and Prawns:</b></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">The ever-reliable Max Daly wrote a <a href="https://www.vice.com/en_uk/article/pawwq7/monkey-dust-the-uks-latest-nightmare-drug-is-not-what-media-says-it-is">scathing critique </a>of the media's obsession with horror stories combining shocking images with vicarious gore. </span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">The
combination of media sensationalism and hyperbole makes it harder to
understand what is really going on and reinforces prejudice, fear and
misunderstanding.</span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">The
various drugs sold as "monkey dust" can cause convulsions, paranoia,
hallucinations, delusions and possible psychosis. So can alcohol and
benzodiazepine withdrawal but we don't refer to people undergoing
alcohol withdrawal as "cannibals" or "zombies."</span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><b>Working with "monkey dust."</b>Whatever
is in "monkey dust" is likely to be a psychostimulant. It will send up
adrenalin, causing intense fear and panic responses. It may also send up
dopamine, causing delusions, euphoria and possible hallucinations. It
may also send up serotonin, also causing hallucinations and increasing
the risk of convulsions and overheating.<br /><br />Depending on what is in a
batch, other drugs consumed and individual responses the drug may wear
off quite quickly, but could also last for longer periods of time. MDPV
can be long acting and so unpleasant symptoms can last 12-24 hours,
possibly longer.</span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">"Monkey
dust" could contain a range of different drugs, and there is no set
"antidote" or protocol for responding to episodes. The guiding principal
should be assessing and responding to symptoms not trying to guess what
they have used. </span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;"><br />In
mild to moderate episodes, reassurance, de-escalation approaches and
keeping the person calm can resolve the situation. Where the person is
experiencing significant levels of delusion and paranoia, a
safety-driven approach which endeavours to keep others safe, while
looking after the wellbeing of the casualty is a priority.<br /><br />This
could require management of convulsions, hyperthermia, and in some
situations restraint to prevent significant harm in high-risk settings.</span></span><br />
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: small;">Medical interventions to manage convulsions, psychosis, blood pressure or cardiac problems may also be required.</span></span>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-80770498933590489152017-02-13T20:27:00.000+00:002017-02-19T16:05:00.716+00:00SCRA Dependency: the learned helplessness in treatment servicesAs
those who have participated in the KFx NPS training course over the past
couple of years will know, the course spends some time looking at
responses to Synthetic Cannabinoid Receptor Agonists (SCRAs, Spice,
Mamba.) <br />
<br />For several months before the Psychoactive Substance Act
came in to force there was an urgent need to plan for what could happen
once the PSA was enacted. <br /><br />The course stressed that there would
be dumping of residual stocks, as on-line suppliers and head-shops got
rid of prohibited stock and, as had happened with ever NPS before it, it
ended up sold via the street market.<br />
<br />The course also stressed that
agencies needed to prepare for what could happen yet. There was an
urgent need to get treatment protocols and pathways in place so that
those who had become dependent on SCRAs could access treatment. Agencies
needed to start this process before SCRAs were banned. The development
of care pathways and proactively engaging with dependent SCRA users was
an essential measure and given the looming enactment of the PSA, a
time-limited one. <br /><br />The risk of not acting ahead of the
prohibition was that dependent users, unable to access appropriate
treatment, would self-medicate using other substances. All too
predictably, this has started to happen in a number of areas. Numerous
participants on training courses across the UK have recounted cases of
dependent SCRA users drifting to heroin or other opiates to stave off
their opiate-esque withdrawal symptoms. The same trend was picked up by
<a href="https://www.vice.com/en_uk/article/exclusive-this-is-whats-happening-in-britains-drug-scene-right-now">Max Daly writing for Vice. </a><br /><br />Concerned about the lack of tools and
resources for working with SCRA dependency, the existing <a href="http://www.kfx.org.uk/resources/cannast2015.pdf">Cannabis Dependency Toolkit</a> on the KFx website was adapted to reflect SCRA
dependency. The <a href="http://www.kfx.org.uk/resources/SCRAst2015.pdf">SCRA Dependency Toolkit</a> has proved popular with a number
of workers to prompt discussion about SCRAs and start the process of
addressing dependency and promoting change. <br /><br />The area that still
needed to be addressed was how to respond effectively to physical
dependency, specially where pharmacological interventions were
indicated.<br />
<br />The only significant report on the management and
treatment of SCRAs was produced by Project Neptune and the <a href="http://neptune-clinical-guidance.co.uk/wp-content/uploads/2016/07/Synthetic-Cannabinoid-Receptor-Agonists.pdf">section on SCRAs republished separately in 2016</a>.<br />The report has very little concrete information on treatment of withdrawal symptoms, saying only: <br />“No
specific medications are indicated for SCRA harmful use or
dependence and no substitute prescribing is currently available.
Symptomatic management of withdrawal symptoms may be indicated in some
cases.” <br /><br />In the absence of clear direction, piecemeal resources
have emerged but haven’t been evaluated, reviewed or been shared with
wider audiences. Medical responses have included Buscopan or
phenothiazine for nausea. However misuse of Buscopan in custodial
settings has increased wariness of using antihistamines in such settings
and measures such as peppermint oil have been trialed. <br /><br />At least
one prison treatment prescriber used their initiative and used
Pregabalin with some success, until told by senior management not to
continue as the medicine was not licensed for this purpose. In other
settings, benzodiazepines (such as chlordiazepoxide) have been used. <br /><br />In
a contemporary drugs field where centralized agencies work slowly to
national protocols and “evidence-based treatments” can take an age to
emerge, we have been left with too little concrete on offer. <br /><br />When
resources like the<a href="http://sandpit.bmj.com/graphics/2017/nps/nps-v40-web.pdf"> BMJ's infograph on NPS</a> don’t even make mention of
physical withdrawal symptoms, it can hardly be a surprise that GPs and
treatment workers may miss the link between presenting symptoms to SCRA
withdrawal and prescribe accordingly. <br /><br />This ongoing void is
increasingly dangerous. Some drugs agencies have stated (both publicly
and to dependent users) that it would be easier to work with them if
they were using heroin as there would then be a clear treatment
protocol. Given such messages from helping agencies, it can hardly be
surprising that dependent, unsupported users have done just that. <br /><br />Following
numerous courses in Kent and elsewhere, and after discussion with a
number of agencies, there was a clear need for an additional resource to
complement the SCRA Dependency Toolkit. The initial idea was for a
Severity of Withdrawal index. This would follow on from the dependency
toolkit: for those identified as having a physical or psychological
dependency, a more detailed exploration of their symptoms could take
place. The second stage of this would be a tiered collection of
interventions ranging from holistic to inpatient treatment, with
potential pharmacological interventions for different presenting
symptoms. <br /><br />On the back of one such discussion, as the tool was
being discussed, participants on courses were discussing potential
treatments. One we kept coming back to was Mirtazapine. It seemed that
it had the potential to address several key issues including craving,
sleep disruption, nausea, appetite loss, anxiety and neural pain. It
also had an advantage of being less prone to and risky from a misuse
point of view, especially when compared to Pregabalin which also could
be useful in managing several of the symptoms of SCRA withdrawal. <br /><br />The
Index and Treatment suggestions are very much at a draft stage. What is
urgently required is that clinicians stop waiting for some
authoritative national guidance on SCRA treatment. Using the guidance
from Neptune, the only clinical guidance is “symptomatic management of
withdrawal symptoms may be indicated in some cases.” This should be used
as the rationale and argument for trialing appropriate pharmacological
interventions. <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihjfI8MoynHCFInn1ulhCgd3FGqg0KS3Z70WtXlXPHTPMen4QbhPPTlBf8EVnQouFBwY1o6DnB6sFzrvaSTm2cbUw9GPNgMfYR6mtBa001xDcPufvx6OSrgBa7qZYUuQr9cDxw6Q/s1600/2017-02-13_20-25-01.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="286" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihjfI8MoynHCFInn1ulhCgd3FGqg0KS3Z70WtXlXPHTPMen4QbhPPTlBf8EVnQouFBwY1o6DnB6sFzrvaSTm2cbUw9GPNgMfYR6mtBa001xDcPufvx6OSrgBa7qZYUuQr9cDxw6Q/s400/2017-02-13_20-25-01.jpg" width="400" /></a></div>
<br /> In turn where measures have been successful (or
not) they need to be written up, even if it is only as a brief letter to
medical journals. Then and only then will the published evidence base
start to emerge. It requires agencies to take the lead and there should
be no need to wait any longer.<br /><br />The draft SCRA Withdrawal Screening Tool and potential interventions can be <a href="http://www.kfx.org.uk/resources/SCRA_SWSIv1.1.pdf">downloaded here</a>.<br />It is in draft form and all feedback and suggestions are gratefully received.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com3tag:blogger.com,1999:blog-36144663.post-61186197846100782512015-09-06T18:24:00.000+01:002015-09-06T16:43:16.266+01:00full circleAs anyone who has come on the KFx Novel Psychoactives course will know, early on we look at the known statistics about some of the newer compounds, and caution against the hype that suggests that we stand before an unstoppable wave of new compounds that have changed the face of drug taking.<br />
<br />
Despite the "one new drug a week" type headlines, not all new drugs come to market in significant quantities. And of those that do, not many achieve lasting popularity. And none of the new pretenders come close to the popularity of mephedrone in its heyday.<br />
<br />
We also talk a fair bit about Ecstasy on the course. Which of course isn't new or legal. But as the course stresses, it's tempting to chase after the shiny new Novel Psychoactives, whilst failing to recognise that traditional, time honoured substances like MDMA have never gone away and are now enjoying a renaissance.<br />
<br />
One of the things asserted in the NPS course is:
<br />
<div style="direction: ltr; language: en-GB; margin-bottom: 0pt; margin-top: 0pt; text-align: left; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: inherit;">"We need to keep abreast of NPCs.
But we don’t need to lose sight of some fundamentals here:</span></div>
<br />
<div style="direction: ltr; language: en-GB; margin-bottom: 0pt; margin-top: 0pt; text-align: left; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: inherit;">• NPC use in part rose and peaked
because the “right drug” – 4-MMC – arrived at the right time: pre-austerity,
poor quality cocaine and MDMA.<br />
</span></div>
<span style="font-family: inherit;">
</span><br />
<div style="direction: ltr; language: en-GB; margin-bottom: 0pt; margin-top: 0pt; text-align: left; unicode-bidi: embed; vertical-align: baseline;">
<span style="font-family: inherit;">•Some evidence that while a small number
of people are dabbling with NPCs, the majority, given a choice, will gravitate
back towards the “classics” of cocaine, MDMA, cannabis and speed."</span></div>
<br />
It has been interesting therefore to see the results of the annual research on drug trends in the UK, the <a href="https://www.gov.uk/government/statistics/drug-misuse-findings-from-the-2014-to-2015-csew">Drug Misuse -</a><span style="font-family: inherit;"><span style="font-size: small;"><a href="https://www.gov.uk/government/statistics/drug-misuse-findings-from-the-2014-to-2015-csew"> Findings from the 2014/15 Crime Survey for England and Wales</a> and </span></span><a href="http://www.hscic.gov.uk/catalogue/PUB17879">Smoking, Drinking and Drug Use Among Young People in England - 2014.</a><br />
<br />
Smoking, Drinking and Drug Taking.... covers the age group 11-15. It shows small increases in the use in last year of cocaine, MDMA, LSD and Magic Mushrooms.The increases are very small - a fraction of a percent in each case. Cannabis, it is interesting to note, has dropped, with use in the last year at the lowest levels that the survey has ever recorded.<br />
<br />
The Crime Survey covers the age group 16-59 but presents detailed information for 16-25 year olds too.<br />
It shows similar increases in a number of drugs, but with more marked increases than the younger age range.<br />
Use of the following drugs in the past year showed amongst 16-25 year olds increased in the 2014/15 survey.<br />
<ul>
<li>cocaine: 4.8%, up from 4.2% the preceding year</li>
<li>Ecstasy: 5.4% up from 3.9% the preceding year</li>
<li>LSD: 1.2% up from 0.9%</li>
<li>Mushrooms: 1.5% up from 0.8%</li>
</ul>
Interestingly the Ecstasy and LSD figures means reported use of both drugs is at the highest levels for around ten years. Ecstasy use in last year was reported as 5.5% in 2003/4 and LSD last reached this level at 2001/02.<br />
<br />
In order to try and determine if this is a statistical blip or the start of an increase in recreational drug use, we need to try and understand what is driving this modest increase.<br />
<br />
The increase in Ecstasy use is likely, at least in part, down to improved availability and quality. <a href="http://www.vice.com/read/uk-this-is-whats-actually-in-your-ecstasy-394?utm_source=vicefbus">Newer synthesis routes</a> have resulted in an increase in production of high quality, strong MDMA pills. And Dark Web successors to the Silk Road, such as Dream Market, have made access to pills easier than ever.<br />
<br />
The increase in LSD is marginal, but more of a suprise. Some of it may simply be down to improved access via the Dark Web. <br />
Some <a href="http://thetab.com/blog/2015/07/30/a-new-summer-of-love-lsd-use-hits-record-high-for-15-years-47199">media commentators</a> have suggested that this is a retro trend linked to tastes in retro fashion. <br />
It may also be some distortion where people have had used novel psychoactives such as 25i-NBoMe and or 1P-LSD and these have ended up recorded as LSD in the survey. Or if this and the increase in mushroom use are any more than a blip, it could signal a resurgence of interest in psychedelics.<br />
The mushroom example is especially interesting. Now we don't know exactly what sort of mushrooms people are taking, based on the research. But this is one of the only drugs that isn't affected by global production issues. They grow and can be picked (illegally) in the UK. Legitimate commercial sales ended in the UK in July 2005, and resulted in a rapid drop in reported use in the UK that has persisted until this year. It may be again that supply via the Dark Web is playing a role here. But I await with interest the next set of figures to gauge whether this is a blip or something different.<br />
<br />
Either way, and importantly, it does rather undermine the Government's repeated claims about the efficacy of drugs policy and the mantra that "drug use is down." Some drug use is clearly, according to the research, up.<br />
<br />
My belief that MDMA use was something to focus on, and was probably more of an issue than many NPS, has been borne out by the latest research.<br />
<br />
My other key concern has not (yet) come to pass. The levels of heroin use in the Crime Survey are lower than the preceding year, and, at less than 0.1% of 16-24 year olds reporting use in the last year, at their lowest ever levels.<br />
<br />
These figures are probably more prone to problems with research than recreational drugs. Those who are most excluded from society, the homeless, vulnerably housed, and those incarcerated are under represented by the research. It may be that those who are most likely to be using heroin are also the most likely to be under-counted.<br />
<br />
Other proxy indicators of heroin use, such as seizures and police activity are also affected by a number of other factors. Cuts to police funding have an impact on the policing of drugs, so changes in such indicators are not automatically indicative of reduced use.<br />
<br />
Either way, i am not convinced that the downward trend will not sustain, and we will start to see an increase in levels of heroin use again. This is in part because historically heroin has followed a cyclical pattern of use and if the past trends hold true, it will start to increase again. <br />
<br />
Other key factors that I fear will contribute to this upsurge are:<br />
<ul>
<li>increased production in Afghanistan. According to the <a href="http://www.theguardian.com/world/2014/nov/12/afghan-opium-crop-record-high-united-nations">UNODC</a> production in 2014 was at its highest level ever, a situation liable to worsen with the pull out of western troops and increased instability in the country;</li>
<li>increased regional instability maximising opportunities for smuggling and distribution;</li>
<li>increasing homelessness and exclusion from wider society in the UK. In this regard, a key risk will be the ending of <a href="http://www.theguardian.com/housing-network/2015/may/18/housing-benefit-cuts-disaster-young-people">housing benefit to under 21s</a>, which will increase exclusion of young people</li>
<li>increased access to all drugs via the dark web, increasing the prospects of new micro-dealing networks </li>
<li>the banning of synthetic cannabinoids: while some people are using synthetics in place of "normal" cannabis, there is concern that some people who use them will move to (or back to) heroin when these compounds are banned. </li>
</ul>
Once, we could have expected street level drugs agencies to be the first place where any such increase in heroin use would show up. But even this can no longer be taken for granted. As services have been rebranded, it will be interesting to see the extent to which those at the start of their drug using careers access them. But we should watch Needle Exchange statistics very carefully as it is likely to be here that any upsurge in heroin use will show up first.<br />
<br />
Although it is gratifying to get it "right" on the MDMA issue, i don't really want to be right about heroin. We are ill prepared for an upsurge in use so I very much hope to be wrong. <br />
<br />
<br />
<br />
<br />
<br />KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com5tag:blogger.com,1999:blog-36144663.post-88707332686793490492015-08-18T09:44:00.003+01:002015-08-18T09:57:25.713+01:00Barriers to NSP Access: Safeguarding and Scripting IssuesThis short series of blogs came about after a series of training courses where the issue of Secondary Distribution was discussed. This in turn led to discussion about why people were unable or unwilling to attend Needle and Syringe Programmes (NSP) in person, and strategies for addressing this.<br />
<br />
In previous articles, we've looked at what Secondary Distribution is, why it may happen, its strengths and limitations and strategies to increase first person attendance.<br />
<br />
This final piece looks at the issues of safeguarding and scripting/use on top and how they may deter attendance at the NSP.<br />
<br />
<b>Use on top:</b><br />
To what extent do people on OST who use on top still use NSP effectively? Do we know? I suspect we don't have a robust evidence base for this but annecdotally, both workers and people on OST see the tension between using on top and compliance as a driver to disengage.<br />
<b> </b><br />
The situation has probably got more fraught as more and more agencies work within hub-and-spoke models. The location of multi-disciplinary teams under one roof undoubtely has efficiencies in terms of cost and may well help facillitate access to a range of other services.<br />
<br />
It does also, however, mean the walls between NSP and other parts of the service are significantly lowered and in some places removed completely. A person on a script can quite realistically present to get injecting equipment and find themselves speaking to someone directly involved in their prescribing.<br />
<br />
This situation has been exacerbated by the increasing political and commissioning pressure to be less tolerant of long term prescribing, the pressure to reduce, not increase peoples doses, and the increasing political unacceptability of people who are on OST also using illicit substances.<br />
<br />
The combination of hub models and the pressure on services to get people "off" OST and not have people using illicit substances in turn creates a serious tension between the agency and people attending for NSPs and it's all too easy to see why people disengage.<br />
<br />
There are theoretical, practical and idealistic responses to this situation. While in the current climate a "perfect" response may not be possible, improvements can probably be made to most services in this area.<br />
<br />
<b>Solutions:</b><br />
<b>1: Clear policy: </b>the first requirement is that the organisation as a whole develops a clear position on use on top and that this is first communicated internally and communicated clearly to attendees both of prescribing and harm reduction services. Ideally, this position will be one that can work with use on top and injecting. But whatever the position arrived at, it needs to be communicated clearly and in a way that is intelligble.<br />
<br />
<b>2:Internal information walls: </b> We could revert to a model where NSP is separated out from other aspects of service. This ring-fencing of information within the NSP can reassure injectors that confidentiality is located within the NSP rather than the wider organisation.<br />
<br />
However it is not always going to be a practical model and there are some significant drawbacks:<br />
<ul>
<li>in practice there is not sufficient demand for NSP in many agencies to space and staff for a dedicated service; workers will invariably be expected to undertake other duties. And there is a very real risk that workers and volunteers who don't see people at other stages of their treatment journeys become less aspirational for the people they do see.</li>
</ul>
<ul>
<li>even when partial ethical walls are built around NSP, these are largely make believe. Workers may not formally share information but it will still leak between individuals and between teams. Workers may end up playing an unhelpful game where they have to pretend not to know things that they have learned informally. This is neither ethical nor therapeutic.</li>
</ul>
<ul>
<li>such walls means that essential information such as increased overdose risk, mixing drugs, lapse, social risk factors or under prescribing are not addressed properly.</li>
</ul>
<ul>
<li>If honesty is a key tennet of successful recovery, a model of NSP based on reinforcing deception is unhealthy and needs to change.</li>
</ul>
<b>Harm Reduction Interventions: </b>Some of the risks of use on top can be reduced by good harm reduction interventions. Indeed this is one of the reasons why we so want people on OST who do use on top to continue to engage with NSPs. Without this contact we lose the chance to deliver these potentially life saving messages.<br />
<ul>
<li>overdose advice, such as not using alone, or reducing amount used on top</li>
</ul>
<ul>
<li>route change, including consideration of smoking on top</li>
</ul>
<ul>
<li>Naloxone training and provision </li>
</ul>
<b> </b><br />
<br />
<b>Proportionate responses:</b>In order for people on OST and workers in NSP to be confident that they can share information about use on top, they need to be confident that this information will be used proportionately and appropriately.<br />
A good starting point therefore is good internal policy, training and assessment tools relating to use on top and the appropriateness (or not) of continued prescribing in the face of use on top.<br />
<br />
While there is significant political and commissioning pressure to deliver patients in "abstinent recovery" organisations can and should be confident in asserting that the package of care is client centred and therapeutic, even while working constructively with use on top.<br />
With a clear understanding that it is:<br />
(a) better to acknowledge use on top than ignore it and<br />
(b) better to work with it than drive the person from the service<br />
we can then communicate this to people who are on OST and continue to work with them, whether in prescribing or NSP.<br />
<br />
<b>Joint working responses:</b><br />
Assuming that organisations are able to work pragmatically and proportionately with use on top, then it should become more feasible for prescribers and key workers to explore why it's happening and what the best interventions are. Use on top could be happening for a myriad of reasons including:<br />
<ul>
<li>consistent under prescribing</li>
</ul>
<ul>
<li>low dose or overly slow titration periods</li>
</ul>
<ul>
<li>poor explanation about the reality of OST and limitations of a therapeutic dose</li>
</ul>
<ul>
<li>strong dependency on ritual aspects of injecting</li>
</ul>
<ul>
<li>use on top as a treat</li>
</ul>
<ul>
<li>use on top as a way of staying in contact with services</li>
</ul>
<ul>
<li>preferring to be maintained or reducing too fast</li>
</ul>
<ul>
<li>using on top at times of stress</li>
</ul>
<ul>
<li>difficulty in managing triggers.</li>
</ul>
In order to properly address and respond to use on top we need to acknowledge that it is going on and in a non-punitive way explore why, and solutions.<br />
<br />
A range of interventions could be offered including:<br />
<ul>
<li>switching from methadone to subutex</li>
</ul>
<ul>
<li>increasing dose levels</li>
</ul>
<ul>
<li>exploring issues around habituation on injecting process or self harming</li>
</ul>
<ul>
<li>identifying other rewards as a replacement for injecting</li>
</ul>
<ul>
<li>discontinuing or slowing a reduction programme</li>
</ul>
<ul>
<li>stress management strategies</li>
</ul>
Even if<b> </b>such an approach doesn't result in a reduction in use on top immediately, the fall-back position of harm reduction still means the person is retained in service and hopefully engaging honestly. We can still work to reduce harm and, importantly the person can still engage with both parts of the service openly, knowing that their situation will be discussed.<br />
<br />
<br />
<h4>
Safeguarding:</h4>
The other issue that has come up repeatedly as deterring engagement with NSP is the way questions about safeguarding are approached.<br /><br />The ACMD report <i>"Hidden Harm" </i>highlighted the need to look in to parental status of what it termed "problem drug users," saying: "in order tocontinue to monitor this important consequence of problem drug use, we consider it essential to re-establish a reliable method of recording if a problem drug user has children and where they are living."<br /><br />This put the onus on drugs agencies to, as a matter of course, ask about and record if a person attending a service has children, and look out for risks to them. The pressure to look in to this has been significantly increased as the issue of Safeguarding has risen up the agenda. The Statutory Guidance "Working together to Safeguard Children" stresses that "<i>the child’s needs are paramount</i>" and imposes an obligation on organisations saying "l<i>ocal agencies should have in place effective ways to identify emerging problemsand potential unmet needs for individual children and families. This requires all professionals, including those in universal services and thoseproviding services to adults with children, to understand their role in identifying emerging problems and to share information with other professionals to support early identification and assessment.</i>"<br /><br />There's a huge tension between these statutory requirements and the need to offer an accessible service to people who inject drugs. Does the idea of the child's needs being paramount mean that exploring this should be prioritised over getting the person who injecting to engage with services in the first place.<br /><br />It seems counterproductive to pursue such a measure if (a) it carries a very real risk that people will disengage from the service and in turn dissuade others from engaging and (b) where people are engaging, asking important questions about family structure and function is less likely to be elicit honest answers if it takes place too early before trust has been established.<br /><br />So, again balance needs to be achieved to engage and retain people in NSP whilst also creating the opportunity and climate to explore safeguarding issues in an effective and productive way.<br /><br /><b>1: Joint training: </b>Or for that matter any training. There's still a significant number of people involved in Safeguarding, especially within Social Services, who are inadequately trained around drugs. Most will, hopefully, have had basic drugs awareness training. However, unless there's been a greater exploration of harm redution, safer injecting, attitude awareness and treatment. Without such training, the risk is too many workers will have a knee-jerk reaction to encountering injecting drug use where children are a factor. Without the knowledge, skills and comprehension to assess the situation in a more nuanced way, it will hard for both NSP workers and people who inject to feel confident disclosing and sharing information.<br /><br />The best way to achieve the desired outcome will be joint training where drugs workers, social workers and other key players can share training around safeguarding and drugs. This provides an opportunity for workers to develop all-important personal relationships and trust, clarify issues, problems and boundaries and look at shared solutions.<br /><br /><b>2: Policy development and communication:</b> As with the use on top issue discussed earlier, agencies should develop a clear position statement which is understood by all staff and can be shared with NSP attendees in an clear and intelligble way. It cannot and should not offer unrestricted confidentiallity, but should make it more transparent what will and will not need to be shared.<br /><br /><b>3: Trust worker judgement:</b> Ideally, there should be a recognition that workers can use their judgement, and in the first instance achieving attendance and building trust should be a priority. The worker should be able to assess when sufficient trust and confidence has been established to explore difficult issues such as child welfare. The message to workers should be "you need to assess the situation in relation to children of people who inject, but you should decide when exploring this issue is productive, and should not happen prematurely where there is a significant that to do so would cause the person to disengage from the service. Such disengagement represents a greater risk to both adult and child."<br /><br /><b>4: Foster idea of benefit not threat</b>: How we frame questions can have a big impact on the answers we get. So if for example we simply ask "do you have any children at home" there's a risk that the question will be seen in a threatening light. Especially if it's been prefixed by a warning that there's a limit to confidentiality and child safety is a "red-line." But let's try and find ways of selling the questions better. So for example if the agency had a contingency fund to buy and fit lockable medicines cabinet for people who inject and have children. The worker could then prefix the questions about children by discussions such as:<br />
"<i>we have sharps boxes with small apertures and non-return mechanisms which are safer if you have children in the house, so let me know if this sort of box would be better for you.</i>.."<br />"t<i>here's always a risk that, even if you try and store your equipment safely out of reach, children find it so we encourage everyone to use a lockable medicine cabinet for storing drugs and equipment. if you don't have one at home and need one we can help with this..."</i><br />
"<i>it can get busy in the needle exchange and it's not the best environment for children, so if you do have children and need to attend with them, it's better if you make an appointment so you can be seen somewhere quiet and as quickly as possible....</i>"<br />
<h4>
Conclusions and next steps:</h4>
NSP sits amidst a nexus of conflicting tensions. Compliance with treatment, returns, child safety, community atttitudes, funding and commissioning all have an impact on how services are delivered and how well they can work. Recent conversations with workers in NSPs have highlighted the extent to which these tensions are having a real deterrent effect on attendance and engagement. Effective engagement with an NSP is valuable, not just because of the life-saving harm reduction benefits that it can offer. The wider engagement that it can lead to is important for the treatment interventions that come with it, and the chance to address wider safety concerns such as the wellbeing of children. It is therefore self-defeating if the requirements to address treatment and child-safety actually have the effect of causing people to disengage from services. <br /><br />There are solutions to these issues, and it is imperative that these discussions start to take place in a meaningful way within NSPs and wider agencies now.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-42722168506152680342015-08-06T15:50:00.001+01:002015-08-11T07:42:31.699+01:00NSP: navigating the barriers of Assessment and ConfidentialityThis series of articles about NSP started with a consideration of Secondary Distribution and looked at reasons for first-person non-attendance, and the pros and cons of secondary distribution.<br>
<br>
As the earlier articles noted, whilst NSPs should acknowledge and work with secondary distribution, we also need to address the barriers to first person attendance and how make access as easy as possible.<br>
<br>
Over a number of workshops and discussion, four entangled issues have come to the fore as key barriers,which can and must be addressed to facillitate first-person attendance.<br>
<br>
1: <b>Assessment:</b> bloated assessments, imposed too early, seeking repetitve and non-relevant information<br>
2: <b>Confidentiality:</b> confusion over anonymous versus confidential services, and lack of clarity about how information is shared deters engagement. this issues links to:<br>
3:<b> Safeguarding:</b> the drive to assess the well-being and needs of children of injectors may deter attendance by injectors<br>
4: <b>Conflict with scripting:</b> lack of clarity and confusion about use on top deters scripted injectors from attending.<br>
<br>
This article will look at the first two issues. We will return to the second two in the last in the series.<br>
<br>
<b>Assessment and Record Keeping</b><br>
Assessment procedures have a habit of developing a life of their own. They start small, and over time bloat and morph in to multi-page assessment documents. Various workers have reported that they are expected to complete mini-epics as a prerequisite to distributing injecting equipment.This is very problematic, because:<br>
<ul>
<li>early on in the relationship, insufficient trust has been built up to make such an assessment a useful process</li>
<li>NSPs aren't always clear about information sharing (e.g. in terms of use on top) and this lack of clarity about confidentiality when completing assessment documents is not helpful, </li>
<li>too often, questions are not relevant to NSP, or are duplicated from other assessment,</li>
<li>information collated isn't always stored or used in any meaningful way - so doesn't get used to deliver a better service, but is merely collected for its own sake.</li>
</ul>
<b>The need for assessment:</b><br>
To cover basic dilligence, some assessment is essential. Even workers with significant antipathy to assessing things will acknowledge that (for example) it is important that they assess the age and level of intoxication of someone attending NSP. So if we can accept that <u>some</u> assessment is a prerequisite for safe exchange, we therefore need to establish <u>what</u> we need to asssess to deliver competent NSP.<br>
<br>
Having acknowledged this, we then need to record this information in a meaningful, and hopefully useful way. <br>
<b> </b><br>
<br>
<b>Minimum assessment:</b><br>
In order to meet a basic Duty of Care to injectors, workers need to be confident that the person is getting the correct equipment for their needs, and that they know how to use it safely.<br>
We <i>could</i> assume that the person is correct in terms of equipment choice and how to use it. But such an assumption could be erroneous. There are certainly young steroid users who haven't a clue what they are using. Likewise, people injecting NPS could also be unclear about process or technique.But confusion and poor practice isn't the exclusive preserve of these groups. So the safest way forward is to assess rather than assume, especially where people are new attendees at NSP.<br>
<br>
We need to know:<br>
<ul>
<li><b>What is being injected: </b>this will determine should the drug be injected in to a muscle, under the skin or in to a vein. It will also determine should an acid be added, will it need to be heated and will it need filtering. This will also highlight OD risks.</li>
<li><b>Where - which sites are being used: </b>this will determine which equipment the person should be using, and highlight key harm reduction information</li>
<li><b>Where - the environment: </b>If the agency is to give practical advice and prioritise resources where needed, it will be important to know who is homeless or injecting in street settings, and who is housed. Swabs, hand wipes and sterile water should be targetted at homeless injectors.</li>
<li><b>When: </b>the frequency of injecting will determine how much equipment the person needs for a sterile needle for each injection</li>
<li><b>Who: </b>is the equipment for the person presenting or someone else? And is the person injecting themselves or someone else? This flags that the other person ideally attends themselves, and the need for specific harm reduction information </li>
<li><b>How: </b>this isn't an exploration of the entire process - just to ensure that the person is familiar with the equipment that <b>you</b> distribute. How to put handles on spoons, what sort of acid you give out, do you supply water and amp crackers. As different exchanges supply different equipment, it is important to explain what you give out.</li>
</ul>
In terms of staff training, anyone who is delivering NSP should be able to ask these questions, and be able to understand and react appropriately to the answers. <br>
<br>
These questions, along with statistical and monitoring information (gender/age/geographical identifier and ideally ethnicity, sexuality) form the basis of an initial assessment.<br>
<br>
In order to minimise obstacles to engagement, the aim should be to get such an assessment undertaken at the earliest opportunity BUT the key priority is still to ensure that the person receives sterile injecting equipment. It may be on initial attendances, the person doesn't have time or willingness to engage even for a short assessment. The injector should be supported and encouraged to leave enough time on the next visit to undertake a basic assessment.<br>
<br>
<b>Disclaimers: </b>If, after a number of visits, it is apparent that the person doesn't wish to engage with an assessment, a decision should be reached about the appropriateness of continuing NSP to this person. If provision does continue, the agency should consider asking the person to sign a disclaimer, which acknowledges that the injector does not wish to undertake any assessment process and as such the NSP will not be held liable for any harm arising from distribution of equipment.<br>
<br>
<br>
<b>Anonymous versus Confidential: </b>Both people attending services and those working within them seem to get the concepts of anonymity tangled up with the issue of confidentiality.<br>
<br>
An <b>anonymous</b> service means that the person can engage without any information that links to their identity being used or recorded. So while the person may offer a name, initial, postcode or date of birth to create a unique identifier (for statistical purposes), this doesn't tie in to the person's real identity and as such can't be used to identify them or link to other records.<br>
<br>
A <b>confidential</b> service is one where a person's identity may be known, but their identity and how it and information about them is used and shared is restricted. <br>
<br>
People attending an NSP are entitled to expect a confidential service. But the term "confidential" is widely used without clarification. No service offers a completely confidential service. There will always be times when NSPs will need to share information - with or without the client's knowledge and consent. Agencies should also be clear where confidentiality lies - at a team, project or other level.<br>
<br>
People who are concerned about their personal privacy or their
identity as an injector being exposed may be keen on attending
anonymously. However, a wholly anonymous service can have a big drawback -and this relates to advice and record keeping.<br>
<br>
<b>Record keeping </b>matters. Again it is something that some workers resist strenuously. But it shouldn't just be a make-work exercise. It can have significant benefits for all parties, and thought should be given as to how to make it work well.<br>
<br>
Good record keeping is essential as soon as an organisation is doing more than equipment out/in and "leaflet level" information i.e. verbally presenting stock information such as is found on standard literature/resources.<br>
<br>
Where the NSP is delivering more tailored interventions - such as specific advice, referral or signposting to other services, person or situation specific guidance then record keeping is essential.<br>
<br>
<ul>
<li>in terms of accountability and professional standards, it ensures that the NSP can demonstrate that it fulfilled its duty of care and, should practice be called in to question, can draw on written records to demonstrate actions taken.</li>
<li>in terms of continuity it ensures that, regardless of who the injector next sees at the NSP, there's a record of issues to be followed up. This is useful, not just to ensure that advice or referrals are being actioned. It also demonstrates an ongoing interest in the person's wellbeing. </li>
<li>record keeping can help ensure workers focus on current issues that need addressing rather than repeating other messages that may or may not be relevant.</li>
</ul>
Herein lies the tension between anonymous services and what we could call NSP+ - a programme that delivers more than equipment - offering detailed advice, information and care planning to injectors. A NSP+ service needs to have proper records, and as such can't operate on a truly anonymous basis. Records need to be linkable back to a known, identifiable individual.<br>
<br>
One way through the conundrum is to structure the NSP in terms of levels engagement, engagement and record keeping.<br>
<br>
<ul>
<li>At a basic level (NSP) a person can access equipment, and get leaflet-level information. </li>
<li>a minimum assessment as described above should be undertaken </li>
<li>such service can operate on anonymous-type identifiers and with minimal record keeping.</li>
</ul>
The next level of service (NSP+) includes a raft of additional services including tailored harm reduction advice, BBV testing, vaccines and care-planning in relation to injecting health. When engaging with NSP+ the following would be required:<br>
<ul>
<li>additional personal identifiers to allow for record keeping</li>
<li>ongoing case notes</li>
<li>a more comprehensive assessment of injecting related needs.</li>
</ul>
In order to make such a proposition acceptable and appealing to people using the service, consider it more as an exercise in offering an "enhanced" service. As an analogy, consider on-line shopping. I can just log on and shop as a "guest" customer. But by registering and signing up I should get an enhanced service, such as special offers, priority service, better customer support and other benefits. What I don't want is just lots of spam. <br>
<br>
So in the same way NSP is a basic service, and there's a better, enhanced service that you are encouraged to sign up for - NSP+. It has to have benefits, not merely mean the agency gets a load of information and the client gets the same service.<br>
<br>
<b>The limited nature of confidentiality</b><br>
Organisations should be very clear - both to themselves and to those who use their services - that they can at best offer a limited level of confidentiality.<br>
<br>
<ul>
<li>The organisation should determine where confidentiality rests - at a team (e.g. within NSP) or Project, or even at a wider level;</li>
<li>the limits of confidentiality should be mapped and clearly explained to service users as early as practical, in a way that is meaningful and understood;</li>
<li>wherever possible, workers should try to get the client's<u> informed consent</u> so that information sharing can take place, with the client's knowledge, and where it serves the client's best interest.</li>
</ul>
Where information sharing has to take place, there are a number of hierarchies of sharing which could be selected. The risks and priorities in each situation will determine the most appropriate. These could include:<br>
<ul>
<li>information sharing with client's knowledge and consent (if not approval)</li>
<li>information sharing with client's knowledge but without consent</li>
<li>information sharing without client's knowledge or consent.</li>
</ul>
Where the situation allows for it, it will be preferable that knowledge and consent can be obtained, and the client retains some ownership over the process where possible.<br>
<br>
<b>The Hub of the Problem</b><br>
The issue of confidentiality becomes especially challenging in the move towards hub models where all services including prescribing, key working and harm reduction are all under one roof. Some services have few if any specialist NSP workers. As such a number of workers and volunteers with varying levels of training may end up giving out equipment. There have been numerous accounts of effectively anyone who knows which is the pointy end of a needle "covering" distribution of equipment as required.<br>
<br>
Key issues here related to the key issues of confidence, continuity and confidentiality. <br>
<br>
<b>Confidence: </b>Well trained workers and volunteers who understand injecting want to deliver a great service can help even unwilling customers to engage. They can ask the right questions, give helpful advice, and are not afraid to ask questions. Under-confident workers don't want to display their lack of knowledge and risk avoidng questions and discussions. Some under-confident workers will discourage their client from asking questions, and run the risk of viewing their client as unwilling to engage whereas the problem doesn't lie with the client at all.<br>
<br>
So whoever is delivering NSP should be properly trained to a high standard otherwise they will be a barrier to good engagement.<br>
<br>
<b>Continuity: </b>Even with good record keeping, having an unfamiliar face each time a person goes to the NSP is not helpful. While there may be transfer of relevant information between workers, this doesn't transfer to a transfer of the worker-client relationship. it's not easy to build up a trusting relationship when you rarely see the same worker twice.<br>
<br>
<b>Confidentiality: </b>Whilst we can talk about information sharing and informed consent, this goes out the window where the client attends to use the NSP but the worker delivering on that occasion happens to be someone who also plays a role in prescribing, or key working or another area of work. However much we pretend that information is confidential within NSP, when the person using the service sees a person they know in other roles, no amount of reassurance alters the fact that the person's injecting behaviour has been disclosed without them meanting to do so, to a person they wouldn't <span data-dobid="hdw">necessarily</span> have told. All our paper policies are redundant if the person using the service has little control over who they see within the service.<br>
<br>
There are a couple of solutions to this problem. <br>
<br>
The first is to refocus on a model of NSP where the service is primarily delivered by a cohort of trained workers covering needle exchange duties on a regular, rota basis.<br>
<br>
Having dedicated workers, properly trained, and working on a regular basis helps to address the issues of confidence, continuity and confidentiality discussed above. It should also mean that the significance of NSP as a core part of a service is not lost. It isn't a bolt on to a service, to be covered by anyone not doing anything at that moment. And time spent delivering it should be factored in to workload and service delivery, not rushed to get back to the monitored and audited work.<br>
<br>
The other solution is to consider how the whole agency works with use on top.And it is to this and the issue of safeguarding that we will return in the next and final instalment.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-42263220498278302342015-08-03T14:06:00.000+01:002015-08-03T14:06:50.013+01:00Carrots and Sticks and NSPs[part 2 of a series about Needle and Syringe Provision, exploring practice and ethical issues]<br />
<br />
The <a href="http://kfxblog.blogspot.co.uk/2015/07/needle-and-syringe-programmes.html">preceding blog article</a> highlighted some of the legal issues regarding secondary distribution. This one considers reasons why secondary distribution happens, and some of the pros and cons of secondary distribution.<br />
<br />
A key function of NSPs is to get sterile equipment in to the hands of injectors when it is needed and hopefully remove used equipment from circulation. Secondary distribution assists this process and as such represents an essential facet of distribution. Although essential, it isn't ideal. For a collection of reasons, some people will be unable or unwilling to attend NSP themselves and so rely on others to attend.<br />
<br />
It could simply be that geography, travel costs, work or other commitments make it impractical to attend an NSP in person.<br />
<br />
Where
the NSP is primarily just distributing equipment and offering little
more in terms of advice or other input, getting someone else to collect
for you makes a lot of sense. In such settings the perception will be
that there's little benefit in attending in person. In order to attend
there needs to be some sense of added value, or why bother?<br />
<br />
For other people, barriers to attending NSP may be more complex:<br />
<ul>
<li>injectors may have been ASBOd out of area or have other restrictions that make it difficult to attend in person</li>
<li>there may be fears around child protection issues, deterring people from attending</li>
<li>in hub-style provision, scripted injectors may be wary of attending as it could draw attention to use on top</li>
<li>perception may be that the service is not "for me" - not orientated
to steroid users, BME or LGBT injectors, young people, those not in
recovery.</li>
<li>pressure to bring back returns </li>
<li>onerous assessment tools.</li>
</ul>
So secondary distribution represents an essential access point to
sterile equipment for an unknown number of people. As such the NICE
guidance on NSPs rightly endorses it. However, it is not without disadvantages. Some of these are significant.<br />
<br />
<br />
Where injectors take advantage of secondary distribution, this can create another barrier to service access. The distributor can become a gate-keeper. The recipient receives injecting equipment from them. They may also receive advice, information, guidance and other input from the distributor. <br />
<br />
As the recipient can access sterile equipment from the distributor (along with additional advice) there is reduced reason for the recipient to attend a NSP. What they receive is therefore limited to what the distributor can offer. A range of interventions such as professional wound care, testing for BBVs, vaccines and access to treatment are therefore less accessible.<br />
<br />
In truth we can't be confident that the distributor is distributing the "correct" equipment or accurate information. They may have only collected one or two types of equipment and so can't offer a range of paraphernalia. <br />
<br />
And we don't know how it's being distributed. Is it being sold? Distributed pre-filled? Single item distributed with each bag of gear sold? There may be a tacit assumption that the secondary distribution is a benign, philanthropic activity but this may not be the case. We can't even be confident that the equipment distributed is sterile, as the move towards bulk-bagged Insulin syringes increases the risk that used equipment can be passed off as sterile.<br />
<br />
The role of distributor as gate-keeper could be especially significant where the recipient is vulnerable, where abuse or exploitation could be an issue or where the recipient is a young person. So far from being an atruistic act, the distributor could be maintaining control and power through the act of distribution.From a Maslowe-esque point of view, the role of distributor can confer status, recognition, respect and status.<br />
<br />
Returns is another key issue. Agencies may give out large quantities of injecting equipment for secondary distribution but there isn't always consideration of how it is to be returned. Now in some settings, especially amongst some steroid users, secondary distribution is associated with secondary returns. Here, one person collects and returns used equipment for a number of peers, bringing back large amounts of equipment. Whilst this is to be welcomed, it's probably the exception not the rule so secondary distribution risks contributing to the problem of low returns.<br />
<br />
As it will be preferable for people who currently get injecting
equipment from peers to attend NSP in person, in coming articles we'll
look in more detail at how to address
some of these barriers, especially pressure on returns, assessment,
scripting and safeguarding concerns.<br />
<br />
In the meantime, looking at the issue from a broad perspective, organisations need to:<br />
<ul>
<li>acknowledge and accept that secondary distribution is a component of comprehensive NSP</li>
<li>make proactive efforts to encourage recipients of secondary distribution attend in person:</li>
<ul>
<li>stressing to distributors the benefits of attending in person</li>
<li>exploring reasons why they can't/won't attend in person</li>
<li>weighing up "greater harm" principle - does withholding the secondary distribution increase or reduce risk?</li>
<li>working with distributors to ensure they give out the correct equipment and 'right' advice - especially those who are distributing significant amounts of equipment to a number of peers</li>
</ul>
</ul>
<ul>
<li>address barriers to attending in person </li>
<ul>
<li>outreach where geography is an issue</li>
</ul>
<ul>
<li>addressing fears around confidentiality and scripting</li>
</ul>
<ul>
<li>streamlining assessment processes</li>
</ul>
</ul>
<ul>
<li>maximise and stress benefits of attending service in person - informed, compassionate, caring staff offering a confidential, non-judgemental service including but not limited to needle distribution.</li>
</ul>
<ul><ul>
</ul>
</ul>
<ul>
<li>identify and challenge situations where secondary distribution increases rather than reducing risk, such as the sale of pre-filled syringes, incorrect equipment distribution, lack of disposal options and inadequate amounts supplied. </li>
</ul>
<ul><ul>
</ul>
</ul>
<br />
<br />
<br />KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-4935785875998779992015-07-29T10:37:00.002+01:002015-07-29T10:37:41.518+01:00Needle and Syringe Programmes: challenges old and newThe last few Safer Injecting and NSP courses have highlighted a resurgence of concerns about key areas of policy and practice. At the heart of this is the ongoing tension between the provision of a low-threshold harm reduction service whilst simultaneously trying to negotiate the needs of injectors, commissioners and the wider public.<br />
<br />
As we've navigated these discussions in training, there seemed to be some merit in writing up the key issues not least to open up broader discussions and explore possible solutions.<br />
<br />
<b>Secondary Distribution: a starting point</b><br />
<br />
Secondary distribution represents a useful starting point for this discussion. Primary distribution is the 'formal' distribution of syringes and needles via NSPs. It is widely aknowledged that some of this equipment will then be redistributed amongst peers - secondary distribution. In some settings this may be partially formalised where peer advocates undertake such distribution with the explicit knowledge and 'blessing' of the service. More frequently it is undertaken informally where additional equipment is requested for the distribution to family, partners, friends and peers. There is also wholly informal and unplanned distribution where those with equipment will give equipment to those without in emergency or social situations.<br />
<br />
We don't really know how much secondary distribution goes on. The explicit, intentional secondary distribution is easier to map as customers directly request additional equipment for distribution. The level and extent of wholly informal secondary distribution is probably widespread but hard to estimate.<br />
<br />
Secondary distribution is an essential component of getting sterile equipment in to the hands of an injector at the point where it is needed.<br />
<br />The <a href="https://www.nice.org.uk/guidance/ph52/resources/guidance-needle-and-syringe-programmes-pdf">NICE Guidance on NSP</a> is explicit on the subject stating NSPs should "<i>not discourage people from taking equipment for others (secondary distribution), but rather ask them to encourage those people to use the service themselves.</i>"<br />
<br />
Despite this, some agencies remain wary of engaging with secondary distribution, with a range of responses on offer ranging from an outright refusal to allow it, allowing it on a one-off basis, through to unrestricted, large quantities being given out.<br />
<br />
<b>The Law:</b><br />
In practice some aspects of secondary distribution are slightly more nuanced than the NICE guidance would suggest. <br /><br />The distribution of paraphernalia is covered by Section 9a of the Misuse of Drugs Act 1971 (as ammended in 2005). Section 9a made it an offence to distribute items for the administering or preparing a controlled drug but explicitly exempted syringes from the legislation<b>, </b>meaning they remain legal for distribution. Importantly the exemption did not specify <u>who</u> could undertake this distribution making the secondary distribution of needles and syringes wholly lawful.<br />
<br />
After much lobbying and campaigning, the law on other paraphernalia was gradually relaxed and in 2003 the law was amended to allow distribution of other specified items:<br />
<br />
<b>"</b>the following articles are exempt if they are dispensed by a <b>doctor, a
pharmacist or someone working lawfully within drug treatment services</b>:<br />
<br />
<div style="padding-left: 18px;">
<ul style="margin: 0; padding: 0;">
<li style="list-style-image: url(shop/bullet.gif);"> Swabs</li>
</ul>
</div>
<div style="padding-left: 18px;">
<ul style="margin: 0; padding: 0;">
<li style="list-style-image: url(shop/bullet.gif);"> Utensils for the preparation of a controlled drug</li>
</ul>
</div>
<div style="padding-left: 18px;">
<ul style="margin: 0; padding: 0;">
<li style="list-style-image: url(shop/bullet.gif);"> Citric acid</li>
</ul>
</div>
<div style="padding-left: 18px;">
<ul style="margin: 0; padding: 0;">
<li style="list-style-image: url(shop/bullet.gif);"> Filters</li>
</ul>
</div>
<div style="padding-left: 18px;">
<ul style="margin: 0; padding: 0;">
<li style="list-style-image: url(shop/bullet.gif);"> Ascorbic acid</li>
<li style="list-style-image: url(shop/bullet.gif);">Water ampoules of up to 2ml"</li>
</ul>
</div>
<div style="padding-left: 18px; text-align: left;">
However, as the text above makes clear, while the revision added some specific paraphernalia to the list of exempt equipment it also specified who could distribute it - certain professionals and "<b>someone working lawfully within drug treatment services." </b>This is a curious wording. Can someone be working lawfully or unlawfully in a drug treatment service? But either way it does mean that secondary distribution of the items listed is generally not lawful. It remains legal for the secondary distribution of needles and syringes to take place but not these other items.If an agency were giving out pre-packaged equipment for secondary distribution, some of the contents of the pack would be unlawful for secondary distribution.<br />
<br />
Now in truth, we shouldn't get too hung up about this legal issue. There have been no prosecutions against any services for secondary distribution, nor are there likely to be any. This does not mean that an organisation should be cavalier in terms of secondary distribution.<br />
<br />
There is a clear need for thought as to what is distributed, how and why, so an organisation can be clear that (a) secondary distribution is essential in the context and (b) there is a public interest and (c) the organisation has endeavoured to minimise the risks associated with secondary distribution.<br />
<br />
The next part of this blog (hopefully next week) will look at barriers to service access and ways to improve access.<br />
<br />
<br />
<br />
</div>
KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-18721587842063092015-05-31T18:13:00.000+01:002015-05-31T18:13:38.026+01:00The Psychoactive Substances Bill – a fundamental shift in drugs legislation and state control.<!--[if gte mso 9]><xml>
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<span style="font-family: Arial,Helvetica,sans-serif;"></span><span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">Part 1: Commentary </b></span><span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">Every now and then, a piece of legislation emerges which
fundamentally changes the way that the State seeks to regulate how people
choose to get intoxicated. The Misuse of Drugs Act was one such piece of
legislation. If it becomes law, the Psychoactive Substances Bill will represent
another such seismic shift.</span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">It is essential to recognise that, whilst the Bill emerges
against a backdrop of concern about Novel Psychoactive Substances (NPS), its
breadth and reach far exceeds newly emergent drugs. It represents a step change
in how substances are and will be regulated. </span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">Up until now, substances were lawful to produce and supply
provided that they were not currently regulated either by the MDA or the
Medicines Act. The Psychoactive Substances Bill reverses this position and says
that all psychoactive substances will be illegal to produce or supply unless
specifically exempted. </span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">This fundamentally changes the way that the State manages
the risk of substances. Until now the onus has been on the State (via the ACMD)
to demonstrate that any specific substance was so dangerous that it needed to
be “controlled” under the MDA. Now any substance, old or new, will be
automatically prohibited for production, importation or supply unless
specifically exempted. It’s all too dangerous for us to access unless the state
determines otherwise.</span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">The Act to a large extent nullifies the role of the Advisory
Council on the Misuse of Drugs (ACMD) as any new emergent Psychoactive
Compounds are automatically covered by this Act. Their only role in relation to
new drugs would be (presumably) to determine if they should also be controlled
under the MDA, and if so in which Class. </span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">The Act contains provision to exempt specific psychoactive
substances and the Secretary of State has the power to add to this list via
Statutory Instrument. There is no formal or independent mechanism for such
reviews to take place beyond a loose requirement that the “<span style="line-height: 115%;"><span style="font-family: Times,"Times New Roman",serif;">Secretary
of State must consult such persons <span style="mso-spacerun: yes;"> </span>as
the Secretary of State considers appropriate</span>.</span><span style="font-size: 7pt; line-height: 115%;">” </span><span style="line-height: 115%;"></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The list of exemptions includes:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<ul>
<li><span style="font-family: Times,"Times New Roman",serif;"><span style="line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Controlled Drugs and Medicines,</span></span></li>
<li><span style="font-family: Times,"Times New Roman",serif;"><span style="line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Alcohol, </span></span></li>
<li><span style="font-family: Times,"Times New Roman",serif;"><span style="line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Tobacco and Nicotine,</span></span></li>
<li><span style="font-family: Times,"Times New Roman",serif;"><span style="line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Caffeine,</span></span></li>
<li><span style="font-family: Times,"Times New Roman",serif;"><span style="line-height: 115%;"><span style="mso-list: Ignore;">·<span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span></span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Food.</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Aside from the obvious inherent contradiction in
restricting some very low-risk compounds (e.g. Nitrous Oxide) while not acting
on others (e.g. alcohol, tobacco) the legislation in its current form makes
prohibits supply of a number of lawful substances, such as Areca Nut (betel,
paan).</span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">This is however not the key issue. It will be
relatively easy for such substances to be exempted prior to the Act coming in
to force. It’s the idea that from this point on the relative risk or safety of
a substance is irrelevant. If it’s psychoactive and not exempt, it is
forbidden.</span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Because the legislation is coming at a time of
ill-informed moral panic about NPS, the odds are that the legislation will be
passed without significant changes to it. It’s a bad time for the sector to
lose voices such as Drugscope, however muted they had become over time. The
voices that have got the Government’s ear are more likely to be those who will
endorse such a blanket ban.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">But, ideological objections aside, will this
legislation work? That in part depends on how one measures success. If the
experience of the Irish Republic is anything to go by, then it will have a
significant impact on so-called Head-Shops. The vast majority of Irish
Head-shops closed down when similar legislation was introduced. The trade and
use of NPS has not, however ceased. It’s still goes on, but more underground,
akin to more traditional drug markets.</span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The other potential development will be the
relocation of key suppliers outside of the UK. The legislation creates offences
around importation, and includes requirements that can be imposed on internet
service companies. However it seems likely that suppliers with websites and
storage outside of the UK, and especially outside of the EU will be able to
supply NPS with a low level of risk to purchasers in the UK.</span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">In the longer term, as successors to the Silk Road
emerge and stabilise, on-line sale of both old and new psychoactive substances
will continue and grow via virtual markets. Ultimately, a future Government
will have to recognise and accept that prohibitive responses are and will
become increasingly obsolete. Sadly this Government is intellectually too
myopic and ideologically opposed to any such insight and instead will leave us
a terrible legacy: a piece of legislation that views all possible psychoactive
substances as equally dangerous and a single response to them – ban them all.</span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h3 class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">Part 2: The legislation.</b></span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">The main provisions of the proposed legislation restrict
production, supply and importation of Psychoactive Substances.</span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-spacerun: yes;"> </span>A Psychoactive
Substance is defined as “is
capable of producing a psychoactive effect in a person who consumes it, and is
not an exempted substance.” A psychoactive effect is “a substance produces a
psychoactive effect in a person if, by stimulating or depressing the person’s
central <span style="mso-spacerun: yes;"> </span>nervous system, it affects the
person’s mental functioning or emotional state.”</span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: Arial;">In its current form
t</span>he Bill creates key offences of production, supply, importation and
exportation. It <u>doesn’t</u> make possession for personal use an offence BUT
the Bill creates the power for the Police to stop and search for suspected
offences under the Act, to seize substances and to destroy them. </span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;">There is also provision for the searching of vehicles,
buildings etc.</span>
<span style="font-family: Arial,Helvetica,sans-serif;"><br />
The offences are:</span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">Producing a psychoactive
substance</b></span></h4>
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"></span></h4>
<br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">
</b><span style="font-family: Times,"Times New Roman",serif;">(1) A person
commits an offence if—<br />
(a) the person intentionally produces a psychoactive substance, <br />
(b) the person knows or suspects that the substance is a psychoactive substance,
and<br />
(c) the person— (i) intends to consume the psychoactive substance for its psychoactive
effects, or (ii) knows, or is reckless as to whether, the psychoactive
substance is likely to be consumed by some other person for its psychoactive
effects.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">Production
here means “</span><span style="line-height: 115%; mso-bidi-font-family: Arial; mso-bidi-font-size: 7.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">producing it by manufacture, cultivation or any
other method.</span><span style="font-size: 7pt; line-height: 115%;">”</span><span style="mso-bidi-font-family: "Times New Roman";"></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">Supply, a psychoactive substance</b></span></h4>
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"></span></h4>
<br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">
</b><span style="font-family: Times,"Times New Roman",serif;">(1) A person
commits an offence if—<br />
(a) the person intentionally supplies a substance to another person,<br />
(b) the substance is a psychoactive substance,<br />
(c) the person knows or suspects, or ought to know or suspect, that the substance
is a psychoactive substance, and (d) the person knows, or is reckless as to
whether, the psychoactive substance is likely to be consumed by the person to
whom it is supplied, or by some other person, for its psychoactive effect.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">Additional
clauses cover Possession with Intent to Supply and Offer to Supply.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h4 class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;">Importing or exporting a psychoactive
substance</b></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Times,"Times New Roman",serif;">(1) A
person commits an offence if—(a) the person intentionally imports a substance,<br />
(b) the substance is a psychoactive substance,<br />
(c) the person knows or suspects, or ought to know or suspect, that the substance
is a psychoactive substance, and (d) the person—(i) intends to consume the
psychoactive substance for its psychoactive effects, or (ii) knows, or is
reckless as to whether, the psychoactive substance is likely to be consumed by
some other person for its psychoactive effects.</span></div>
<span style="font-family: Times,"Times New Roman",serif;">
</span><div class="MsoNormal">
<span style="font-family: Times,"Times New Roman",serif;">(2) A
person commits an offence if—</span></div>
<span style="font-family: Times,"Times New Roman",serif;">
</span><div class="MsoNormal">
<span style="font-family: Times,"Times New Roman",serif;">(a) the
person intentionally exports a substance, <br />
(b) the substance is a psychoactive substance,<br />
(c) the person knows or suspects, or ought to know or suspect, that the substance
is a psychoactive substance, and (d) the person— (i) intends to consume the
psychoactive substance for its psychoactive effects, or (ii) knows, or is
reckless as to whether, the psychoactive substance is likely to be consumed by
some other person for its psychoactive effects.</span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h4 class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";">Commentary:</span></b><span style="mso-bidi-font-family: "Times New Roman";"> </span></span></h4>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">One of the key challenges in
drafting this legislation will have been to ensure that labelling products as “plant
food” or “not for Human Consumption.”</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">The key
wording in the proposed legislation to address this is “</span>knows, or is reckless as to
whether, the psychoactive substance is likely to be consumed”</span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">The
expectation is that a court could determine that a person was acting in a
reckless way by the production or supply of compounds which a reasonable person
could assume were for the purposes of intoxication, irrespective of how they
were packaged.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><h4 class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";">Enforcement Powers:</span></b></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">In
addition to the criminal sanctions of fines, imprisonment or action under the
Proceeds of Crime Act, the Bill introduces new powers to prohibit activity or
close premises.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";">Prohibition Notices </span></b><span style="mso-bidi-font-family: "Times New Roman";">could be served against
individuals who are believed to be carrying out prohibited activities such as production
or supply of prohibited activities, requiring them to stop any such activity.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";">Premises notices </span></b><span style="mso-bidi-font-family: "Times New Roman";">can be issued to people who own,
manage or lease premises where there is a belief that prohibited activities in
relation to Psychoactive Substances are taking place, requiring that any such
activity ceases.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">In
situations where such notices have been breached or in other circumstances,
Prohibition or Premises Orders can be issues by a court. The standard of proof
for these is on balance of probability, though they could be issued as part of
a sentence for an offence under the Act.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"></b></span></div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"></b></span></div>
<h4 class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";"></span></b></span><span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";">Commentary:</span></b></span></h4>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: "Times New Roman";"> </span></b><span style="mso-bidi-font-family: "Times New Roman";">If the experience of Eire is anything
to go by, the Prohibition and Premises orders will be a key tool to act against
shops and other retail outlets. As there is no requirement to prove to criminal
standards that the any criminal breach has taken place, it will be relatively
easy to enforce and effectively stop sale via shops. </span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-bidi-font-family: "Times New Roman";">The
full text of the bill can be viewed and downloaded here:<br />
<a href="http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf">http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf</a></span></span></div>
KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com2tag:blogger.com,1999:blog-36144663.post-68000624575260641692014-09-07T18:55:00.003+01:002014-09-07T20:05:31.574+01:00The Language of New Drugs - From Education to Assessment<!--[if gte mso 9]><xml>
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<h2>
</h2>
The KFx <a href="http://www.kfx.org.uk/training_and_consultancy/courses_cats_bees_and_butterflies.php">Cats, Bees and Dragonflies course</a> explores the subject of newer, emerging drugs. One
of the issues we address very early in this course is terms of reference.
This inevitably brings up the vexed question of what collective terms to use
about newer compounds.</div>
<div class="MsoNormal">
<br />
For well rehearsed reasons we should eschew the phrase
“Legal Highs.” Many of the compounds are no longer legal, and not all are
stimulants. There is debate as to whether or not people construe legality to
equate with safety. I am of the mind that ‘legal’ has connotations of being
sanctioned or approved. It suggests legality via permission. As this is not the
case with our newer compounds, I prefer “unregulated” as opposed to “legal.”</div>
<div class="MsoNormal">
The phrase that has become <i style="mso-bidi-font-style: normal;">de rigeur</i> amongst academics and policy experts is Novel
Psychoactive Compounds (or substances). It’s the phrase of choice for the EU,
and the EMCDDA defines it thus:<br />
<span style="font-family: "Times New Roman","serif";">
“<i>a new narcotic or psychotropic drug, in pure form or in preparation, that is
not controlled by the United Nations drug conventions, but which may pose a
public health threat comparable to that posed by substances listed in these
conventions</i>.”<br />
</span><span style="mso-bidi-font-family: "Times New Roman";"><br />
There are a number of problems with this definition, not least some of the
compounds are not that new: Nitrous Oxide has been around since the latter half
of the 19<sup>th</sup> Century, 4-mmc was first synthesised in 1929 and a lot
of the benzo-type drugs doing the rounds at the moment were first synthesised
in the 1960s. <br />
It also creates the small problem that as soon as the drug <b style="mso-bidi-font-weight: normal;">is </b>controlled by the UN drug conventions it ceases to be a Novel
Psychoactive Compound (NPC). </span></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";">Most
problematically for me it has little or no relevance as a term to end users. A
resource, service or awareness session entitled referring to Novel Psychoactive
Compounds will not register with key target groups. Asking people “<i style="mso-bidi-font-style: normal;">what NPCs have you used in the last month</i>”
won’t elicit the information that I am looking for. It’s akin to when the
language switched from talking about “glue sniffing” to “volatile substance
abuse.” The language may be more accurate but what it gains in accuracy it
loses in comprehension.</span></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";">The
other thing that is interesting about all the widely used phrases: “Novel
Psychoactive <b style="mso-bidi-font-weight: normal;">Compounds,</b>” “Legal <b style="mso-bidi-font-weight: normal;">Highs,</b>” and “Research <b style="mso-bidi-font-weight: normal;">Chemicals</b>” is that the word <b style="mso-bidi-font-weight: normal;">Drugs</b> is absent. According to Rick
Bradley at KCA, presenting at a seminar in 2014, </span>about 85% of NPS users
do not recognise themselves as drug users. </div>
<div class="MsoNormal">
The language we have all adopted
contributes to the sense that these are somehow distinct from other drugs.</div>
<div class="MsoNormal">
<br />
In turn, this linguistic sleight of hand has, to my mind,
disempowered drugs workers. The recurrent theme from training sessions is a
sense of not understanding this new world of NPS. These are often experienced
workers who can deal with the full spectrum of “traditional” drugs. Reminding
these workers that these are still drugs, much like ones they can and have
worked with, does much to overcome this sense of disempowerment.</div>
<div class="MsoNormal">
<br />
So over time I have tried to find a language that works to
address these problems. I ended up finding that the phrase “<b style="mso-bidi-font-weight: normal;">Newer Unregulated Drugs”</b> worked
reasonably well. Except when the law changes. But it’s largely immaterial as I
am not egotistical enough to think the phrase will ever catch on. What’s more
important is that we have the discussion and explore the role language and
terminology plays in constructing paradigms.</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Language of
Assessment:</b></div>
<div class="MsoNormal">
What we call our emerging drugs also has a bearing on the
assessment process. If we don’t ask and prompt about newer drugs, we may not
get this information volunteered. And when it comes to newer drugs this brings
with some very specific challenges.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">1: Not perceiving
substances to be drugs:<br />
</b>As highlighted earlier, there’s some evidence that some people may not
consider their “legal” substances to be drugs, so if they are asked about other
<b style="mso-bidi-font-weight: normal;">drugs</b> may not volunteer emergent
drugs. </div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">2: Unfamiliar with
collective terms:<br />
</b>We want to try and avoid the term “legal highs” for reasons mentioned and
use of phrases such as Novel Psychoactive Compounds may not have a high
recognition factor with young people.</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">3: May not be
familiar with drug families or link drugs to families<br />
</b>Routinely we would ask people about (for example) their benzodiazepine use.
But asking this doesn’t automatically mean that the respondent will link their
Etizolam use to the use of benzos, and volunteer this as a response. Similarly,
although we ask about cannabis use, the respondent may not volunteer that they
are smoking synthetic cannabinoids.</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">4: May not know what
they have used or have misidentified it:<br />
</b>The emergence of generic slang such as “legals” could cover a wide range of
drugs. Regionally, slang such as “Monkey Dust” or “Bubble” could refer to a
specific compound such as mephedrone or any unknown white powder.<span style="mso-spacerun: yes;"> </span>In turn “mephedrone,” once referring to
4-mmc, could now be used interchangeably for other white powder drugs. So
assumptions both by user and worker as to what a person is actually using could
be both misleading and dangerous.</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><b style="mso-bidi-font-weight: normal;">5: We don’t want to give people a shopping list:</b><br />
</b><span style="mso-bidi-font-weight: normal;">Especially when working with younger, naïve users, it is important that the
assessment process doesn’t end up introducing the client to a whole list of
substances with which they were unfamiliar. So while initially tempting, an
assessment form which either lists or illustrates a wide range of different products
is risky. It is still unlikely to be comprehensive – there are SO many brands
on the market now. But it also risks introducing substances to a client who was
hitherto unaware of that compound of family of drugs. We need to prompt, but
without exposing the respondent to still more compounds.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Assessment to Prompt,
not Promote:<br />
</b></div>
<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1I-oX4fLpP84ejY_G7GabVrcjFadlGUTeYW5Ice4qj98J5abMdV8L1EaQAWFKhOnlnG4OWm5MiXdIJFo7eQGe9007MBsFL0WxtkapkuFa1jzf3Pf_SF4ddOe7XMs4pBk8ocM2-Q/s1600/sc1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1I-oX4fLpP84ejY_G7GabVrcjFadlGUTeYW5Ice4qj98J5abMdV8L1EaQAWFKhOnlnG4OWm5MiXdIJFo7eQGe9007MBsFL0WxtkapkuFa1jzf3Pf_SF4ddOe7XMs4pBk8ocM2-Q/s1600/sc1.jpg" height="200" width="153" /></a>After a numerous training sessions and a number of false starts, a
screening process emerged which addressed all my key concerns. It sits
alongside an existing standard screen and looks specifically at newer drugs. Rather than exploring specific substances it looks at types
of compound and routes. So for example by asking about smoked substances it can
elicit synthetic cannabinoids, kratom, or salvia without naming the substances.
Even vague references to “I smoked something, I’m not sure what it was…” can be
incorporated.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Likewise, by asking
about “white powders” we can explore all the different brands and unbranded
substances, again without having to give names. Using the same format, the tool
asks about Pills and Pellets, and Other Substances (swallowed, inhaled etc) to
cover other drug groups.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
In training we use the Drug Map to explore the relative
location of different drugs. We can use it to explore </div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghAMAcF0Rv7z151K4iOoefWUUefUWYPY4v9rCBxzK2xRnE2dMJvDw8iAZvxjJ-03hZvk6gi3msbV1yf6-SAzywMYHxlyE4P1W1TZUtO_GCkpnO-MySOBTAPU_w9IcEuVTdK51NXA/s1600/sc2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghAMAcF0Rv7z151K4iOoefWUUefUWYPY4v9rCBxzK2xRnE2dMJvDw8iAZvxjJ-03hZvk6gi3msbV1yf6-SAzywMYHxlyE4P1W1TZUtO_GCkpnO-MySOBTAPU_w9IcEuVTdK51NXA/s1600/sc2.jpg" height="320" width="233" /></a></div>
potency, duration and
effects. In the context of assessment it is left blank, so the respondent can
describe how the substance affected them – strong stimulant effect, very
hallucinogenic, drowsy and so on. This is useful, not least because it ensures
that the client can articulate their experience of the substance. It can also
highlight where there’s a high chance they have used something other than their
names substance – where the effects described are at variance with typical
reports of that drug.<br />
<div class="MsoNormal">
The assessment tool goes on to explore key issues stemming
from use and develop an action plan. Sample pages are shown below.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As with other KFx resources this Assessment Tool can be
downloaded from the KFx website<a href="http://www.kfx.org.uk/resources/nudst.pdf"> here</a>. It is free to download and use. If you
have any feedback I would be keen to hear it and will revise the tool as
feedback is received.</div>
<div class="MsoNormal">
Ideally use of the tool will be combined with staff training
to increase awareness and confidence of responding to Newer Unregulated Drugs.
Such training is of course available via KFx.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";"></span><b><span style="mso-bidi-font-family: "Times New Roman";"></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGCd_7ToaZVvITU8D2HfG8zLdSjGVsB5_Uf-pPSNbIj8irVgXH80ri-CH3pbb_krPRjy8v7n9n6WOh4G3IWXZSbSG1JU1nvalwWYehm23aRlROAgc_UwI3uoWf7GDR9KOL2CGTdQ/s1600/sc3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGCd_7ToaZVvITU8D2HfG8zLdSjGVsB5_Uf-pPSNbIj8irVgXH80ri-CH3pbb_krPRjy8v7n9n6WOh4G3IWXZSbSG1JU1nvalwWYehm23aRlROAgc_UwI3uoWf7GDR9KOL2CGTdQ/s1600/sc3.jpg" height="182" width="400" /></a></b></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<b>LINKS: </b></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="mso-bidi-font-family: "Times New Roman";"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="mso-bidi-font-family: "Times New Roman";"> <a href="http://www.kfx.org.uk/resources/nudst.pdf">The KFx NPS Screening Tool</a></span></div>
<span style="mso-bidi-font-family: "Times New Roman";">
</span><span style="mso-bidi-font-family: "Times New Roman";"></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="mso-bidi-font-family: "Times New Roman";"></span></div>
<span style="mso-bidi-font-family: "Times New Roman";">
</span>
<span style="mso-bidi-font-family: "Times New Roman";"></span><br />
<div class="MsoNormal">
<span style="mso-bidi-font-family: "Times New Roman";"></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.kfx.org.uk/drug_facts/drug_facts_researchchemicals.php">The KFx Newer Unregulated Drugs Briefing - includes Look-Up Table (August 2014 update)</a></div>
<br />
<span style="mso-bidi-font-family: "Times New Roman";"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="mso-bidi-font-family: "Times New Roman";"><a href="http://www.kfx.org.uk/resources/Newer_Unregulated_Drugs_List_8.14.pdf">Newer Unregulated Drugs - Just the Look-Up Table (August 2014 update)</a></span></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<span style="mso-bidi-font-family: "Times New Roman";">
</span>
<span style="mso-bidi-font-family: "Times New Roman";"></span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="mso-bidi-font-family: "Times New Roman";"><a href="http://www.kfx.org.uk/drug_facts/drug_facts_mephedrone.php">Mephedrone Briefings (revised August 2014)</a></span></div>
<span style="mso-bidi-font-family: "Times New Roman";">
</span>
<span style="mso-bidi-font-family: "Times New Roman";"></span>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com2tag:blogger.com,1999:blog-36144663.post-17480033661688570272014-07-14T17:00:00.000+01:002014-07-15T08:06:06.330+01:00Old Waves, New Waves, Permanent Waves<!--[if gte mso 9]><xml>
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A couple of years ago I wrote a blog article about the
strained relationship between radical politics and drug dependency. On
that occasion I was looking at the challenge that social movements such as
Occupy face when people experiencing problematic drug use and people engaged in
social protests end up sharing the same created spaces – or what Hakim Bey
called “Temporary Autonomous Zones.”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was reminded of this blog on reading Alistair Sinclair’s
excellent article in Drink and Drug News entitled “<a href="http://drinkanddrugsnews.com/wp-content/uploads/2014/07/DDN-0714.pdf">Catching the Wave</a>.” Locating his discourse firmly from the perspective that the “<i>personal
is political</i>,” Sinclair argues “<i>while we have been encouraged to focus on the ‘canaries
in the mine,’ those who are the first visible casualties of a sick society,
fixing them and returning them to a productive life, we have been discouraged,
interestingly from looking at the mine itself</i>.”</div>
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Whilst agreeing wholeheartedly with Sinclair here, a bit
that I find fascinating is the line “<i>we have been discouraged…from looking at
the mine itself</i>.” Discouraged by whom, and why?</div>
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<br />
I originally looked TAZs in the context of radical politics.
Since then it has been interesting to observe the new TAZs of the Recovery Movement
emerge. The Recovery Walks, Festivals, Alcohol Free Bars are each examples of
temporary spaces creating their own rules, norms and dialogues outside of the
societal mainstream. In this respect they represent a radical, grass-roots
derived response to substance dependency. </div>
<div class="MsoNormal">
From the point of radical politics
there is a great deal here to admire – the gathering of groups of people who
find common cause and who, with minimal reliance on external agencies, have
grown their own communities. </div>
<div class="MsoNormal">
<br />
Here though, lies the first challenge. As Bey noted when
talking of Temporary Autonomous Zones, as the initial rush of creativity is
lost, a TAZ can stultify, and deteriorate to a structured system that stifles creativity.
Those who make the path by walking it risk creating a new highway that all
follow and from which only the brave or the foolhardy deviate.</div>
<div class="MsoNormal">
There are however, bigger challenges. Perhaps these are why,
as Sinclair notes, we are discouraged from looking at the mine itself. <br />
<br />
Sinclair’s article talks with the passion of a <i style="mso-bidi-font-style: normal;">fin de siècle </i>theorist of how we are “<i>staring in to an abyss and
facing the ‘challenges of modernity</i>.’” Radical talk indeed. Almost
revolutionary. How well does such radicalism sit alongside 12 step traditions? </div>
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<br />
Given the AA tradition that “<i>Alcoholics Anonymous has no
opinion on outside issues</i>,” there is a clear tension between internal personal
audit and a process of external fault finding. An addict is sick, and must
acknowledge this if they are to recover. But does the same model that
encourages this introspection actively discourage acknowledgement of the sick
society? </div>
<div class="MsoNormal">
<br />
This sense of being unable or unwilling to look at the mine
rather than just treating the canaries is reinforced by other articles of
faith. The Serenity Prayer for example, the acceptance of things that
can’t be changed, throws up the sharp question is a failing society something
that should be accepted with serenity. Likewise, the invocation to “<i>sweep off
our side of the street</i>,” discourages a more radical approach which seeks to
challenge the causes. "<i>His faults are not discussed. We stick to our own</i>.” </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It would of course be wrong to elide all recovery communites
and these aspects of AA tradition. Sinclair’s article takes a far wider view of
recovery and is not rooted in a Fellowship paradigm. But at present much of UK
recovery does draw on Fellowship traditions and as such it is firmly located
within an apolitical nexus.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While the spaces that the recovery community create may
themselves be apolitical, they are unavoidably located within a wider political
context. The political idealism which has driven much of what is now labeled ‘recovery’
has very definite views of canaries and mines and recovery. Once recovered, a
canary should very much get itself back down the mine, and become a
hard-working canary, especially if it wants any more millet. <br />
<br />
So very far from critically looking at the society that creates the sickness, the
political paymasters are disinterested in healing a sick society rooted in
inequality. They want the sick well so that they can go back to being efficient
healthy cogs in the machine, but with an adjusted mind-set that allows them to
cope with the machine better, in gratitude and humility.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have no doubt that Sinclair’s right about our sick society
and the need for communitarian responses. At present we risk a combination of
temporary autonomous zones ossifying in to permanent ones, an ideological bedrock
that eschews controversy, and paymasters who are more interested in human function
than the human condition. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While some aspects of emergent recovery communities are
deeply radical in spirit and execution, and while some individuals do speak
loudly about the wider issue of our sick society, the fear is that the lack of
radicalism will leave people in the same mine as they were ever in.</div>
KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-35425284479864479652013-11-26T19:24:00.001+00:002013-11-26T21:26:13.588+00:00Head-shops: Regulation or Prohibition<!--[if gte mso 9]><xml>
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<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">This is our chance to have a radical shift in drugs policy. But we're going to end up with more prohibition...again.</span></b></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Recent
legislative proposals and media coverage have pushed the subject of
“head-shops” to the top of the drugs agenda. It has also been a recurring theme
for me in recent workshops, hence this article, to explore head-shops more
closely, especially in relation to the retail and regulation of Novel
Psychoactive Compounds (NPCs). </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Though no statutory
figures exist, anecdotally there has been a significant increase in the number
of head-shops in the UK. The Angelus Foundation<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[1]</span></span></span></span></a>,
says that there are in excess of 250 in the UK, based on on-line research and
liaison with trading standards. As they acknowledge, this may not be an
accurate figure. Part of the problem in counting head-shops is that (a) there
is no clear definition of what would constitute a “head-shop” and (b) there is
no licensing or regulatory framework that would enable local authorities to
keep track of such shops.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">For the
purpose of this article, I am going to consider a head-shop to be any retail
outlet where a significant proportion of its sales includes NPCs or other
psychoactive substances. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Head-shops
have proliferated in step with a growing market for NPCs. The growing
availability of un-regulated psychoactive compounds has coincided with cheap
empty retail units in town-centre locations. There are a number of independent
traders, and a smaller number of chains. The ambience, product range and
willingness of outlets to ‘self-police’ vary massively.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Workshop observations: </span></b><span lang="EN-GB" style="mso-ansi-language: EN-GB;">The issue of head-shops has cropped
up repeatedly during recent workshops. In a number of different areas,
participants have noted the sudden and significant impact that the arrival of a
new head-shop has had on local drug patterns. This has included changes within
night-time economy, impact on door-staff, presentations in custody and A+E, and
demands on drug services.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Sadly, much
of the reporting is anecdotal. There is no routine recording of NPC usage and
its links to Hospital admission, drug service usage, or offending behaviour. As
such, reports from agencies of local shifts in use and behaviour are hard to
evidence. But the consistency and regularity of these reports in workshops
makes them compelling and hard for me to ignore.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Head-shops v. On-line retailing: </span></b><span lang="EN-GB" style="mso-ansi-language: EN-GB;">A key concern is that head-shops,
rather than on-line retailers that provide the more ready access point to
people under 18s. Most of the websites require some form of credit or
debit-card payment and this, combined with the requirement to have things
delivered to the home, acts to some extent as a barrier to younger purchasers.<br />
Head-shops on the other hand are much more accessible and accept cash payments.
They also remove any lingering misgivings about home deliveries or using cards
online. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Head-shops
also allow for more impulsive, less considered use. The process of ordering
online, the selection process and the delayed delivery mitigate against
impulsive use (to an extent.) Whilst a punter may purchase impulsively, they
may be more considered than when buying in a shop. So the presence of a
town-centre head-shop may provide a readily accessible point for the impulsive
purchase of NPCs by younger people.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Conversely,
a counter argument can be made FOR head-shops. Their products may be risky, but
the same can be said for wholly unregulated street drugs. Does the presence of
a head-shop undermine street drug markets, providing a less risky alternative?
This argument has certainly been made by colleagues noting that in areas with
easy access to unregulated NPCs they have seen less injection of mephedrone.
But conversely some areas with easy access to legal white powder stimulants from
head-shops have seen injecting of these compounds in place of street drugs.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">At the very
least some head-shops will at least try to ensure that they don’t sell to
under-18s, through measures like checking ID. This at least provides a modicum
of control which doesn’t exist in street settings.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">The pressure for change: </span></b><span lang="EN-GB" style="mso-ansi-language: EN-GB;">At present the media are building up
a fine head of steam in relation to head-shops and politicians are not far
behind. The odds are the present situation will not be allowed to continue.
There are two courses of potential action – to regulate the industry or to
clamp down on it.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">The Angelus
Foundation is pushing for such an approach, supporting an amendment to the
Antisocial Behaviour, Crime and Policing Bill, <a href="http://www.blogger.com/blogger.g?blogID=36144663#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[i]</span></span></span></span></a>
which says:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><i style="mso-bidi-font-style: normal;">It is an
offence for a person to supply, or offer to supply, a psychoactive substance,
including but not restricted to- <br />
(a) a powder;<br />
(b) a pill;<br />
(c) a liquid; or<br />
(d) a herbal substance with the appearance of cannabis,</i></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><i style="mso-bidi-font-style: normal;">which <span style="mso-spacerun: yes;"> </span>he knows, or has reasonable cause to believe,
to be so acting, that the substance is likely to be consumed by a person for
the purpose of causing intoxication.</i></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">This clause would require significant revision in
order to be viable. At present it would probably make it illegal to sell tea
and coffee, and the simple measure of dying a product like “Exodus Damnation”
pink would get round the strictures of clause (d) in the proposal. As it stands
it wouldn’t criminalise end users and doesn’t result in the closure of shops. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">The
response in Ireland has been subtly different and creates a system of Closure
Notices and Closure Orders for head-shops selling intoxicated substances.<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[2]</span></span></span></span></a>
This piece of legislation importantly includes a “reverse burden of proof,”
requiring retailers to prove to the court that a product was NOT sold for human
consumption, irrespective of any wording on packaging. <br />
Further, importantly, the legislation doesn’t criminalise end-users but does
provide scope to close down retailers. The Mirror<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[3]</span></span></span></span></a>
claims that this legislation reduced the number of head-shops from “</span>from
100 to six in three months.” </span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">In lieu of
regulatory or prohibitive legislation, a variety of piece-meal responses have
emerged. The use of the Intoxicating Substances (Supply) Act 1985 was
successfully used in Leeds.<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[4]</span></span></span></span></a>
Attempts to use Trading Standards legislation failed in Chester due to a
botched case.<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[5]</span></span></span></span></a>
</span></span></div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Police enforcement action against head-shops in Wales used more conventional
approaches, including charges for drugs offences related to cannabis and
charges for money-laundering.<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[6]</span></span></span></span></a></span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Elsewhere
Police and Trading Standards have been more and more inventive, exploring other
branches of legislation relating to cosmetics, chemical storage and fire safety
to apply pressure to head-shops. There are many such avenues that could be
explored. For example, synthetic cannabinoids, sold as “herbal incense” would
need to be safe to use as instructed – when placed on a incense burner. As they
would release toxic, intoxicating fumes if heated they would be an easy target
for Trading Standards in their current form – they are not safe or fit for
purpose as “incense” or “pot-pourri.” But this is a temporary measure – it
would be easy to relabel the product to side-step this issue. <br />
Another potential issue is the insurance of head-shops. It will be interesting
to see how many shops are covered for building insurance if they cover
significant amounts of chemicals on site, and if they have valid employer’s
liability insurance given the chemicals on site.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">All the interventions so far have been prohibitory and
restrictive rather than regulatory. </span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">However, they haven’t resolved the issue of NPCs and prohibitive
responses may have their own unintended consequences.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Sale of
NPCs is not restricted just to head-shops. There is a thriving market in less
typical retail outlets ranging from newsagents through to fast-food shops. This
is an issue that has recently been highlighted by Max Daly in Drugscope.<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn7" name="_ftnref7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[7]</span></span></span></span></a><span style="mso-spacerun: yes;"> </span>So restriction or banning of head-shops runs
the risk of driving the products in to a range of other outlets which could be
still harder to regulate.<br />
We have already seen that as an existing product is prohibited they are firstly
discounted massively on websites and post-prohibition sold via other outlets
including car-boot sales, pubs and under the counter in head-shops. With no
mechanism for regulating shops or reimbursing retailers post-prohibition, it is
inevitable that prohibition will see residual products dumped on to the market.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Clamping
down on head-shops does nothing to address on-line side of distribution which
would persist even if head-shops were closed down. It’s worth noting that the
primary distribution channel for mephedrone prior to it becoming a controlled
drug were on-line suppliers, rather than head-shops.<br />
And it’s also worth stressing that it easier to hold a shop-based retailer to
account than a virtual one.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Regulation</span></b><span lang="EN-GB" style="mso-ansi-language: EN-GB;"> would require a significant step change in
terms of drug strategy. It must be said that some of the current head-shops see
themselves as having some moral and social values and endeavour not to supply
to younger people. But the lack of a regulatory framework and the moral
‘flexibility’ of some outlets means that head-shops are certainly not
“off-limits” to younger purchasers. One participant on training recently
described how her existing older clients were up in arms about the behaviour of
the local head-shop, as they saw children in school uniform queuing for NPCs. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">The current
legislative and regulatory framework is confusing and widely misunderstood. And
in truth the current options for agreeing a regulatory framework are distinctly
limited. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">A key
option would be to require “head-shops” to be licensed by a Local Authority.
This could open up a range of control options including:</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Vetting
and training of staff</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-list: Ignore;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Requirements
to check ID in relation to age</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-list: Ignore;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Control
over where shops can open and when they can trade</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span style="mso-list: Ignore;"><span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"></span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Capacity
to remove licences in response to emergent problems.</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Regulation requires licensed substances: </span></b><span lang="EN-GB" style="mso-ansi-language: EN-GB;">At present there are some limited
legal barriers to the sale of products that are NOT controlled drugs or
medicines.<br />Whilst many
of the NPCs currently sold carry “adults only” or “not for under 18s” badges
there is limited legal basis for this. The rationale for such voluntary
age-restriction is more politic than legal. By attempting to legal sales to
“informed adults” retailers are slightly better protected from litigation. It
may also have been intended to reduce political and media ire but is clearly
becoming less effective in this regard. </span></span></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">It is also intended to protect
retailers from falling foul of the Intoxicating Substances Supply Act (1985)
which makes it an offence to supply an inhalable product to a person under 18
where it is known that it will be used for intoxication. Originally intended to
deter the sale of solvents, it has also been applied to the sale of some NPCs.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">The key obstacle to regulation is the legislation
relating to the sale of medicines. At present products are sold “not for human
consumption,” and variously sold as “research chemicals” or other flags of
convenience, so that they do not fall foul of the Medicines Act.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">The greater the extent to which retailers acknowledge
that their products are sold for the purpose of intoxication, the more the
products are likely to fall within the scope of the Medicines Act. In itself,
this doesn’t happen just because a retailer gives a customer advice about a
substance. <span style="mso-spacerun: yes;"> </span>So when for example the Daily
Mirror says “</span><i style="mso-bidi-font-style: normal;">Legal highs:
Store worker flouts drug laws to dish out drug advice to customers</i><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftn8" name="_ftnref8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">[8]</span></span></span></span></span></a><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">” this isn’t strictly accurate. The provision of advice on its own
doesn’t put the retailer on the wrong side of legislation. But it DOES make it
easier for the Borderline Products Team at the MHRA to conclude that the
product in question is being sold for the purpose of ingestion and as such
should be considered a medicine. However, to reach this stage, the MHRA would
have to consider and reach such a decision and, until such a decision was
reached, the substance in question would still not be subject to the strictures
of the Medicines Act.</span></span></div>
<div class="MsoNormal">
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">So whilst the provision of verbal advice about doses
and choice of compound nudges retailers closer to restriction under the
Medicines Act, it’s a long way from having a product or family of products
labelled “medicines” by the MHRA.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">Where the provision of advice about choices or usage
does leave retailers more exposed is in the event of someone suing for damages
– citing breach of Duty of Care.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">At present retailers shelter behind the “Not for Human
Consumption” claim which is often backed up by assertions that the product
should not be ingested and medical help sought if taken. This wording is in
part a defence against products being brought under the Medicines Act. But it
is just as important as a defence against civil litigation. </span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">If a product were sold as a “legal high,” and the user
were harmed as a result of taking it, it should be possible to sue the
supplier, or possibly the manufacturer. The retailer would have to demonstrate
that they had taken “reasonable care” to avoid “actions or omissions” that they
could “reasonably foresee” could cause harm to (for example) a purchaser.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">In most legitimate retail settings, this “reasonable
care” would involve ensuring that the products were as safe as possible, fit
for purpose and packaged appropriately with information on how to use the
product safely.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">At present, with NPCs retailers attempt to side-step
the risk of being sued by the wording on packaging. It may well be that anyone
attempting to sue a retailer for harm arising from use would fail, because the
retailer could reasonably argue that the products were not intended for
consumption and were clearly labelled as such.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">This defence could however be undermined if the
retailer also gave advice about consumption. It would then be easier to
demonstrate that the retailer was aware of the use to which the product was
probably going to be put, irrespective of the wording on the package.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">Ultimately such a decision would need to be made by a
court. But herein lies our stumbling block.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">If head-shops were somehow licensed or brought within
the ‘harm-reduction’ fold, then they would no longer be able to shelter behind
the “not for human consumption” dodge. The very act of describing how to use
specific products more safely would hole the defence against negligent claims
below the waterline.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">So while on the one hand it may be desirable to
encourage NPC retailers to work collaboratively with drug services to develop
safer retail models, they would in turn need to ensure that their products were
safe to consume – probably an insurmountable barrier for most retailers. It
would also mean that the substances would likely fall under the purview of the
Medicines Act.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";"></span></span></div>
<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB; mso-bidi-font-family: "Times New Roman";">In order to achieve licensed, regulated head-shops,
we would also need products which could be licensed and regulated too,
requiring changes to the Medicines Act, Misuse of Drugs Act, and a slew of
other pieces of legislation. We would probably need to adopt an approach more
like New Zealand, which allows for the sale of products whose safety has been
adequately demonstrated.</span></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">Over the next few months, it seems more likely
that the indirect methods of policing head-shops mentioned earlier will be
replaced by prohibitive legislation. It would be really desirable if instead we
could have a sensible discussion. Are we safer with regulated head-shops which
can be licensed and vetted? Possibly. Can we achieve this unless we also
licence some of the products that they sell? Probably not. And is the
Government going to explore this as an option as part of their exploration of </span></span><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="font-size: 11pt; line-height: 115%;">responses
to NPCs? Well, never say never but there will be few people more astounded than
me if they do.</span></span><br />
<div style="mso-element: footnote-list;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br clear="all" /></span>
<br />
<hr align="left" size="1" width="33%" />
<div id="ftn1" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[1]</span></span></span></span></a><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;"></span></span></span></span>
http://www.prnewswire.co.uk/news-releases/over-250-headshops-in-uk-are-selling-legal-highs-says-angelus-foundation-232476221.html</span></div>
</div>
<div id="ftn2" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[2]</span></span></span></span></a> http://www.attorneygeneral.ie/eAct/2010/a2210.pdf<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn3" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[3]</span></span></span></span></a> http://www.mirror.co.uk/news/uk-news/legal-highs-labour-looking-clamp-2715685<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn4" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[4]</span></span></span></span></a> http://www.westyorkshire.police.uk/news/men-charged-landmark-legal-highs-case<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn5" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref5" name="_ftn5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[5]</span></span></span></span></a> http://www.chesterfirst.co.uk/news/122737/case-against-chester-legal-high-shop-owner-dismissed.aspx<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn6" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref6" name="_ftn6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[6]</span></span></span></span></a> http://www.southwalesargus.co.uk/news/10765334.Five_released_on_bail_following_raids_in_Newport_and_Cwmbran/<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn7" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref7" name="_ftn7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[7]</span></span></span></span></a> https://pressfolios-production.s3.amazonaws.com/uploads/story/story_pdf/50357/503571385371333l7hrMWTLRGE8jGSPOYMw.pdf<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
<div id="ftn8" style="mso-element: footnote;">
<div class="MsoFootnoteText">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.blogger.com/blogger.g?blogID=36144663#_ftnref8" name="_ftn8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 115%;">[8]</span></span></span></span></a> http://www.mirror.co.uk/news/uk-news/legal-highs-uk-skunkworks-worker-2644152<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
</div>
</div>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div style="mso-element: endnote-list;">
<span style="font-family: Arial,Helvetica,sans-serif;"><br clear="all" />
</span><br />
<hr align="left" size="1" width="33%" />
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div id="edn1" style="mso-element: endnote;">
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
<div class="MsoEndnoteText">
<a href="http://www.blogger.com/blogger.g?blogID=36144663#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><span class="MsoEndnoteReference"><span style="font-family: "Calibri","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">[i]</span></span></span></span></a> http://www.publications.parliament.uk/pa/cm201314/cmpublic/antisocialbehaviour/memo/asb52.htm<span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></div>
</div>
</div>
KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com3tag:blogger.com,1999:blog-36144663.post-23904157341699738942013-10-28T07:54:00.000+00:002013-10-28T07:54:34.479+00:00<h2>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Krokodil Feeding Frenzy</span></span></h2>
<h3>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span></h3>
<h3>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Bad journalism and dodgy bulletins increase confusion and fear over desomorphine</span></span></h3>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"> About twenty years ago, the Observer ran an article entitled "Ice Storm Cometh," detailing the experience of Crystal Meth in Hawaii, with police chiefs warning how it would devastate here next. Cue numerous senior Police Officers undertaking 'fact-finding missions' overseas, and American DEA bods coming here and briefing on the peril.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Since then it's been fairly quiet on the meth front; use has crept up slowly and is becoming a more significant issue in London in some parts of the club scene. But like the crack epidemic of which we were also warned, we've been spared the worst excesses so far.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">But the media do love a good drug scare story. And the new villain in town is desomorphine. Except that's not very exciting so the Russian slang term Krokodil gets used instead.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Despite the fact that there's not been a single, toxicology-confirmed case of desomorphine use in the UK, it hasn't stopped the media running hyperbolic stories, shot through with factual errors and topped off with salacious graphic images of infected wounds. The mainstream media have been bad enough but the on-line and 'citizen media' have been just as irresponsible in their reporting.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">So what's been said and what do we really know?</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span><br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>About the drug: </b></span></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b> Desomorphine</b> is the shortened chemical name of the drug <b>dihydrodesoxymorphine. </b>This drug was first synthesised and patented in the 1930s. It was marketed in Europe under the brand name Permonid as a short acting potent opiate analgesic.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b> </b></span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">As a drug in its own right it shares the same risks as other powerful opiates - risk of dependency, overdose, and risks relating to non-sterile injecting practices. As a drug, correctly synthesised in sterile conditions, it is not going to destroy body tissues or cause infections. So it is utterly erroneous to describe it as the "<i>drug that eats addicts</i>." The drug itself does no such thing. But contaminants in the drug and injecting practice can and will cause infections. The drug is widely referred to by its slang name Krokodil. The exact reason for this are unclear. Numerous articles claim it's because the necrotised, wounded skin of injectors looks reptilian. Others argue that during the conversion process an intermediate product called </span><span style="font-size: small;">Clorocodide is produced, and Krokodil is a play on this term.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>Desomorphine </b>is synthesised from <b>codeine (</b><i> </i><b><i>3-methylmorphine</i>). </b>There are a number of ways this can be done. One uses some of the same processes involved in the conversion of pseudoephedrine to methamphetamine, chemicals including phosphorous and iodine.</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Often the chemicals involved in a synthesis will sound far more dangerous than they really are, especialy in the hands of a journalist. So for example ammonia may be involved in a synth or an extraction. it was widely used to make freebase cocaine in the sixties and seventies. So when reports say "ingredients include household cleaners" it is probably a reference to ammonia. Likewise, solvents are often required. So the presence of solvents like petroleum or kerosene are not going to be uncommon. Hydrochloric acid is routinely used to acidify base drugs, including pharmaceutical compounds. It just sounds much more spectacular in the media. </span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">A key source of codeine will be pain-killer tablets. Tablets also contain lots of other material besides the active drug: fillers and binders, coating, flavourings and so on. A commonly available source of codeine, co-codamol tablets will contain a low dose of codeine alongside a high dose of paracetamol. If the paracetamol isn't successfully removed, it will end up causing significant liver damage with repeat use.</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">It is possible, with time and effort, to remove all these adulterants, and using a clean synthesis process end up with desomorphine. <br /><br />In practice the end product will invariably be highly impure, and will include tablet residue, leftovers of the chemicals used in the synth, and other additives which may or may not intensify the hit - antihistamines, anti-nausea tablets, caffeine, benzos etc.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Desomorphine, if of high quality, would (according to wikipedia) be 8 - 10 times the strength of morphine (or effectively 3 times the strength of heroin/diamorphine) but with a shorter period of effect 1-3 hours.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"></span></span><br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>Problems related to desomorphine use:</b></span></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">As a strong, short acting opiate, desomorphine use is likely to cause significant problems, especially when injected. The short duration of effect means that dependent users will need to use more frequently - starting to enter withdrawal after three or four hours will get in the way of sleep or other activities.<br />The short duration of effect also means more injections and this inevitably speeds up vein damage and wounding.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">All these problems are going to be worsened by poorly-made street 'krokodil,' the slang name for the home-made desomorphine used in Russia and the Ukraine. The various chemicals used may be toxic, especially in high doses, and the presence of other contaminants increases the risk of infection. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">These problems are made much worse in Russia by the limited availability of treatment services for drug injectors. There is a desperate shortage of effective needle exchange, woundcare and opiate substitution therapy. This means that injectors will routinely reuse equipment, that wounds will go untreated until they are life-threatening, and alternatives such as methadone hard to come by.</span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">So the pictures of "krokodil" with the clains that the drug is "eating victims" should be properly captioned stressing that a combination of poor chemistry, lack of sterile injecting equipment and poor treatment interventions caused these problems.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"></span><br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>Desomorphine in the UK? </b> </span></span></h4>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">So far there have been no confirmed cases of desomorphine use in the UK. However that hasn't stopped various commentators and the media talking up the drug. And if there's one way to increase interest in a substance amongs potential users, it's to write incessantly about how strong and dangerous it is. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Concern about desomorphine in the UK have been fuelled by some ill-advised bulletins, some commentary from medical sources and some abysmal journalism. </span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">In July 2013 a warning started to circulate in Gwent, Wales,saying "</span></span><!--[if gte mso 9]><xml>
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<![endif]--><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b><i>"there is in circulation mephedrone (MCAT)cut with
petrol. This is being both sniffed and injected. It does smell of
petrol. Injecting is resulting in burns / serious wounds / necrosis
around injecting sites. It is reported to be being cut in Wales,
following attempts to replicate what is being sold in and around Bristol.
It is being called various things including Fert and Crocodile."</i></b></span></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">This warning and follow up discussions were highly confusing. They were largely based on second-hand reports from users and there was no analysis (as far as I know) of this "mephedrone cut with petrol." What the bulletin and the subsequent media coverage did was create the idea that a product being called "Crocodile" was being sold, that it involved petrol in the mix, and that it was causing serious injecting complications.</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">So for example <a href="http://www.walesonline.co.uk/news/wales-news/police-warning-over-crocodile-trend-5315508">Wales Online </a>cited Controlled Drugs liaison officer Roger Booth, saying
"<i><b>there is a circulation of mephedrone cut
with petrol.This is being sniffed and injected.Injecting results in burns and wounds leading to necrosis, it’s called crocodile – not to be confused with Krokodil.</b></i>”</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br />Interviewed in the same article Booth goes on to say "<i><b>The only reason I can think they are using petrol [to cut with
mephedrone] is because it allows them to take it in another way as it’s
normally in powder form</b></i>.”</span></span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">This all sounds very serious but makes very little sense. Mephedrone is a water soluble drug which means it needs no further chemical treatment to make it injectable. The idea that adding petrol would be added either as a 'cut' or to 'take it another way' is nonsense of the first order. </span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">Further, petrol is highly volatile (vaporises easily at room temperature) and so even if mephedrone were contaminated with a solvent like petrol, it would rapidly vaporise from the powder if left open at room temperature. </span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">Possible explanations include that someone was trying to remove another contaminant from mephedrone using a hydrocarbon as a solvent or it was another drug imported dissolved in a solvent. Possibly some mephedrone being sold was cut with something insoluble in water and users were using a solvent like petrol to make it injectable. But importantly this whole story so far lacks any of the drug being analysed.</span> <br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">One would hope the local drugs agency would help stop the myths spreading but instead Kaleidescope seemed to have added even more speculation, with Martin Blakeborough quoted in the same article saying: "<i><b>It’s a very nasty concoction. It reacts to your skin ,
creating abscesses and it effectively burns your skin. It’s a very nasty
drug because in many ways petrol is worse than mephedrone.Normally when people snort glue or petrol they do so because it acts
as a hallucinogenic but in this instance I’m not totally sure what they
get from it, perhaps it gives them a bit more of a rush.”</b></i></span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">A couple of months later the issue of desomorphine was given a major lift in the media thanks to an article in the <a href="http://www.gloucestercitizen.co.uk/Doctor-warns-killer-Russian-drug-Krokodil/story-19830300-detail/story.html">Gloucester Citizen</a> in which local Doctor, Allan Harris rattles through a list of drugs that he's heard a bit about and makes some loosely factual statement about each. On Krokodil he says "<i><b>Another drug coming into fashion is Krokodil. It is caused nasty necrosis, or cell death. </b></i><i><b>It has come from Russia and is very unpleasant. There are plenty of warning signs that it could be in Gloucester. It is cheap and nasty and causes damage to the point where you can see someone’s bones through their skin</b></i>."</span><br />
<br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">This article didn't elaborate on these "plenty of warnings," but the Independent picked up on the Story giving Doctor Harris a whole article to expand on this. And the evidence <a href="http://www.independent.co.uk/voices/comment/krokodil-the-heroin-substitute-is-a-real-threat-we-must-warn-of-the-potentially-devastating-effects-8844357.html">in the Independent? </a>. in an article shot through with errors Harris says "<i><b><span style="font-size: small;">T</span></b></i><i><b>o date I have only seen one patient where I suspected he’d used Krokodil.</b></i>" The reason for this suspicion? Client saying they'd used this substance? Toxicology? No. "<i><b>He had been a long-term heroin user, but suddenly lost a great deal of muscle tissue from gangrene at the site of an injection</b></i>."</span><br />
<br />
<div class="article-title">
<span style="font-family: Arial,Helvetica,sans-serif;">Dr Harris didn't get to expand on the evidence for this being Krokodil in this article. But Vice picked up on the Independent story and piled error on top of error with the willing help of Dr Harris, who had by this time clearly developed a taste for media attention.. So in an article entitled <a href="http://www.vice.com/en_uk/read/has-the-flesh-eating-killer-drug-krokodil-made-it-to-uk">Has Krokodil, the Flesh-Eating Street Drug, Made Its Way to the UK?</a>a 'journalist' conducts an interview with Dr Harris. <br /><br />Near the start there's an interesting point - where the writer says "<i><b>We tried to negotiate whether to call the drug “krokodil” (from the
Russian) or to Anglicise it <u>now that it had made its way over from the
mainland</u> and start referring to it as “crocodile”. (I've used the former
here, but <u>Dr Harris was pretty adamant about using the latter.</u>)"</b></i> Two important points here, both underlined:</span></div>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;">the article now asssumes it is "over here" and</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;">the term Krokodil and term Crocodile are being mixed up, when Crocodile was already causing confusion as as term in Wales for some mephedrone that may have a petrol smell.</span></li>
</ul>
<div class="article-title">
<span style="font-family: Arial,Helvetica,sans-serif;">So the interviewer asks about the case mentioned in the Independent which Dr Harris thinks may have been Krokodil. He says:<br /><br />"<i><b>It’s a bit retrospective really because it was <u>a few years
ago now</u>. At the time, I just thought it was the citric acid burns of a
heroin user, but looking back the tissue destruction was far, far in
excess [of what you'd expect from that]. When you get citric acid issues
you usually get second-degree burns, but this actually took out a huge
crater of all the forearm muscle. When you took out the dead tissue you
could actually see the tendons moving at the base of this crater and the
bones as well – so <u>pretty much like these horrific pictures you see on
the warning leaflets for krokodil</u>... Looking back, it didn’t fit at all with citric acid because that’s an
irritant but no worse, really, than a slight infection. This was
actually very, very disproportionate</b></i>."</span></div>
<div class="article-title">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">The person in question had subsequently died, and the interviewer asks if it has been confirmed that Krokodil was involved. Dr Harris says "Investigations are ongoing. I couldn’t say for sure, I’m afraid. We’re
still waiting on the toxicology results from the coroner."</span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">Based on this Dr Harris appears to have had a client who had a very severe bacterial infection following injection. Many bacterial infections can cause the severe tissue damage and necrosis described by Dr Harris. In point of fact many of the injuries attributed to desomorphine and it's "flesh eating" properties are the result of bacterial infection through contaminants in the mix or non-sterile injecting practice. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">By the sounds of it no tissue samples were taken, and no identification of the pathogen causing the wound or the drug injected is now possible. but based on it looking like pictures of krokodil wounds, Dr Harris has been willing to be quuoted repeatedly saying he thinks it may have been Krokodil.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">Astonishingly, before the end of the article, it does get worse, and goes in a loop back to the Welsh Mephedrone/Petrol/Crocodile story when Dr Harris abandons chemistry and grammar in one fell swoop saying "<i><b>They’re krokodilising Mkat – you know, “meow meow” – to
make it injectable and more potent so we’ve seen more intravenous
mephedrone use recently to compensate for the reduction in heroin</b></i>."</span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">So the claim being made now is that the rationale for adding petrol to mephedrone was to make it more potent and injectable.Mephedrone should be water soluble without addition of any other chemicals, provided it hasn't been adulterated with an insoluble cut. And petrol only features in the production of desomorphine as a solvent. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">So thanks to a confusing, unsubstantiated briefing from Wales and a Doctor in Gloucester who has piled further unwarranted assertions on top of each other, and some journalists unable to fact check and take unconfirmed single-sources we end up in a position where the following has become "fact"</span><br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;">krokodil is in the UK</span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;">MCAT is being treated with petrol as a way of "krokodilising it.</span></li>
</ul>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;">Not wanting to miss out on the Krokodil feeding frenzy, the Huffington Post arrives late at the table with an attention-grabbing headline: <a href="http://www.huffingtonpost.co.uk/2013/10/24/krokodil-drug-graphic-pictures-uk_n_4156584.html">'Krokodil' Trend Of Flesh-Rotting Drugs Hits UK.</a></span></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;">Having little new to add the article is salaciously padded with pictures of injecting wounds. The article starts with the claim "<i><b>Branded "cannibal heroin" for literally rotting users from the inside
out, it costs £5 a hit on the street and contains a toxic mix of
codeine, gasoline, paint thinner, industrial cleaning oil, and alcohol</b></i>."</span></div>
<div class="title-news">
<br /></div>
<span style="font-family: Arial,Helvetica,sans-serif;">There's not a single source mentioned for this availability or price point. And it hadn't been branded "Cannibal heroin" until the Huff needed a snappy name for it. Once again Dr Harris appears for a quote, saying ""I've already treated one case and I'm sure that in the coming years I will see more." Other drugs workers who tried to balance the piece, stressing that there was no confirmed evidence that Krokodil was on sale in the UK were selectively quoted and their caveats disregarded.<br /><br />The article also builds on the mephedrone/petrol idea saying Mephedrone "<i><b>after a spate of alleged deaths...disappeared into obscurity. Now, it has been reincarnated as an injected drug to rival crack and heroin, with experts warning its use is parallel to the deadly krokodil...Police have warned mephedrone is being mixed with petrol and the toxic combination, unsurprisingly, reacts to skin, creating abscesses as it effectively burns flesh. Dr Harris, along with police officials, have branded the trend "krodilising" for having the same fixing process and level of addictiveness.</b></i>"</span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">Despite the unwarranted reporting in the Huff article, it was recirculated by agencies including, unbelievably, Drugscope, who should have been writing corrective pieces not redistributing the offending article. </span><br />
<br />
<h4>
<span style="font-family: Arial,Helvetica,sans-serif;">In Conclusion </span></h4>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;"> The use of Krokodil in Russia is clearly a significant health issue The loss of life and wounds are horrific but importantly are not caused by the drug desomorphine <i>per se</i>. The risks stemming from a poorly-made short acting drug are worsened by poor access to needle exchange, healthcare and treatment. </span></div>
<div class="title-news">
<br /></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;">There may be desomorphine being prepared and used in the UK. It's certainly possible. But there's no evidence of it at this time. Relatively low access to OTC Codeine should reduce the risk of it becoming a mass-market drug as is claimed in Russia.</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"> </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;">There are certainly people injecting mephedrone and, since prohibition the quality of mephedrone has become more variable. Irrespective of the addition of petrol or not, there is plenty of evidence that mephedrone injecting can cause serious soft tissue infections. </span></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;">And we have plenty of things to be aware and concerned about - some potentially stronger-than-average heroin in Wales and Milton Keynes; deaths related to PMA in pills sold as Ecstasy. </span></div>
<div class="title-news">
<br /></div>
<div class="title-news">
<span style="font-family: Arial,Helvetica,sans-serif;">What we desperately don't need is wildly inaccurate articles which start off as supposition and hearsay, and over a couple of months morph into fact thanks to poor journalism and professionals who should really be more careful with what they say. There is clearly a public health lesson here. But it's not about desomorpine. It's the reporting of desomorphine. </span></div>
<br />KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com6tag:blogger.com,1999:blog-36144663.post-26863947379555550542012-12-10T19:23:00.000+00:002012-12-10T19:23:12.435+00:00From Pay Day loans to the Pot-Trap<!--[if gte mso 9]><xml>
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<div class="MsoNormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="EN-GB" style="mso-ansi-language: EN-GB;">How poverty
and pay-day loans are driving people to the cannabis cultivators.<br /></span></b></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">As
austerity bites, bills soar and Christmas hoves in to view, the legitimised
high street “loan-sharks” – the pay-day loan companies, are minting it. But as
CABs around the country will attest, more and more people are struggling to
meet repayments or astronomic interest rates. People already in debt face
losing more and more under a burden of crippling debt.Outside the
same CABs, an offer of salvation is at hand - Cannabis cultivation.<br /></span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">As Police
enforcement activity against large cannabis farms has become more and more
effective, some cannabis cultivators have adopted a different strategy: instead
of growing 500 plants in one house, why not grow 50 plants across ten houses?
That way, it’s less likely that you lose the entire crop, and it requires ten
times as much police research, ten warrants and ten raids. All of this needs to
be executed in the limited germination-to-harvest time-frame. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><br />Whereas
previously, growers would have rented properties themselves for larger
grow-houses and installed their own gardener, with smaller growing set-ups,
there’s no need to rent a whole property. It’s easier to find someone who has a
spare room and install the plants in there. For a while, people wanting a bit
of extra money provided much of this space. But, of late reports from a number
colleagues highlight that it is people falling deeper and deeper in to debt are
being approached by growers. The offer is typically to have debts cleared in
return for growing space. Significantly, some workers suggest that those in
debt are being targeted with these offers; a colleague in the Midlands said
that he knew of people being approached in the queue outside the CAB being
approached with a view to housing a grow-room.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><br />From the
growers’ point of view, it’s a minimal risk, maximum return situation. They may
get grow space for little outlay. The person who lives in the property, afraid
of repercussions, is unlikely to share information with the Police. If there is
enforcement action, the grower is insulated from risk of prosecution. The
Occupier ends up running the risks, for minimum, if any reward. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><br />For the
people caught in this position, the situation is dire. On the one side, there
is escalating interest if pay-day loans go unpaid. This could result in court
action or loss of housing due to mounting debt. On the other hand, there is the
risk of criminal proceedings and possible custodial sentences for cultivation
of cannabis. If this wasn’t bad enough, there is the additional risk of
reporting the growers or failing to cooperate in delivering the harvest.</span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"><br />Another
worker working with a woman in this situation described her client’s intense
fear as the plants grew bigger that someone would discover her harvest. But
stuck in a triangle of debt, fear of police and fear of growers she felt
utterly trapped and couldn’t see a resolution. Her only hope, as she saw it,
was to get to harvest time, clear her debts and start over. </span></span></div>
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<span style="font-family: Arial,Helvetica,sans-serif;"><br />It seems likely
that as more people are forced deeper in to debt and end up taking out loans
that they can’t repay, there will be a growing pool of desperate people for the
cannabis cultivators to draw on. For those
facing this situation or already trapped in this position we need some
responses. These could include:<span style="mso-list: Ignore;">·<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;">
</span></span><span lang="EN-GB" style="mso-ansi-language: EN-GB;"></span></span></div>
<br />
<ul>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Education
and awareness raising within debt-advice services to highlight the perils of
being drawn in to cannabis cultivation as a solution to unmanageable debt</span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;">A
police amnesty so those who have been drawn in to allowing cannabis cultivation
can get out of the situation without criminalisation and with regard for
personal safety;<span style="mso-list: Ignore;"> <span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></li>
<li><span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;">Housing
providers taking a supportive view of people coerced in to such cultivation so
enforcement action doesn’t result in homelessness.</span></span></li>
</ul>
<span style="font-family: Arial,Helvetica,sans-serif;">
</span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB" style="mso-ansi-language: EN-GB;"> At this
stage it is hard to know the extent of debt is driving people to be unwilling
hosts for cannabis growers. But anecdotal evidence says it is on the increase.
It is important that those stuck in this situation are recognised not as villains
but as victims.</span></span></div>
KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com4tag:blogger.com,1999:blog-36144663.post-26659045813877208202012-10-17T12:05:00.001+01:002012-10-17T12:07:30.089+01:00Anabolic Steroid Users, Needle Exchange and the Peril of Publicity<!--[if gte mso 9]><xml>
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<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
There have been a fair few media stories over the past few
years about the increase in Needle Exchange usage by people using Performance
Enhancing Drugs – especially anabolic androgenic steroids.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
A classic of the genre is this one from the BBC: <a href="http://www.bbc.co.uk/news/uk-england-bristol-19650743"><span style="font-size: 9.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">http://www.bbc.co.uk/news/uk-england-bristol-19650743</span></a><span style="font-size: 9.0pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">. </span>In
truth through, the stories are highly interchangeable – usually some statistics
about increased usage from a Needle Exchange, comments from drugs workers and
experts, and some comment from a user about their use.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
Inaccuracies and sensationalist reporting aside, the ongoing
news stories originating from Needle Exchanges about steroid use is something
or a double-edged sword.<br />
<br />
On the one hand, needle exchanges and drug projects need to ensure that they
retain the funds and resources that allow them to continue. As the welcome
downward trend in heroin injecting continues, it is essential that funders and
commissioners are aware that other populations need access to needle exchange.
And so identifying and publicising the level of service usage – and the level
of need is essential.<br />
<br />
Indeed, some services, researchers, harm reduction advocates and academics are
clearly of the mind that highlighting the level of use is one of the key tools
for securing the funds required to develop and expand services to steroid
users. Such expansion could include better specialist services – highly trained
staff, opportunities to have blood analysis undertaken and better health care.
To secure such funding, demonstrating a level of need is essential. </div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
In order to do this, agencies need to record drug of choice.
It also helps to identify and respond to trends, and also so that they can
ensure staff are trained and resources. The agency needs the profile of their
clients, funders demand it and resources hinge on it.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
People who use Anabolic Androgenic Steroids often view the situation
differently. They are acutely conscious that their drugs of choice occupy an
unusual position within the Misuse of Drugs Act 1971. The drugs are currently
legal to possess, even if not prescribed, putting them in a privileged position
compared to most other Controlled Drugs. There have been changes to this in the
past year – introducing a requirement to be in personal possession at the point
of importation, but the removal or a requirement for the drugs to be “in
medical form” to be lawful. These changes make it theoretically harder to
purchase and import high quality “licensed” products on-line, whilst making the
possession of counterfeit or underground products now wholly lawful.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
As such some people using steroids think that they have a
vested interest in keeping steroids “off the radar” and trying to reduce the
extent to which it comes to wider public attention and certainly off the agenda
of legislators. Even the argument that better evidence of need could result in
better service provision cuts little ice here. Whilst we don’t know the exact
figure, a fair proportion of people injecting steroids elect to purchase their
elected equipment on-line rather than using needle exchanges. For some this is
merely practical: not all needle exchanges give out the range or quantity of
equipment that some users want. Others just don’t want to be seen using needle
exchanges. A few argue that if they can afford it they should buy it rather
than using a free service they view as being in greater need. But of the needle-exchange
refuseniks, a fair few are making a very deliberate decision not to use needle
exchanges to avoid contributing to statistics which could reveal the nature and
extent of steroid use.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
One of the recurring responses, from moderators on a leading
UK body-building website makes the case thus:</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin: 0cm 1cm 10pt;">
<i style="mso-bidi-font-style: normal;">Steroid users should
never, EVER use an <span class="high">exchange</span>. <br />
<br />
Steroids are class C atm. They govt are always looking for the next "vote
winner". Let's re-classify steroids to 'save the children' will be the
call. How will they manipulate this change? From spurious data and figures that
would be used to drive home a message to joe public that "the UK has a
massive steroid problem". Look how many users there are compared to year
xxxx etc etc. The more people using exchanges, the more convincing their
argument, even when you and I both know relatively speaking it is no-where near
problematic proportions. <br />
<br />
As such, <span class="high">needle</span> <span class="high">exchange</span>
discussion is not encouraged on [this bulletin board.]</i></div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
Judging by the various threads and discussions this view is
on the increase with more and more people electing to use on-line suppliers
rather than needle exchanges.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
In an (admittedly) small on-line poll less than one in four
people using injectables said that they used pharmacy exchange all the time. A
staggering 63% voted “I never have, and never will use an exchange.” </div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
Given the track record of Government on drug prohibition, I
can’t help feeling that some of the concerns of those who caution against
needle exchange are well founded. One would hope that a rational Government
would recognise that criminalising and driving a group underground would be
counter productive. So far, in no small part due to careful presentation of
evidence by leading lights in the UK, the ACMD has shied away from rescheduling
steroids and the Government, despite the obvious temptation of the Olympics,
has not seen an urgent need to do so. But against an ongoing drip-drip-drip of
negative steroid media stories, I wonder how long until the status of steroids
is renewed again.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
Why, some will ask, does it matter if steroid injectors
don’t use needle exchange? If this population can afford and are willing to
purchase their own equipment, why should agencies be at all concerned? <br />
<br />
Some workers (and indeed some commissioners) have endorsed this approach,
saying that needle exchange isn’t really “for” steroid users and as such if
they can afford their own equipment they should really buy it not use Needle
Exchange.<br />
<br />
Personally I have no truck with this analysis. I don’t remember a similar
argument for means testing needle exchange being made for other drugs. Needle
exchange is intended to be available to all who inject non-medical drugs,
because of the public health need of such a service, irrespective of ability
pay.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
We want people to use services because that way we can
ensure people get advice about injecting technique, access to advice,
woundcare, BBV testing and vaccinations. Certainly many steroid injectors have
a good understanding of what they are taking and how to use it. Others don’t
and they need access to this information.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
Not all steroid users are sourcing equipment on line; almost
a quarter, for whatever reasons, needle exchange represents an essential source
of equipment.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
So here’s the catch 22. </div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
In order to demonstrate need and to attract funding to
provide great services agencies need steroid injectors to attend. But those
same injectors are concerned about attending and being counted because, rather
than seeing this resulting in better services, they fear that the aggregated
statistics will be used to justify criminalising steroid use. </div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
Agencies don’t help their case by stressing the confidential
nature of their service and then ending up all over the front pages of the
local press, highlighting how much steroid use has increased. If there were
ever a way of reinforcing the fear that use of needle exchange puts steroids
more firmly in the public eye and increases risk of prohibition, this is surely
it.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
So what’s the solution? In the short term, needle exchanges and
other commentators need to think carefully about the pros and cons of
highlighting increases in steroid use to the media. Not, I should stress,
because this directly impacts on UK policy, but because the same steroid users
who read the papers today are the ones who, tomorrow may be disinclined to use
needle exchange.</div>
<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">
<br />
More fundamentally, it highlights the importance of drugs
policy being independent of political ideology. If users feel that they can’t
trust how statistical data is being used, and they can’t believe in an
evidence-based drugs policy it’s hardly surprising that they will seek to keep
their use “off-radar.” Rather than viewing wider recognition of use as a way of
garnering resources and better services, it is viewed with great fear.</div>
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 11pt; line-height: 115%;"><br /><span style="font-family: Arial,Helvetica,sans-serif;">People using anabolic androgenic steroids and
discussing this issue on forums are deeply suspicious of the use of statistics
and research by needle exchanges and how it impacts on the media and wider
policy. Agencies need to recognise and respond to this suspicion and work to
undo the damage.</span></span>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com5tag:blogger.com,1999:blog-36144663.post-71261807900563032852012-04-23T12:11:00.000+01:002012-04-23T12:11:54.465+01:00Changes to Steroid Legislation - swings and roundaboutsChanges come in to force today which affect steroids and other performance enhancing drugs and ancillary compounds.<br />
<br />
The key changes are:<br />
<ul>
<li>to remove the requirement that drugs are in a "medicinal form" making possession of non-pharma products lawful and </li>
<li>to introduce a requirement of personal custody at time of importation, making purchasing on line unlawful. </li>
</ul>
The changes which affect drugs in Schedule 4ii of the Misuse of Drugs Regulations can be found here: <a href="http://www.legislation.gov.uk/uksi/2012/973/contents/made%20">http://www.legislation.gov.uk/uksi/2012/973/contents/made </a>and a more helpful Explanatory Note here: <a href="http://www.legislation.gov.uk/uksi/2012/973/pdfs/uksiem_20120973_en.pdf">http://www.legislation.gov.uk/uksi/2012/973/pdfs/uksiem_20120973_en.pdf</a><br />
The Explanatory Note explains:<br />
<br />Amendments relating to Schedule 4<br />
<blockquote class="tr_bq">
<i>7.7 At present the provisions specified in regulation 4(2) of the 2001 Regulations (the prohibition on importation and exportation of controlled drugs) are disapplied in relation to drugs listed in Part II of Schedule 4 to the 2001 Regulations in respect of the prohibition on importation and exportation when imported or exported “by any person for administration to himself” and when contained in a medicinal product.<br /><br />7.8 The instrument will make clear that regulation 4(2) of the 2001 Regulations is limited to importation and exportation of drugs listed in Part II of Schedule 4 when carried out in person by the same person who then administers such drugs to himself. The instrument also removes the term “medicinal product” from the 2001 Regulations (including by omitting the definition of such term contained in regulation 2(1)) with the effect that the term “medicinal product” no longer applies to provisions under the 2001 Regulations in general.</i></blockquote>
<i></i><br />
The change made to remove the requirement for the products to be a "medicinal product" represent an interesting shift. The rationale for doing so when the ACMD advised the Government to remove this wording was that <i> </i><br />
<blockquote class="tr_bq">
<i>"The ACMD do not believe the term ‘medicinal product’ assists in the enforcement or legal framework for anabolic steroids under the Misuse of Drugs Act 1971. The ACMD consider that the term ‘medicinal product’ should be removed from the legislation as the term does not serve a recognised purpose"</i></blockquote>
<br />
<a href="http://library.npia.police.uk/docs/ACMD-anabolic-steroids-2010.pdf">http://library.npia.police.uk/docs/ACMD-anabolic-steroids-2010.pdf</a><br />
<br />
This was clearly not a view shared by the Crown Prosecution Service or, for that matter the Court of Appeal who in R. v Foster upheld the conviction of Foster who was found to be in possession of Stanozolol in a non-pharmaceutical form (capsules branded "No Bull".) The case summary is <a href="http://www.criminallawandjustice.co.uk/index.php?/Law-Digests/r-v-foster-court-of-appeal-criminal-division-september-14-2010.html">here <br /></a><br />
Foster's case, and the later prosecution of <a href="http://www.thisiswiltshire.co.uk/news/9223416.Bodybuilder_felt_his_use_of_drugs_was_within_law/">Graham McAdams </a>whose guilty plea was largely influenced by the precedent set by Foster, seemed to indicate a willingness on the part of the CPS for possession of non-pharmaceutical steroids.<br />
<br />These two cases made it more likely that any compounds produced by Underground Labs (UG) would be held to be prohibited under UK law. <br /><br /> The decision to remove the term "Medicinal" from the legislation means that henceforth, possession of UG lab-produced steroids will not be an offence in the UK if this possession is for personal use. This is a mixed blessing. On the one hand it means that prosecutions arising from legislative confusion such as Foster and McAdams should be a thing of the past. However, as such cases were rare, this has no huge implications.<br /><br />More importantly, it means that there is no legal disincentive to possessing UG labs drugs, which may not be produced to the same standards as pharmaceutical products. The worry therefore is that this legislative change will increase the popularity of UG compounds, despite the increased risk.<br />
<br />
<br />
<br />
<br />
<br />The other key legislative change is to introduce a requirement that importation of Schedule 4ii drugs be undertaken by the person using the compound. Effectively this means that the user needs to have the drugs in their personal custody at the time of importation. This in theory makes it unlawful to import by post and restricts people being able to buy compounds on-line.<br />
<br />
<br />
<br />It will probably result in an increase in seizures of drugs being imported in to the UK, especially in bulk. But I suspect in terms of individuals ordering on line, the impact may not be so profound, especially where postage is taking place within the EU. Small quantities of packaged steroids, with a low odour, are not going to be massively easy to detect and so the quantity that slip through are likely to be significant. Those that are seized will be destroyed but it is unlikely to result in an upsurge in prosecutions for unlawful importation.<br />
<br />
<br />
<br />The bigger risk that concerns some commentators in the field, is that it will result in an increase in UK-based manufacture to avoid the issue of importation. This would mean more labs being set up in the UK either making steroids from scratch or packaging imported powder testosterone.<br />
<br />
<br />
<br />Only time will tell if these fears are well founded or not. But it is certainly a cause for concern that the legislative changes could see an increase in UG lab drugs whilst at the same time depenalising the use of such compounds.<br /><br />Advocates of the legislation will probably argue that the previous legislative wording had resulted in a proliferation of steroid availability in the UK. However, with no effective research in to the current levels of steroid use in the UK, the incidence of complications arising from steroid use, and the current ratio of UG to Pharma products used, it will be well nigh impossible to demonstrate if the legislative changes have had a benign impact or not.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-34715112772699009102012-03-21T20:44:00.000+00:002012-03-21T20:44:20.936+00:00drugs and radicalism: it was ever thus (part one)The Occupy movement in London was the subject of significant negative publicity which related to drugs. While some of the allegations made were undoubtedly made by those with a vested interest in denigrating protesters http://www.guardian.co.uk/uk/2011/nov/21/occupy-london-camp-eviction-bid other, first-hand information confirms, to my satisfaction at least, that drug and alcohol problems were an issue amongst some of the people staying at the protest site.<br />
<br />
This is not a new development. It's an old, old problem. It's probably a century old problem, but it's certainly one that has dogged radical politics in the past half century. And it's one that we have yet to engage with successfully. The creation of autonmous spaces - or what Hakim Bey termed Temporary Autonmous Zones - can be a time of positivity and constructive change. But the energy and creation of temporary autonomous space has, all too often, been negated by the arrival of significant drug problems, including problematic alcohol use.<br />
<br />
This has been a very obvious issue for several decades. The issue for Occupy London is only the most recent manifestation of the same problem that dogged road protest sites, especially the M11 campaign, land-squats such as Pure Genius and squatted venues such as Kentish Town's "Rainbow Centre." <br />
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Here's the problem: create autonmous safe space outside society's normal rules, and a collection of people arrive to fill that space. Included in this rich mix are those for whom society's strictures are problematic, including those with prodigious levels of substance use. the TAZ may represent a safe space, free of judgement. It may also represent a place where there may be food, tolerance and opportunities to use a lot.<br />
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The presence of problematic substance use in TAZs is a problem, and one that has never been adequately resolved. As a manifestation of radical politics, those within the TAZ seldom want to involve forces of law and order to address their problem. But the issue left unaddressed almost invariably causes problems for the TAZ. At its most prosaic, it may be the draining of energy, where time and effort that should have been spent on radical action is instead spent trying to resolve internal problems. The tensions between the activists and the "lunch outs" at protest sites like the M11 were the stuff of legend and highlight the energy wasted over these issues.<br />
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The ability of substance use to undermine radical movements isn't limited to TAZs. We could look to at the way that amphetamine and barbiturates chewed through punk, or alcohol and smack through the 'new age' Traveller movement. We could probably look further back - wine and hashish during the Paris Communes, psychedelics during the Summer of Love? At each stage the fine edge between liberation and creativity in acts of rebellion grates uneasily against the way that radical movements are undermined and ultimately sunk by their proclivity for substances.<br />
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Those involved in TAZs have yet to develop a credible response. There is an understandable unwillingness to involve the Police. This is perfectly reasonable given that any embryonic radical movement needs to develop its own responses independent of the powers of the system Individuals may try and refer the person to support and treatment agencies but these often meet with limited success. The day centres and treatment agencies can offer some interventions but don't mean that they can resolve an issue rapidly or even successfully. <br />
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So what is the TAZ left with? Threats? Exclusion? Demanding the person leaves the site? Is all we are left with hand wringing on the one hand, or the time-honoured vigilante response of the boot and fist to that we cannot incorporate? All these things sit uncomfortably with the politics and morality of a Zone that declares itself outside the normal rules of the system. But the alternative - to accommodate and tolerate - doesn't always seem feasible.<br />
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This is a problem that those with an interest in radical politics have to engage with and resolve. A cohesive, practical and workable set of responses to problematic drug use are essential for a radical movement which seeks to carve out autonomous space. Do we tolerate? Treat? Or do we replicate the same responses that the state has followed - to exclude and criminalise.<br />
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I wish I had an answer to this. One solution - the utopian one - is that on the other side of the TAZ is a place where such problems just cease to be. This is an issue I want to come back to in a later blog. But on the journey to these sunny uplands, we still need to make the TAZ workable whilst addressing problematic substance use. And we haven't yet.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-49002990045378984252012-02-04T13:56:00.000+00:002012-02-04T13:56:57.228+00:00Whose Duty - What Duty: Overdose, Naloxone and Acts of Omission<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">A recent piece I penned for<a href="http://www.drinkanddrugsnews.com/"> DDN's</a> "Soapbox" Column provoked a stream of angry responses. Some of these appeared in DDN's letter page the following issue.A few wrote to me directly. A few tweeted about it. I wrote to each of the respondents because I wanted to expand on the issue of acts of ommission and duty of care. This blog piece takes the gist of what I wrote and expands on it. As it draws on case law from the UK it is of limited relevance to other countries.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Let me be clear – I don’t think that a much-expanded use of naloxone per-se and an massive increase in take-home Naloxone is a bad idea. Quite the opposite. It has, can and will save lives. I also believe in the distribution of foil, crack-pipes, Water for Injection and the opening of Supervised Consumption Facilities. Each bring with them legal and ethical issues which need to be carefully explored. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In the case of Naloxone, some of these could be concerned with the administering of Naloxone. But my concerns are not primarily to do with the <u>administering</u> of naloxone which I recognize is a very safe activity and when done properly, within the framework within which people are trained should not create significant problems.</div><div class="MsoNormal"> </div><div class="MsoNormal">So when one advocate of Naloxone states “<i>the law protects those who administer naloxone from prosecution,</i>” I largely agree - though would add that there could still be scope for litigation if an aspect of the administration were negligent. Others may disagree with this. It would be for a court to decide as there isn't a clear precedent for this. Where I think my views diverge is when the same advocate makes the assertion “<i>it doesn’t punish those who fail to administer it.</i>”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I think this is an area that warrants further discussion and exploration, not least because of the case of sad and troubling cases of Evans and Townsend which I think has significant implications here. </div><div class="MsoNormal"> </div><div class="MsoNormal"></div><div class="MsoNormal"></div><div class="MsoNormal">The cases of Evans and Townsend are deeply unfortunate. <br />
<br />
The case dates back to the death in 2007 of Carly Townsend, in Wales, from a heroin overdose. Her mother, Andrea Townsend, and her half-sister Gemma Evans, were prosecuted, convicted and imprisoned for manslaughter on the grounds of gross negligence. Evans and Townsend is an important case because it potentially expands and certainly reinforces the concept of duty of care, especially in overdose cases, what could constitute negligence.</div><div class="MsoNormal"></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Carly had taken heroin which her sister and been instrumental in procurring. In court it was reported that "[Townsend] said she was frightened after Carly's lips turned blue but this only lasted for seconds so she and Evans placed Carly on a bed and she "listened to her snoring from downstairs where she watched television.<br />
She said repeatedly she thought her daughter would "sleep it off". </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Although neither party had specific overdose training, they had placed the victim, Carly, in the recovery position but, critically had failed to call an ambulance. A duty of care was held to exist for both parties for differing reasons – for Townsend (the mother), a familial duty of care existed and for Evans (step-sister), because she had been involved in the supply – although not charged or convicted with supply of the drugs herself. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I think this is a significant point. We accept and recognize the duty of care that can be applied to professionals, it also applies to familial duty of care, and based on Evans, it applies where there is some involvement in the supply (and by extension the administration.) <br />
<br />
At the risk of speculating (which seems to be frowned on by some parties) the older case of <b>Stone and Dobinson </b>(1977) has a bearing here too, because it established that “<i>a duty exists where a person assumes a responsibility for another…</i>” I don't want to follow this line of reasoning too far - Stone and Dobinson is quite an old case and probably should not be relied upon. The idea that a duty of care can exist for bystanders who try to render help has not been supported elsewhere and so such an extension is probably not that useful.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Having accepted the duty of care owed by professionals, some family members, and those involved in the supply and administration to my mind it doesn’t seem to me unreasonable that <b>a person, familial or otherwise, who has taken on the role of a “carer” (</b>in the context of undertaking THN training with a view to administering to an opiate user) <b>could be considered to have a duty of care in law. </b>This would seem a logical extension of Stone and Dobinson, creating a category above that of mere bystander but withouth the established roles of professional or family members.</div><div class="MsoNormal"><br />
Based on this, the next question is this: could a failure to administer naloxone or the failure to call an ambulance after giving naloxone be considered a gross breach of duty of care <i>if</i> the person died of an overdose? Assume firstly that the person (professional or otherwise) has been trained, and that they are in a potential overdose situation. Naloxone is available. For whatever reason the person fails to administer naloxone. Why? Uncertainty, intoxication, fear, dissuaded by another. I don't know. It's a hypothetical. But anyway they don't administer and the person dies. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Based on existing case-law if we take naloxone out of the equation, and we simply leave it with the issue of calling an ambulance or not, then the failure to call an ambulance by a person held to have a duty of care, which resulted in the death of an overdose casualty has been held to be manslaughter on grounds of gross negligence. This is the legacy of Evans and Townsend.<br />
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By extension <i>if </i>a person with a duty of care administered naloxone <i>but </i>then failed to call an ambulance <i>and </i>the casualty then died, I can't see a reason why the same wouldn't apply. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The remaining question relates then to the failure to administer naloxone. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So far, based on everything I have read and every analysis and discussion I have seen, the discussion has hinged on the risks and ethics of <u>administering</u> rather than not doing so.As I have said already, I have few concerns relating to administering, although I would still prefer to see a “good Samaritan-type law” to put the issue firmly beyond doubt.</div><div class="MsoNormal"><br />
My issue, and the one that stems from Evans and Townsend is the <b>failure to administer</b> and, so far, I am not satisfied that this has been adequately considered. While I acknowledge that legal action stemming from a failure to administer naloxone or a failure to call an ambulance post-naloxone which resulted in fatality is unlikely, I am not aware of any ruling, guidance or even a legal opinion which says it can’t happen. Based on current caselaw I think it can. So on that basis I don’t know that the statement “[the law] doesn’t punish those who fail to administer it…” has been demonstrated to be true.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"></div><div class="MsoNormal"></div><div class="MsoNormal">In most settings this isn't a huge issue. It shouldn't preclude roll out of THN especially to family and friends of opiate users. It is simply to highlight that the very process of recruiting and training users, their families and peers to administer THN is a potential double edged sword albeit one with one side larger than the other. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">On the one hand it massively reduces the chances of a fatality – which is overwhelmingly important. But by virtue of the process of taking on a caring role and attending training, the extent to which a duty of care can be said to exist increases, and as such the resultant implications of any omissions – the failure to call and ambulance (or potentially the failure to administer naloxone) go up. It doesn’t mean it shouldn’t go ahead. It means for me that the legal issue should ideally be resolved or at the least those undertaking such a role being made aware of the risks of failing to act, in addition to risk of death.</div><div class="MsoNormal" style="margin-bottom: 12.0pt;"></div><div class="MsoNormal" style="margin-bottom: 12pt;"></div><div class="MsoNormal" style="margin-bottom: 12pt;"> All these issues take me full circle back to an area of concern which related to hostels, an area that has been of overwhelming interest to me for over ten years. In the small number of hostels that work from an “eyes wide open” basis and actively manage use on site, drug related fatalities have been reduced to zero (including in high-risk, heavy using populations). This has been as a result of careful assessment, trained staff, sensible policies and such factors. This has been a significant success. </div><div class="MsoNormal" style="margin-bottom: 12pt;">My concern (and I recognize that it is a hypothetical) is the issue of Duty of Care (post Evans) is again important. Based on everything I have said so far, I think it is possible for a trained member of hostel staff to be prosecuted under criminal law (or sued by a victim’s estate) for a failure to call emergency services. I doubt you would disagree with this. By extension, if at some point hostels start to hold naloxone and receive training on its use, would a failure to use naloxone be a similar breach of duty? I think they would, hence the need for hostel staff to err on the side of caution and administer “to be on the safe side.” If a hostel is “over-zealous” does this mean people would go and use elsewhere? Maybe. I accept that this hasn’t happened yet – but then in the UK naloxone hasn’t been expanded in to hostel settings on the whole. When it does I hope that the issue is monitored very closely. I am aware that these same issue are now being explored very closely in terms of Police carrying and using naloxone. It will be interesting to see how these discussions resolve.</div><div class="MsoNormal" style="margin-bottom: 12pt;"> For a detailed analysis of Evans and Townsend, see the following<br />
<a href="http://www.peterjepson.com/law/Special%20Study%202013/Evans%20%5B2009%5D_1_W.L.R._1999.pdf"><span style="font-size: xx-small;">http://www.peterjepson.com/law/Special%20Study%202013/Evans%20%5B2009%5D_1_W.L.R._1999.pdf</span></a></div><div class="MsoNormal" style="margin-bottom: 12pt;"><a href="http://www.e-lawresources.co.uk/R-v-Evans.php">http://www.e-lawresources.co.uk/R-v-Evans.php</a><br />
<b><br />
<a href="http://agc-wopac.agc.gov.my/e-docs/Journal/0000016472.pdf">Gross Negligence Manslaughter and Dury of Care in Drugs Cases: R v Evans</a></b>: Glenys Williams: Crim LR</div>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-85687095430133523342011-11-10T21:12:00.001+00:002011-11-11T07:42:29.108+00:00Getting needled #1How much needle exchange equipment is wasted? I don’t mean how much ends up not getting returned. That’s an issue I want to return to at a later date. But how much of it gets discarded unused?<br />
<div class="MsoNormal"><br />
This has been an issue since the early days of pre-packaged equipment. I remember when, long ago in the West End of London we moved from pick-and mix equipment to prepacked bags of 10 needles/syringes one of the big discards wasn’t used equipment but large amounts of unused equipment. People wanted one or two needles, we insisted on giving them ten needles and so, predictably, most of the equipment was chucked away, unused.</div><div class="MsoNormal"><br />
Anecdotal information suggests that this situation has not get better and, in some areas, has got much worse. Discussions and training sessions with housing organisations and community wardens has, in some areas, raised the issue of larger quantities of unused equipment being discarded. This has included virtually complete needle exchange packs, suggesting users only wanted one or two syringes and on other occasions discarded spoons.<br />
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As the range of needle exchange equipment has increased, with the advent of (for example, sterile spoons) and more distribution takes place with prepackaged equipment from pharmacies so, the risk is more equipment gets discarded unused.</div><div class="MsoNormal"><br />
The rationale for such bundling is to reduce cost – bulk purchasing reduces costs and prepackaging makes distribution faster. In theory giving out more equipment in bigger bundles should be a winning situation: less episodes of exchange reduces the burden on pharmacies, should mean each episode can be more intensive, and by giving more equipment out should reduce episodes of sharing or reuse. But has this happened in practice?</div><div class="MsoNormal"><br />
In one area for example the package size is 20 syringes per bundle with associated paraphernalia. It makes for a fairly large and obvious package – not discrete. And anecdotal feedback suggests that it is not uncommon for significant amounts of these packs to be discarded unused. </div><div class="MsoNormal"><br />
We don’t know how much equipment is discarded unused. It might be things that the person simply never wanted – such a person who didn’t want to use the provided sterile spoons. It might excess be excess syringes when the person, for whatever reasons, didn’t want all twenty, just one or two for use today. Or it could be the “other” needles – the twenty orange 25G needles that the person didn’t need because they were using the 23G blue needles in the same pack. They had to be provided together as a compromise necessitated by prepackaging equipment, in the knowledge that one lot of needles will be surplus and discarded unused.</div><div class="MsoNormal"><br />
Without knowing how much equipment is being discarded unused, we can’t start to put a price on it. This is bad enough. Worse, without a clear picture of how much equipment is distributed but not used, we risk working under the false impression that we are getting more equipment out to injectors <u>and that it is being used</u>. So we may end up looking at the headline figures – how much equipment is going out – where this figure has gone up, assume that our injectors are getting more clean equipment.</div><div class="MsoNormal"><br />
In the statistics for one area that I was looking at, the quantity of injecting equipment distributed almost doubled in the period from last year to this. We know in the same period that the number of injectors hadn’t gone up. In fact it had gone down. So the doubling in quantity of injecting equipment distributed should mean that the reuse or sharing of equipment would halve, which would be a great outcome. The fear though should be that a significant proportion of this additional equipment distributed is not being used, but discarded. <br />
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Perhaps the reason for the doubling of the distribution is in part because of large pre-packaged bags.</div><div class="MsoNormal">Across the same time frame in South Wales, pack sizes reduced instead of increasing (from ten needles per pack to three.) And while the number of packs distributed increased by around 30% the net result was an overall reduction of the number of needles distributed. Did this mean that the level of sharing and reduce increased? Or did it result in a reduction in wasted equipment?</div><div class="MsoNormal"><br />
We need to know the answers for two key reasons:</div><ul><li>We can’t start to accurately assess the extent to which distribution meets need, if we can’t say with any confidence what proportion of distributed equipment is actually being used;</li>
<li>We could be wasting significant resources if we are distributing equipment which is being discarded unused.</li>
</ul><div class="MsoNormal">There are several things we can do to try and better understand and address this issue.<br />
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The first requires some detailed research. There is a huge information gap that needs to be overcome. In many needle exchange areas the return rate is low, coming in below 50%. But at the same time the level of public discards is (mercifully) very low. This makes it very difficult to assess whether non-returned equipment is being discarded used or unused. We don’t know where it is going. Domestic waste? Building up at home? Public bins? Not known. And this isn’t the key question to be honest. It just means that it makes it harder to assess how much equipment is being discarded unused.</div><div class="MsoNormal"><br />
The only reliable way of eliciting this information will be research with needle exchange customers to assess what proportion of collected equipment is used, and what proportion is discarded, unused. Such research should ideally be cross-correlated against model of needle exchange, and type of equipment. Does large pre-packaging, for example increase the amount of unused equipment discarded. Is there less discarding with pick and mix?</div><div class="MsoNormal"><br />
A less reliable, but useful interim measure will be more accurate monitoring of drug litter and discards to ensure that all such monitoring differentiates between used and unused equipment. While some areas do this it is not universal, and to do so would help monitor trends over time and the impact that changes in provision have on discards.</div><div class="MsoNormal"><br />
If research shows up high levels of equipment is discarded unused, it will highlight the need for changes in practice and policy to reduce this senseless waste. But in the meantime some measures can be taken to maximize the chances that equipment taken from exchanges is used, and not discarded unused:</div><ul><li><span style="font-family: Symbol;"><span style="font: 7pt "Times New Roman";"> </span></span>Maximizing pick and mix distribution to ensure people can take as little equipment (or as much) as they want</li>
<li><span style="font-family: Symbol;"><span style="font: 7pt "Times New Roman";"> </span></span>Avoiding prepackaged equipment exclusively in large quantities</li>
<li>Ensuring that local policing policy and practice does not discourage people carrying quantities of clean equipment</li>
<li>Ensuring that policies in hostels and supported housing is supportive of injectors storing clean injecting equipment on site</li>
<li><span style="font-family: Symbol;"><span style="font: 7pt "Times New Roman";"> </span></span>Provision of suitable bags to carry injecting equipment discretely (such as backpacks) rather than pharmacy carrier bags</li>
<li><span style="font-family: Symbol;"><span style="font: 7pt "Times New Roman";"> </span></span>Provision for homeless injectors and those for whom carrying large quantities is impractical – including distribution of small quantities of equipment with suitable means of disposal.</li>
<li><span style="font-family: Symbol;"><span style="font: 7pt "Times New Roman";"> </span></span>Raising awareness amongst injectors of the cost of equipment distribution with a view to reducing avoidable waste.</li>
</ul>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-18835009979800374062011-09-16T09:16:00.000+01:002011-09-16T09:16:39.857+01:00dope hyper inflationJust over a year ago, I wrote about the wide variance in the value ascribed to cannabis plants during court proceedings. In the <a href="http://kfxblog.blogspot.com/2010/11/dopey-journalism-1-price-of-plant.html">article</a> the range of cited values was from £150 - 800 a plant.<br />
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So a piece in the <a href="http://www.thestar.co.uk/news/local/judge_vows_to_put_anyone_growing_cannabis_immediately_behind_bars_1_3769374">Sheffield Star</a> caught my eye as it highlighted that the values ascribed to cannabis had increased massively - with a meagre haul of five plants valued at £9050 - a staggering value of more than £1800 being ascribed to each plant.<br />
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It's just as well that the values placed on cannabis aren't included in the RPI because we'd then see inflation heading towards the 10% mark in no time.<br />
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<a class="cssButton" href="javascript:void(0)" id="publishButton" onclick="if (this.className.indexOf("ubtn-disabled") == -1) {var e = document['postingForm'].publish;(e.length) ? e[0].click() : e.click(); if (window.event) window.event.cancelBubble = true; return false;}" target=""><div class="cssButtonOuter"><div class="cssButtonMiddle"><div class="cssButtonInner">Publish Post</div></div></div></a>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-89649494330593306592011-03-21T18:55:00.000+00:002011-03-21T18:55:58.517+00:00Is your Drugs Policy fit for purpose?I've been doing a lot of work lately reviewing organisation drugs policies. Some of these have been big organisations, some small. But a clear issue to emerge is the difficulty organisations still seem to be having in writing their Drugs Policies and the accompanying procedures. <br />
The problems seem to fall in to three main groups:<br />
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1: No policy: I remain astonished that so many organisations still don't have drugs policies at all. It's almost fifteen years now since the Wintercomfort trial which saw senior Day Centre staff in Cambridge prosecuted for offences under the Misuse of Drugs Act, and this case should have ensured that every organisation engaging with people who use controlled drugs would have a workable policy in place. But this isn't the case. And the worst offenders? Local Authorities! On numerous training sessions, the social housing providers and day centres tend to have a drugs policy, but the Local Authority staff don't. All too often, the explanation is that the Local Authority has a "zero tolerance" approach to drugs and this is meant to form the basis of the drugs policy. Which leads on to...<br />
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2: Unworkable policy: where policy is in place, all too often it is so keen to demonstrate its anti-drug credentials, that it introduces unworkable clauses that are wholly unrealistic. These policies, if implemented, would see Police being called out for any suspicion of drug activity, and empty buildings where transgressors had been evicted. In truth such policies are never adhered to, leaving a void of confusion where staff, managers and residents interpret their policies as they see fit.<br />
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3: Mismatched Policies: sometimes, the policy itself is fine - but is at odds with the organisation's stated aims. All too often an organisation which should be working in an accessible and flexible way with homeless drug users has a robsutly zero tolerance policy which drives drug use underground or sees people being evicted - the very people the organisation is seeking to house.<br />
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The problems organisations have with their drugs policies are going to be compounded at present by the financial climate and funding cuts. To provide safe, supportive housing in an average sized hostel with people with significant drug related need, higer staffing levels are essential. Realistically three members of staff should be on shift at all times - less than this makes it hard to manage a crisis safely. One member of staff to tend casualty, one to go and summon help and admit emergency services and one to ensure that the rest of the building and residents are safe. Less than this is an accident waiting to happen. And "less than this" will increasingly become the norm.<br />
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Low staffing levels are likely to be worsened by under-trained staff. As budgets are slashed,. so is staff training and so organisations are likely to reduce the amount and quality of staff training which leaves both staff and residents at risk.<br />
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This is all happening at a time where, as part of the BS (Big Society, but interpret as you see fit), we are likely to see more wholly-volunteer run provision for the growing homeless population - including drop-in provision and nightshelters. While such provision my represent a much-needed response in areas of high need and low provision it brings its own risks. The well-meaning, but undertrained and under-resourced provision can become unsafe. Again, it is imperative that such provisionhas suitable training and policy in place so that it can run both safely and lawfully. The spectre of Wintercomfort hangs over provision that fails to do so.<br />
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There is one more factor that may drive some organisations towards ill-considered and mismatched policies. This is the increasingly common elision of "recovery" and "abstinence" and the proposal in the new Government drug strategy that housing provision for drug users should, along with treatment providers, increasingly receive payment by results.<br />
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The need for suitable and stable housing, with appropriate support, represents a critical aspect of the recovery journey. A lack of housing, or the wrong housing can make it much harder for people to start and sustain the process of change. BUT, and it's a big but, refusing housing to people who are not yet abstinent, or returning people to homelessness when they lapse is not beneficial. <br />
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Let's be clear: there is a need for housing which is wholly drug free and has minimal tolerance to drugs. This housing is urgently needed for people who are in recovery and abstinent and are striving to remain so. In such cases a minimal tolerance drugs policy would be wholly in accordance with the organisations aims. But where the primary aim is to provide housing to people who are homeless, and who may also use drugs, such a policy is misplaced. Organisations can and should support and nurture and aspire to the prospect of change and as this happens move people in to appropriate housing. But to use the threat of eviction to stimulate the process of changed hasn't been demonstrated to work. It just drives use underground, increases overdoses and hampers honest dialogue regarding use.<br />
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Given all these challenges and problems besetting housing providers working with drug users, it seems an opportune moment for us to relaunch the Sample Drugs Policy - a document that was originally written after the Wintercomfort Trial and has been revised regularly since then. This version - the seventh - is substantially rewritten with a longer introduction about how to develop a drugs policy. There are some more extensive procedures and flowcharts to help understand how to implement policy.<br />
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This version of the Policy is unashamedly a "high tolerance" model, aimed at organisations working with ongoing users. It will shortly be joined by other models - a moderate tolerance, low tolerance, and minimal tolerance version for use in different settings.<br />
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The development of this version has been much assisted by Homeless Link, and by Stoke On Trent Supporting People, without whom this revision wouldn't have seen the light of day.<br />
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The Sample Drugs Policy 2011 can be downloaded <a href="http://www.kfx.org.uk/resources/htdp2011.pdf" linkindex="22">here</a>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-44601903632673272082011-03-20T17:30:00.001+00:002011-03-20T17:37:46.536+00:00Give me your tired, your poor, your huddled masses: just not in WestminsterThroughout mythology and folk tales, a tried and tested method for Gods and Kings to test the state of their kingdom was to don the rags of a beggar and walk the streets to see if the great and the good were indeed so great or good.<br />
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Were a latter-day deity or monarch to pitch up in Westminster, then far from hoping to get fed and tended, they may well in the future fall foul of a Council by-law which would make it an offence to give food to the hungry or for the tired or sick to lie down.<br />
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Similarly, if the sermon on the mount were relocated outside Westminster Cathedral, the redistribution of fishes and bread would be a fine on conviction. <br />
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It would be hard to miss the proposals from <a href="http://www.westminster.gov.uk/press-releases/2011-02/soup-runs-and-rough-sleeping-could-be-banned-at-we/" linkindex="23">Westminster City Council</a> to criminalise the distribution of food and lieing down or sleeping in an area of Westminster.<br />
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The Council's website describes this as a move "<i>backed by Homeless Charities</i>" and the text on the website focusses on the issue of Soup Runs, asserting that the soup runs turn the area "into a no-go area for many residents and businesses with issues around litter, urination, violence and disorder." <br />
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Few people would disagree that there has been a long-standing need to ensure that any agencies distributing free food are well co-ordinated and take responsibility for ensuring that mess is cleared up afterwards. This concern is nothing new and the same discussions were taking place back as far as the early 90s when Homeless Network attempted to provide some coordination amongst the soup-run providers.<br />
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But the proposals from Westminster Council go far beyond criminalising the distribution of food. They prohibit lieing down or sleeping in the public places covered by the order - making it an offence to "l<i>ie down or sleep in or on any public place</i>."<br />
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If the legislation is passed - and at present it is only the subject of consultation - anyone distributing refreshment or lieing down in the designated area would comit an offence and could be fined.<br />
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<br />
When the Council asserts that this move is "<i>backed by Homeless Charities</i>" it is hard to find a queue of them supporting the measure. <a href="http://www.mungos.org/press_office/845_st-mungo-s-response-to-proposals-by-westminster-council" linkindex="24">St Mungos</a> for example fall far short of backing the measure and instead state that they do not support the proposed ban on rough sleeping.<br />
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The main cheerleader for the measure in the voluntary sector seems to be Thamesreach whose Chief Executive Jeremy Swain is quoted on the Westminster Council website as saying: <br />
"<i>The Westminster cathedral piazza and surrounding area has been the focus for soup run activity and rough sleeping for many years and this has inevitably had a detrimental impact on the lives of people living and working in the immediate vicinity.</i><br />
<i>“It is reasonable that the council should seek to introduce a bye-law covering this specific area whilst at the same time continuing to commit resources towards ending rough sleeping in the borough</i>."<br />
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It is not clear from this statement if Mr. Swain is endorsing both the criminalisation of soup runs and the further criminalisation of rough sleeping. So far he has not deigned to <a href="http://www.thamesreach.org.uk/news-and-views/news/" linkindex="25">cover the issue in his Blog</a>. In the Guardian he is quoted as defending the proposal, but with the caveat "<i>This is not a borough-wide ban, which I would oppose</i>." We look forward to Mr Swain joining the protests when such a borough-wide extension takes place as it surely will if this initial bye-law is passed.<br />
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Nor is it entirely clear how fining people who sleep rough helps anyone. Unable to pay fines, people will be required to beg more or face short prison sentences for unpaid fines - which will simply eat in to Police and court time and increase the isolation and stigma faced by people who are homeless or vulnerably housed.<br />
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But in truth there are others whose stated stance (or lack thereof) in relation to this legislation is more craven. Of these the most notable must be Westminster Cathedral. The deafening silence from this quarter, other than to <a href="http://www.guardian.co.uk/society/2011/feb/28/westminster-council-soup-run-ban" linkindex="26">lament</a>:<br />
"<i>Of those homeless people who congregate in the area, there is a minority of hard drinkers and drug takers who cause residents and visitors distress, which I have witnessed and been told about," a Westminster cathedral representative told the council. "During the day they can often be seen in groups of up to 15, and this can dramatically increase in the evenings with the soup runs.</i>" <br />
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Given such an abandonment of the poor and huddled masses of South Westminster, it is hard to read the Westminster Cathedral website without astonishment at the hypocrisy therein.<br />
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In the <a href="http://www.westminstercathedral.org.uk/index.php" linkindex="27">news section</a>, Father Witon happily burbles: <br />
"<i>CAFOD believes that all human beings have a right to dignity and respect, and that the world's resources are a gift to be shared equally by all men and women, whatever their race, nationality or religion”.<br />
One of the saints said: “the best place to keep your money safe is in the stomachs of the poor”. It is in this spirit that we are all invited to be generous with those who can never say that they have too much on their plate</i> ."<br />
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Clearly this sentiment doesn't extend to the poor of South Westminster.<br />
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This is perhaps where localism and the Big Society have their first head-on clash: the Big Society expects people to give their time and their energy to take on rolls which the state is increasingly unable or unwilling to fund - like care of the poor and the homeless. But on a local basis residents and businesses want to see action against the same poor and the homeless. And it seems that when it comes to South Westminster, localism trumps Big Society.<br />
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In truth <a href="http://www3.westminster.gov.uk/docstores/publications_store/Draft%20Rough%20Sleeping%20and%20Soup%20Run%20Byelaw.pdf" linkindex="28">the legislation as it currently stands</a> is probably unworkable - and certainly would end up being enforced in a partial and selective manner. There are some exemptions proposed in the legislation: so for example sporting events would be exempt, which will be a relief to marathon runners. And while it will be an offence to give people who are starving food, it will remain acceptable to give out promotional nibbles to encourage people to eat in local premises. Heaven's forbid local businesses should be further inconvenienced! But in the event of a Police kettling operation, they wouldn't be able to give out water to people. And as an aside, the right to peaceful protest would be curtailed by this legislation as lieing down - as a form of protest for example - would be illegal under this legislation. <br />
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But beyond these legal concerns and the attitudes of Jeremy Swain and The Westminster Cathedral there is a bigger issue here - and that is the ongoing and accelerated cleansing of the poor and homeless from the streets of the Capital. A process that has included the introduction of ASBOs, the hosing down of rough sleepers and sleeping spots by Council street cleaners, the deliberate under-counting strategies endorsed by the Rough Sleepers Unit and now culminating in a proposal to make such the act of sleeping rough an offence.<br />
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The idea that this will be restricted to one area of Westminster seems naive. Should this piece of legislation be successful, then a rapid extension across Westminster is inevitable. And then, in the run up to the Olympics, seeing am extension to other London Boroughs as the City is cleansed for the marketing jamboree of the Olympics. Westminster proposes, Boris disposes and streets cleared of "huddled masses" for a tourist-friendly Olympics.<br />
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<a href="http://www.westminster.gov.uk/services/housing/supportingpeople/roughsleeping/" linkindex="28">Consultation</a> on the proposed legislation closes on the 25th March 2011.KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-80765634916005981722011-02-14T20:44:00.000+00:002011-02-14T20:44:37.217+00:00Bulletins from the front: deep cuts, unplanned cuts, malicious cuts?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnk4KtLY8yuNo4m_MkV7wnzQqsLc2PakELFFqFAOUTMapkcs9Do60OXiJ_EXCPCakWoPUW5ABYZZR-a4OP0sXnpQLcjcF-BMU0UZnAvEZXazW9KEJpJjebYAgl24vy4FONSknHWw/s1600/neverwhere.jpg" imageanchor="1" linkindex="17" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="103" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnk4KtLY8yuNo4m_MkV7wnzQqsLc2PakELFFqFAOUTMapkcs9Do60OXiJ_EXCPCakWoPUW5ABYZZR-a4OP0sXnpQLcjcF-BMU0UZnAvEZXazW9KEJpJjebYAgl24vy4FONSknHWw/s200/neverwhere.jpg" width="200" /></a></div><br />
<div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">Services being cut…the vulnerable becoming yet more vulnerable…..those who work in public services nervously eyeing the post for the ‘your job is at risk’ notification. Oh, and one public toilet in Manchester. We live in times of concern, worry and uncertainty – well, we do if we are concerned with the welfare of others.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;"> </span></div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">But we knew this was coming; the swing away from investing in the population was going to come at some point (I still haven’t made my mind up if all that spending was ok, being as it came at the apparent cost of letting the City do whatever it pretty much fancied for over a decade). </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">The decisions and beliefs lieing behind the reductions in public spending are surely more ideological than practical, despite the protestations to the contrary. I can live with that. Some of us have seen the swing from investment in the population, via increases in spend on hospitals, schools, housing – well, social housing services if not bricks and mortar – and the swing back to cuts, cuts, cuts. What does appall me is the subsequent response from the public sector itself. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">Working in the world of Supporting People I’ve seen the budget swell larger each year – until this year, with massive cuts apparently required, a series of reductions now have to be made. From the apparent top to bottom of the local government I can see in action the rationale behind what goes and what stays is and, ….well, frankly, the playground can see more sophisticated decision making processes. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">We have a reduction in the number of staff in the team – but is this based on any kind of reasoned approach, a setting of priorities for the programme that needs a particular set of individuals with the right skills, expertise and knowledge to make the best use of limited resources? </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">Guessing you know the answer to that. No, of course not. The whole element of measuring service quality, the staff that actually have contact with the people who use services and those who work every day in those services – looks like its going to be gone baby, gone. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">We’ll still be counting numbers though. We’ll be able to tell you how many,and where. Just not what’s actually going on for people, whether the service is actually making a difference or, worse, whether the service is safe or not. </span></div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">It just gets better. In my naïve reasonings (hah!), I had considered that a thoughtful and planned approach to cutting Housing Support Services would be adopted, with thought about which service for which individuals would have the most consequences if they were reduced – or, in many floating support services in our County, gone altogether. </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-GB" style="font-family: "Arial","sans-serif"; font-size: 10pt;">But again – no. Actually cuts are being made with no rationale and reason. Except that sometimes it seems to take the form of malice. A sense of old scores being settled prevails at times. And I am all too aware that any discussion about the people living in these services, those who are being supported in situations where there is no other support available – there is no thought for them, none that I have seen. I just see a ruthlessness by some to keep their own jobs intact, at any cost. This isn’t what I came in for. </span></div><div class="MsoNormal"><br />
</div>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-29418470208497820212011-02-08T21:49:00.002+00:002011-02-08T21:54:13.856+00:00Reporting in - News from the South West<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqiE1YVnoizH3LH4JZ3a7wDaJdBGe2fj71TuvbJyDFP-owv1RS6gH_Pqo4ri3Ul_mNizbbdZ6Kh0APp6t9S6OydVX5b10qN1jTu8yBDJQ1Rdz7eqpthGQhe8bOshp7DU_tp5dQ/s1600/penelopepsblog.jpg"><img style="float: left; margin: 0pt 10px 10px 0pt; cursor: pointer; width: 200px; height: 70px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqiE1YVnoizH3LH4JZ3a7wDaJdBGe2fj71TuvbJyDFP-owv1RS6gH_Pqo4ri3Ul_mNizbbdZ6Kh0APp6t9S6OydVX5b10qN1jTu8yBDJQ1Rdz7eqpthGQhe8bOshp7DU_tp5dQ/s200/penelopepsblog.jpg" alt="" id="BLOGGER_PHOTO_ID_5571440316672931026" border="0" /></a>I have maintained radio silence for the last couple of months watching how things unravel, but now it is time to break cover.<br /><br />Between now and the end of February councils will be setting their budgets for next year and then we will have a much better idea of the fate in store for some of the most vulnerable members of our society.<br /><br />It seems that unitary authorities are being as short sighted as the executive councils when it comes to removing the funding for a whole swathe of services which currently provide a safety net for those people with multiple vulnerabilities, none of which hit a threshold for a statutory service. Admittedly a lot of the statutory services are being cut too probably by setting the priority criteria even higher.<br /><br />A colleague of mine who works for a district housing department bemoaned that it is as if this government have decided on a full on attack on housing;<br /><br />The grant given to Housing Associations to build new social and affordable housing has been completely cut, but they are still supposed to deliver new housing stock, how? by taking out loans - but how will they repay the loan I hear you ask - through the rent they charge. "affordable" rent = 80% of the market rent, social rent can be whatever (interestingly, I saw a bedsit for rent from a housing association for £103. per week today how affordable is that!!).<br /><br />The bottom line is with loans to repay the Housing Associations are going to take less risks on who they give a tenancy to; the young and upwardly mobile for "affordable" housing or those on 100% benefit (social housing).<br /><br />Already the place of last resort social housing will become the sole residence for the sick, unemployable and the dispossessed with that social calamity of the sink estate making an unwelcome reappearance.<br /><br />Changes to housing benefit will shut yet another escape route for those trying to dig themselves out of the poverty hole. Changes to the Local Housing Allowance will mean that those receiving Housing benefit will only be able to afford property with a market rent that falls in to the lowest 30% (so that will be all the crap accommodation then). but if you are under 35 and single then you will only qualify for the rent for a single room in a shared house.<br /><br />All is not doom and gloom. If there is a will there is a way.<br /><br />In the face of cuts to the Supporting People budget Exeter City Council are looking at innovative and cost effective ways to maintain some housing in the city for non priority homeless. The STAR scheme which has been running for 2 years can offer a temporary flat to someone rough sleeping giving them among other things a reference for a rent deposit scheme. This scheme uses part of the housing act which says a council can house someone without accepting a duty toward them, it counts as temporary accommodation so the council can claim top rate housing benefit and the excess is then used to buy in a bit of floating support. Any local authority could do this even if they don't own their housing stock.<br /><br />I guess what I am trying to say is things are bad, the outlook for the year ahead is grim, but there are ways to keep on ensuring that there is some support available for those people who traditionally slip through the net and we have to keep trying.<br />The time for moaning is over, the time for action is now<br /><br />Over and out.Penelope P-Shttp://www.blogger.com/profile/08272392260127054084noreply@blogger.com0tag:blogger.com,1999:blog-36144663.post-89686320009557176852011-01-10T16:15:00.004+00:002011-01-10T19:50:20.679+00:00Omissions, Contradictions, and Confusion: The 2010 Government Drug Strategy reviewed<div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-GB">“<i>Gone are the days</i>,” reads the introduction of the new drug strategy “<i>when central Government tells communities and the public what to do</i>.” (p2). Yet a mere seven pages later the Government does exactly that, saying “<i>People should not start taking drugs and those who do should stop.</i>” (p9). <br />
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Such contradictions are a recurring theme within the 2010 Government Drug Strategy. Given such contradictions and the serious omissions within the Strategy, it’s a shame that the Strategy received such an uncritical response from the drugs field. The sense of agencies keen in a time of austerity to make nice rather than challenging the Strategy was palpable. <br />
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<b>Vanishing Harm Reduction:</b> In a Stalinesque linguistic purge, the terms “harm reduction,” “risk reduction” or “reducing harm” have been wholly expunged from the Strategy. I wonder to what extent this wanton abandonment of the term “harm reduction” is as much a rejection of the terminology of the previous drug strategies as an ideological rejection of harm reduction by the current Government. But whatever the rationale there is precious little space within the Strategy for pragmatic harm reduction with on-going users. The approaches are supply and demand reduction to prevent use, and abstinence-focussed treatment to end dependent use. But between these two poles there is a gaping void where effective harm reduction measures would have sat. </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">The sole reference to harm minimization is on page 29 where, in somewhat garbled terms the strategy says:<br />
“</span><i>We will achieve better outcomes for those entering treatment by:…continuing to promote harm minimization measures including needle exchange and drug-assisted treatments that encourage drug users to enter treatment, in order to reduce the risk of overdose for drug users and the risk of infection for the wider community…”</i></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
It’s not entirely clear from this wording if “drug assisted treatment” has now been demoted to an intervention “that encourages drug users to enter treatment” rather than being a treatment in its own right. But the overwhelming sense I get from the amount of space and time given to NSP in the document is that it is not considered a priority within the Strategy. The fear must be that this reduction in priority will give commissioners and fund-holders the green light to cut spending on this area to the bone.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b>Recreational users: </b>Whilst this (limited) acknowledgement of the role of needle exchange is welcome, and the implied retention of overdose-prevention strategies is also welcome, this still leaves a substantial population with their needs wholly unmet: non-problematic, non-dependent users. This group, the largest proportion of people within the drug using population don’t seem to be effectively considered within the drug strategy – certainly not from a harm-reduction point of view. </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;">The Government drugs information service “FRANK,” is presented in the strategy less as a way of making people “aware of the consequences of their actions” and as a way of providing “accurate and reliable information on the effects and harms of drugs…” Whilst it will be a welcome development of Frank succeeds in providing “accurate and reliable information” it seems likely that Frank will be required to become much more partisan – promoting behavior change and stressing risks much more than providing any harm reduction information in literature or on the phone.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;">This development is certainly in keeping with the expectations of the Centre for Social Justice who demanded reform of Frank saying that this was "<i>imperative if we are to prevent young people from engaging in drug and alcohol abuse so we urgently call for wholesale reform of Talk To Frank and the messaging within it.</i><span lang="EN-GB" style="font-size: 11.5pt;">" <span style="font-size: small;">(</span></span><span lang="EN-GB" style="font-size: small;"><a href="http://www.centreforsocialjustice.org.uk/client/downloads/DrugStrategy.Dec2010..pdf" linkindex="31">ref</a></span><span lang="EN-GB" style="font-size: small;">)</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;">With the Release drugs helpline facing closure, and Frank heading more firmly in a “drugs are dangerous, don’t do them” direction, it becomes harder to see where accurate, pragmatic harm reduction information for the vast majority of recreational users is going to come from. </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Power of evidence – or just power? </span></b><span lang="EN-GB">Given that the Conservatives now form part of the coalition Government, it’s interesting to see how the Government’s strategy on drugs has abandoned some of the measures that the Home Affairs Select Committee recommended in 2002. Back then, a more-radical, not-in-power-at-the-moment David Cameron advocated, with the committee, several things, including:</span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-GB">"<i>We recommend that an evaluated pilot programme of safe injecting houses for heroin users is established without delay and that if...this is successful, the programme is extended across the country</i>"</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-GB"><i>We recommend that a target is added to the National Strategy explicitly aimed at harm reduction and public health;</i></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;">"·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-GB"><i>We recommend that Section 8 of the Misuse of Drugs Act 1971 is amended to ensure that drugs agencies can conduct harm reduction work and provide safe injecting areas for users without fear of being prosecuted</i>;" (</span><span lang="EN-GB"><a href="http://www.publications.parliament.uk/pa/cm200102/cmselect/cmhaff/318/31815.htm" linkindex="31">ref</a>)<br />
<a href="http://www.publications.parliament.uk/pa/cm200102/cmselect/cmhaff/318/31815.htm" linkindex="32"></a></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB"><br />
It is a shame that none of these worthy interventions survived Cameron’s journey from opposition to Prime Minister and that have not featured in the new Strategy.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">While these evidence-based interventions have not survived to see inclusion in the Strategy, some interventions which have no evidence base have been included. So for example the strategy exhorts a return to the days of ex-users going in to schools to do prevention work. It has been reframed as “<i>Community Recovery Champions – people who are already in recovery…who will be encouraged to…contribute to prevention in communities and schools.</i>” (p21)</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB"><br />
This is a real retrograde step and one for which there is no evidence base of effectiveness.It is effectively a return to the old-days of ex-users telling young people "not to do what I did," but presupposes (I hope) that people in recovery will be slightly more subtle than some of the shock tactics that were used in the past. It was always a useful tool against those who were not going to use anyway, but short of simply rescreening "Better Off Dead" (which was the sum total of my own drugs education at school) the Strategy couldn't be much less use than those already using or inclined towards use.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Contradicted and Confused:</span></b></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">Behind the scenes, when the Strategy was being drafted, there must have been some serious horse-trading going on as various factions tried to get their perspectives incorporated. The Lib-Dems appear to have sacrificed any hope of liberalisation of the drug laws as the price of becoming “coalition prank monkey.” Certainly the Lib-Dem manifesto aim to “e</span><i><span lang="EN-GB">nsure that financial resources, and police and court time, are not wasted on the unnecessary prosecution and imprisonment of drug users and addicts” </span></i><span lang="EN-GB">has vanished and instead the Strategy promises that this will be decided locally by Police and Crime Commissioners and that drug possession will appear on Crime Maps. “<i>Drug dealing and drug possession</i>,” the Strategy ominously (and ungrammatically) warns “<i>is a crime</i>.”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">The other key area of tension that was played out behind the scenes was the turf war between Ian Duncan Smith who has had a longstanding interest in drugs and wanted to see the DWP take a leading role in drug strategy, and the Home Office with whom drug strategy has typically rested. Others lobbying hard to influence drug strategy was the <a href="http://www.cps.org.uk/" linkindex="33">Centre for Policy Studies</a> </span><span lang="EN-GB">the Conservative think-tank where Kathy Gyngell gave the Strategy the most luke-warm of receptions saying “<i>Fair words about recovery are just not enough. Nor is hope of a ‘recovery contagion’ unless many, many more people are paid for to go into abstinence based therapeutic programmes like those run by The Providence Project and the Ley Community, unless methadone prescribing is capped</i>.” (<a href="http://www.cps.org.uk/index.php?option=com_content&view=article&id=489:the-new-drug-strategy--just-two-cheers-&catid=23:prisons-and-addiction&Itemid=42" linkindex="34">ref</a>) </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">The manifestation of these tensions is apparent within the strategy, and when the Drug Strategy is considered in context of the wider policy picture, these contradictions and confusion become all the more apparent and concerning.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Contradiction 1: </span></b><span lang="EN-GB">“commitment to an evidence-based approach.”<br />
Page 9 of the strategy affirms that the Government “<i>values the work and the independent advice of the ACMD, which has experts from fields that include science, medicine, law enforcement and social policy. We are committed to both maintaining this expertise and ensuring the ACMD’s membership has the flexibility to respond to the accelerating pace of change.</i>” <br />
<br />
These are fine words, but the stated commitment rings hollow when considered alongside clause 150 of the Police Reform Bill (<a href="http://www.publications.parliament.uk/pa/cm201011/cmbills/116/11116.95-101.html#j401" linkindex="35">ref</a>) which would remove the obligation to maintain those representatives from medicine from the ACMD. </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB"><br />
<b>Contradiction 2: </b>“vulnerable young people”<br />
The strategy highlights that “<i>vulnerable groups – such as those who are truanting or excluded from school</i>” face increased risks in relation to drugs. Reducing school exclusion should therefore be a critical aim of any intervention to support vulnerable young people.<br />
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</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">It will be interesting to see how the needs of vulnerable children and the need to reduce school exclusion sits alongside proposed powers discussed on Page 10 of the strategy to “<i>tackle problem behaviour in schools, with wider powers of search and confiscation. We will make it easier for head teachers to take action against pupils who are found to be dealing in drugs…</i>”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">The proposed White Paper on Schools, <a href="http://publications.education.gov.uk/eOrderingDownload/CM-7980.pdf" linkindex="36">The Importance of Teaching</a> proposes increasing the authority of Heads to exclude, but at the same time increasing their obligation to take responsibility for excluded pupils.<br />
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</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Contradiction 3: </span></b><span lang="EN-GB">“rehabilitiation in a Payback Jacket.”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">On the one hand, there is a clear desire stated within the strategy to use community interventions such as Drug Rehabilitation Requirements, to help move people away from dependency and offending. However, this desire is at odds with the Government’s desire to ensure that justice is seen to be done – and so the Strategy proposes “<i>combining drug and alcohol requirements with other sentencing options, such as Community Payback, to make sentences more robust and ensure that punishment is visible to the community.</i>”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">Whilst some form of reparation and payback is clearly essential, the priority surely must be to address drug dependency first and foremost. And it is hard to see how a day of highly visible “community payback” in a fluorescent jacket will represent a contribution towards recovery capital.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Contradiction 4:</span></b><span lang="EN-GB"> “forensics”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">As part of its response to ‘legal highs’ the Strategy says the Government will “<i>improve the forensic analytical capability for new psychoactive substances and will establish an effective forensic early warning system.” </i>(p15)</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">Such a system would be very welcome indeed – and would be better still if it would also provide early warning of contaminants in heroin and such like. Unfortunately, however, since the Drug Strategy was published, the<a href="http://www.bbc.co.uk/news/uk-11989225" linkindex="36"> BBC reported</a> that the UK Forensic Science Service would be wound up from 2012. It is not clear, therefore where a forensic early warning system of the type proposed in the Strategy would come from, and if indeed it can ever happen now. With Forensic analysis shifted to either cash-strapped police forces or private enterprises it is hard to see where the money for such a scheme would come from.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Contradiction 5: “</span></b><span lang="EN-GB">housing need”</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">The recognition of housing need from page 22 of the Strategy is very welcome, and the report stresses “<i>the importance of providing accommodation for these people.</i>” The importance of Supporting People in this context is noted and the strategy mentions that the Programme will have £6.5 billion investment over the next four years.<br />
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What the strategy doesn’t mention is that this money represents a 11.5% reduction in SP money, is not drug-specific and is not ringfenced (<a href="http://www.insidehousing.co.uk/news/care-and-support/supporting-people-budget-reduced/6512140.article" linkindex="37">ref</a>). So in some areas of the UK we have already seen swingeing cuts to SP funding and provision with budget cuts of 40-50% being announced in some areas and entire services being culled. So the proposal in the strategy and the reality on the ground are substantially at odds.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">The Great Unresolved Issue:<br />
</span></b><span lang="EN-GB">At the heart of the Strategy is a commitment to “<i>recovery</i>.” The strategy title includes “<i>building recovery.</i>” But within the addiction field the term “<i>recovery</i>” is argued over and defined in various ways, so within the Strategy too the term “<i>recovery</i>” is subjected to various interpretations and indeed it is hard to find two consecutive sentences where “<i>recovery</i>” has the same meaning in both.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB"><br />
A clue to the Government’s interpretation of “recovery” is the subtitle to the strategy – “<i>supporting people to live a drug free life.</i>” So here the aim of recovery is equated with abstinence.<br />
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But the Strategy seems unwilling to commit to this interpretation. On page 18 of the Strategy the ambition is for “<i>individuals to leave treatment free of their drug or alcohol dependence so they can recover fully</i>.” This would mean that the result of treatment is an end to dependence, but not necessarily abstinent. And “recover fully?” Well in the next paragraph this is expanded on with the words “<i>into full recovery and <b>off drugs and alcohol for good</b>. It is <b>only</b> through this permanent change that individuals will cease offending, stop harming themselves and their communities and successfully contribute to society.” </i>[emphasis added].<br />
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So within this interpretation, full abstinence is the only solution. Not managed use, controlled use, or substitution. Ironically this interpretation of “recovery” is at odds with many recovery advocates who would argue that abstinence alone does not equate – or even lead to full recovery and the sense of personal and spiritual wholeness is an essential component of true recovery, not mere abstinence.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB"> In the next paragraph, the Strategy offers a different interpretation: “<i>wellbeing, citizenship and <b>freedom from dependence.</b></i>” So abstinence is not essential here. And a sentence later the definition has shifted again: “<i>it is an individual, person-centred journey, as opposed to an end state, and one that will mean different things to different people.</i>”<br />
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So in the space of six lines the Strategy has veered from a position that expounded that the only outcome should be “<i>off drugs and alcohol for good,</i>” and moved to a “<i>person centred journey as opposed to an end state.” <br />
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</i>A couple of sentences later the Strategy changes course again and defines an end-state saying “<i>our <b>ultimate goal</b> is to to enable individuals to become <b>free from their dependence</b>.</i>” All crystal clear then except that, a sentence later the ground has shifted again. “<i>Supporting people to live a <b>drug-free life</b> is at the heart of our recovery ambition</i>.” <br />
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Such confusion and ambiguity at the heart of the drug strategy should be a cause of huge concern. As we move towards payment by results, the interpretation of a successful result becomes more and more important. Is the successful result complete abstinence? Or is it an end to dependency? These are not the same and, if the past is anything to go by, can become the source of huge controversy.<br />
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Certainly in her ongoing battle against the NTA, Deirdre Boyd of <a href="http://www.addictiontoday.org/" linkindex="38">Addiction Today</a> has repeatedly argued for abstinence as a core feature of recovery and so is unlikely to settle for less as a “success” for the new strategy.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Recovered enough to work? </span></b><span lang="EN-GB">The definition applied to “recovery” is not, however, merely of ideological importance or for providers who will be paid by results.<br />
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It is also critically important in terms of eligibility to benefits and readiness for work. So, for example, on page 23 of the strategy, the document says “<i>we will offer claimants who are dependent on drugs or alcohol a choice between rigorous enforcement of the normal conditions and sanctions where they are not engaged in <b>structured recovery activity</b>, or building <b>appropriately tailored conditionality</b> for those that are.</i>” [emphasis added]</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">There are two phrases here to which are hard to decipher. “<i>Structured recovery activity</i>” is a loaded phrase. It hinges in part on what interpretation is being applied to “recovery.” And the idea of “<i>structured activity</i>” begs the question “what activity?” and “whose structure?” It suggests that someone who is starting to engage in recovery-oriented interventions (such as, for example, starting to attend a self-help group on a sporadic basis) would not be involved in “structured recovery activity” and so would be subject to “<i>rigorous enforcement of normal…sanctions.</i>” But if the definition of “recovery” is not defined, then how can job centre staff be clear if a claimant is involved in “structured activity?” Elsewhere it is accepted that substitute prescribing is both an aspect of recovery and structured. So would this measure mean that someone was engaged in “structured recovery activity?” Given that on such questions a person’s receipt of benefit and in turn things like housing may hinge, it is a critical question.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">It seems inevitably that, without very explicit clarification for job-centre staff here, claimants will be exposed to local and arbitrary interpretation of what level of compliance is required – meaning that people engaged in the “wrong” kind of recovery, or taking too long to recover in the “right” way will be removed from the benefit system.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><b><span lang="EN-GB">Challenge Now!</span></b></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-GB">So that’s our muddled, contradictory, drugs strategy. Maybe it’s no bad thing. Maybe the fact that it is in a state of flux – even though it has now been published – means that it is more malleable and can be more easily challenged, refined, adjusted and improved. Because at the moment it is contradictory, muddled and confused. It is more of an optimistic wish list – where the Government wished to get to, rather than a map of how to get there. But it will require a great deal more critical analysis rather than the warm words of endorsement from the field if the Strategy is to resolve the issues that are currently unresolved.</span></div>KFxhttp://www.blogger.com/profile/04914172646273739006noreply@blogger.com2