Showing posts with label "Drug Strategy" UK. Show all posts
Showing posts with label "Drug Strategy" UK. Show all posts

13 February 2017

SCRA Dependency: the learned helplessness in treatment services

As 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.) 

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. 

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.

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.

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 Max Daly writing for Vice.

Concerned about the lack of tools and resources for working with SCRA dependency, the existing Cannabis Dependency Toolkit on the KFx website was adapted to reflect SCRA dependency. The SCRA Dependency Toolkit has proved popular with a number of workers to prompt discussion about SCRAs and start the process of addressing dependency and promoting change.

The area that still needed to be addressed was how to respond effectively to physical dependency, specially where pharmacological interventions were indicated.

The only significant report on the management and treatment of SCRAs was produced by Project Neptune and the section on SCRAs republished separately in 2016.
The report has very little concrete information on treatment of withdrawal symptoms, saying only:
“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.”

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.

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.

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. 

When resources like the BMJ's infograph on NPS 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.

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.

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.

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.

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.


 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.

The draft SCRA Withdrawal Screening Tool and potential interventions can be downloaded here.
It is in draft form and all feedback and suggestions are gratefully received.

31 May 2015

The Psychoactive Substances Bill – a fundamental shift in drugs legislation and state control.



Part 1: Commentary
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.

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. 

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. 

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.

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. 

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 “Secretary of State must consult such persons  as the Secretary of State considers appropriate.
The list of exemptions includes:

  • ·         Controlled Drugs and Medicines,
  • ·         Alcohol,
  • ·         Tobacco and Nicotine,
  • ·         Caffeine,
  • ·         Food.

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).

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.

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.

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.

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.

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.

Part 2: The legislation.

The main provisions of the proposed legislation restrict production, supply and importation of Psychoactive Substances.
 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  nervous system, it affects the person’s mental functioning or emotional state.”
In its current form the Bill creates key offences of production, supply, importation and exportation. It doesn’t 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.
There is also provision for the searching of vehicles, buildings etc.
The offences are:

Producing a psychoactive substance


(1) A person commits an offence if—
(a) the person intentionally produces a psychoactive substance,
(b) the person knows or suspects that the substance is a psychoactive substance, and
(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.
Production here means “producing it by manufacture, cultivation or any other method.

Supply, a psychoactive substance


(1) A person commits an offence if—
(a) the person intentionally supplies a substance to another person,
(b) the substance is a psychoactive substance,
(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.
Additional clauses cover Possession with Intent to Supply and Offer to Supply.

Importing or exporting a psychoactive substance

(1) A person commits an offence if—(a) the person intentionally imports a substance,
(b) the substance is a psychoactive substance,
(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.
(2) A person commits an offence if—
(a) the person intentionally exports a substance,
(b) the substance is a psychoactive substance,
(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.

Commentary: 

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.”
The key wording in the proposed legislation to address this is “knows, or is reckless as to whether, the psychoactive substance is likely to be consumed”
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.

Enforcement Powers:

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.
Prohibition Notices 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.
Premises notices 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.
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.

Commentary:

 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. 

The full text of the bill can be viewed and downloaded here:
http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf

26 November 2013

Head-shops: Regulation or Prohibition



This is our chance to have a radical shift in drugs policy. But we're going to end up with more prohibition...again.

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).

Though no statutory figures exist, anecdotally there has been a significant increase in the number of head-shops in the UK. The Angelus Foundation[1], 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.

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.

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.

Workshop observations: 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.

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.

Head-shops v. On-line retailing: 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.
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.

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.

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.

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.

The pressure for change: 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.

The Angelus Foundation is pushing for such an approach, supporting an amendment to the Antisocial Behaviour, Crime and Policing Bill, [i] which says:

It is an offence for a person to supply, or offer to supply, a psychoactive substance, including but not restricted to-
(a) a powder;
(b) a pill;
(c) a liquid; or
(d) a herbal substance with the appearance of cannabis,

which  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.

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.

The response in Ireland has been subtly different and creates a system of Closure Notices and Closure Orders for head-shops selling intoxicated substances.[2] 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.
Further, importantly, the legislation doesn’t criminalise end-users but does provide scope to close down retailers. The Mirror[3] claims that this legislation reduced the number of head-shops from “
from 100 to six in three months.”

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.[4] Attempts to use Trading Standards legislation failed in Chester due to a botched case.[5]
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.[6]

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.
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.

All the interventions so far have been prohibitory and restrictive rather than regulatory. However, they haven’t resolved the issue of NPCs and prohibitive responses may have their own unintended consequences.

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.[7]  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.
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.

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.
And it’s also worth stressing that it easier to hold a shop-based retailer to account than a virtual one.

Regulation 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.

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.

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:

  • Vetting and training of staff
  •  Requirements to check ID in relation to age
  • Control over where shops can open and when they can trade
  • Capacity to remove licences in response to emergent problems.

Regulation requires licensed substances: At present there are some limited legal barriers to the sale of products that are NOT controlled drugs or medicines.
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. 
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.

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.

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.  So when for example the Daily Mirror says “Legal highs: Store worker flouts drug laws to dish out drug advice to customers[8]” 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.

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.

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.

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.

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.

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.

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.

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.

Ultimately such a decision would need to be made by a court. But herein lies our stumbling block.

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.

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.

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.

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 responses to NPCs? Well, never say never but there will be few people more astounded than me if they do.



[1] http://www.prnewswire.co.uk/news-releases/over-250-headshops-in-uk-are-selling-legal-highs-says-angelus-foundation-232476221.html
[2] http://www.attorneygeneral.ie/eAct/2010/a2210.pdf
[3] http://www.mirror.co.uk/news/uk-news/legal-highs-labour-looking-clamp-2715685
[4] http://www.westyorkshire.police.uk/news/men-charged-landmark-legal-highs-case
[5] http://www.chesterfirst.co.uk/news/122737/case-against-chester-legal-high-shop-owner-dismissed.aspx
[6] http://www.southwalesargus.co.uk/news/10765334.Five_released_on_bail_following_raids_in_Newport_and_Cwmbran/
[7] https://pressfolios-production.s3.amazonaws.com/uploads/story/story_pdf/50357/503571385371333l7hrMWTLRGE8jGSPOYMw.pdf
[8] http://www.mirror.co.uk/news/uk-news/legal-highs-uk-skunkworks-worker-2644152






[i] http://www.publications.parliament.uk/pa/cm201314/cmpublic/antisocialbehaviour/memo/asb52.htm