Tackling the harms of New Psychoactive Substances - We need to look at the bigger picture
Dr Kathryn Higgins explains how her NIHR-funded research into the wider impacts of New Psychoactive Substances (NPS) provides new evidence to help pinpoint the right treatments for users suffering harmful effects from the drugs.
The deadly dangers of New Psychoactive Substances (NPS) - often previously referred to as ‘legal highs’ - have been widely covered in newspapers with tragic stories of how young people have lost their lives or become seriously ill after taking them.
Their harmful effects have been systematically documented, with synthetic cannabinoids associated with numerous physical and neuropsychiatric side effects, repeatedly resulting in hospitalisation, as has mephedrone use. Even then, their composition can vary from batch to batch. In some cases, NPS can be up to between 100 to 800 times more potent than the drugs they are imitating.
All of this presents a significant health challenge. We wanted to look beyond the reported physiological effects of the drugs and learn more about the wider impact of NPS use on the individual, including why people use NPS in the ways that they do, and what attracts people to them.
Investigating the wider impacts and characteristics of NPS use
We have carried out research funded by NIHR’s Public Health Research Programme (PHR) to look beyond the reported physiological effects of the drugs and learn more about their wider impact on the individual, including why people use NPS in the ways that they do, and what attracts people to them. Significantly, our study did not focus solely on problematic populations, but shed light on NPS use across a wider population level.
Our research explored the varied motives, characteristics (including the risk and protective factors) and the lived experiences of young people using NPS, ranging from ‘experimental’ type users who liked the buzz for a cheaper price compared to other drugs like cocaine or ecstasy, to the ‘dependents’ who needed help from health and social care services for their addiction to NPS and other substances.
We found that peer pressure, family breakdown, lack of parental supervision and support and limited awareness of the effects of NPS were important factors. But an overarching finding was that NPS were always used within a polydrug use context (using more than one drug at the same time) which had the ability to significantly heighten the effects of each individual drug and increase harm.
This wider background of multiple substance use, indicates the importance of looking at the bigger picture when considering the best way forward. To design appropriate treatment, the diverse and complex needs of NPS users needs to be understood to provide suitable interventions.
Developing treatment for different NPS users
Our findings reflect clinical guidance emerging from previous research evidence that interventions need to take into account the service users’ health and other additional issues when planning treatment of care. For example, Project Neptune - a network set up to respond to the challenges of NPS - highlights that a substantial proportion of users’ problems and behaviours were similar to those indicative of stimulant use and alcohol use.
So, rather than look for new ways to treat NPS, future treatment strategies need to look at the bigger picture – looking at what has been shown to work and adjust existing services to include tackling the issues concerning NPS. As our research linked individual characteristics with risk and protective factors, alongside different patterns of drug use, this has given us a guide to start matching up effective evidence-based interventions.
In the final ongoing stage of the research we are working with clinicians, users by experiences, drug and alcohol services providers and other academics to show how we might mould existing interventions, to suit individual circumstances. One of the main aims of this work will be to prevent people’s NPS use from becoming more problematic. The increasingly diverse and changing needs of NPS users require more complex interventions that can facilitate room for adaptation.
Targeting the right treatments
We are using our research findings to develop a tool – the Intervention Refinement Model (IRM) - that can help pinpoint the most suitable type of intervention for specific circumstances. It is crucial that we bring together a wide range of viewpoints from all those in the field of substance use treatment to ensure that the tool is both useful and relevant. This includes views from those who may be offered treatment for NPS use and those who will be delivering treatment.
We know that health is impacted by a diverse range of social, economic and environmental factors. These factors can be determined by several things that are not always in a person’s control such as where they live, level of education, income and level of access to other social resources. Therefore, not everyone will experience health outcomes equally, with some people facing greater hurdles across wider areas in life. That is why prevention programmes need to address the wider determinants of health. It is not enough anymore to look at drug use in isolation. All this calls for a more holistic approach to make interventions relevant for the overall health and wellbeing of the individual.
Variation and Determinants of Novel Psychoactive Substance (NPS) Use: Potential Implications for Policy and Practice' was funded by the NIHR’s Public Health Research (PHR) Programme. The full report is available to read on the NIHR Journals Library website.
More information on the study is also available on the NIHR website.
Dr Kathryn Higgins, Reader, School of Social Sciences, Education and Social Work and the Centre for Evidence and Social Innovation at Queen's University Belfast
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.