Cross Party Working Group on New Psychoactive Substances

4. Information Sharing

4.1 The CPWG examined the work being taken forward in relation to NPS and information sharing. Members heard from experts from NHS Greater Glasgow and Clyde, University of Glasgow and the Scottish Police Authority (SPA) who shared some of the challenges NPS present from an Accident & Emergency (A&E), toxicology and forensics perspective. In addition, the group reviewed a mindmap created by the Scottish Government that illustrated the complex relationship between stakeholders, information held and information shared.

Information Sharing within the NHS

4.2 The CPWG heard evidence from Dr Richard Stevenson, an Emergency Consultant from Glasgow Royal Infirmary, and Dr Hazel Torrance from the Toxicology Service at the University of Glasgow, who outlined the challenges NPS present to the NHS and work being taken forward to tackle these issues.

4.3 Technology to test for NPS agents does not form part of routine toxicology testing provisions within the NHS. Due to the changing nature of the market and the emergence of new substances, new analytical methods need to be devised and validated. This reinforced the need for a NPS Forensic Centre for Excellence to assist in the development of reference standards that the NHS could access.

4.4 There are challenges facing the NHS in capturing and sharing data on NPS. A key issue is that NHS Scotland patient recording systems do not currently include a code to capture NPS use. Collecting data on NPS prevalence and harms within the NHS is therefore limited. These problems are not restricted to Scotland, but are common across Europe and internationally, where the systematic collection of data on NPS in healthcare settings is scarce. In part, this reflects challenges in identifying NPS and the limitations of self-reported use, as well as the difficulty of establishing standardisation across different systems of data capture. Approaches to tackling these barriers to improved data collection are not straightforward, as data capture systems are influenced by local, national and international pressures.

4.5 Nonetheless, in Scotland, positives steps are being taken to improve information sharing through network building, educating clinicians and staff, and adopting a multi-agency approach, such as through Drug Trend Monitoring Groups. Within NHS Greater Glasgow and Clyde three hospitals are taking part in a study to identify NPS that have been consumed by those presenting at A&E Departments. The purpose of the study is to enhance the knowledge base of the use and impact of NPS locally. The findings will be disseminated both locally and nationally with a view to improving information sharing on NPS. However, while the CPWG noted this work was a step forward, more needs to be done at a national level.

4.6 Additional challenges faced by A&E departments are caused by users consuming NPS and consequently presenting in a manner typically consistent with severe mental health conditions. This can lead to a misdiagnosis of the patient and result in subsequent pressures on A&E and mental health professionals in managing the care of the patient.

Forensics

4.7 Barry James, Forensic Scientist from SPA Forensic Services, provided an overview of the SPA response to NPS. He explained that the increase in NPS cases began in 2008. This growing trend has continued and now represents a significant proportion of forensic casework. There are challenges in identifying through existing instrumentation whether a substance is controlled as many new drugs have a similar chemical structure which Gas Chromatography Mass Spectrometry (GCMS) struggles to identify without reference standards. To assist in the identification of NPS a Nuclear Magnetic Resonance (NMR) instrumentation was recently procured by SPA and the Scottish Government to enable the breakdown of and identification of previously unidentifiable NPS's. This will provide greater confidence in analytical results on NPS.

4.8 The SPA is a key stakeholder in sharing information about the substances present in Scotland with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The EMCDDA provides regular warnings and legislative updates to SPA and partners and in turn, SPA ensures this information is shared with appropriate stakeholders. This relationship is fundamental as it provides a robust evidence base to support decisions taken in relation to drugs and NPS.

Mindmap of Key Stakeholders

4.9 The Scottish Government presented a mindmap to illustrate to the CPWG the key stakeholders and the data and information being collected and shared on NPS in Scotland. This illustrated the complexity of the landscape and highlighted the gaps to be filled. A copy of the mindmap can be found on the Scottish Government website.

Consultation on the Forensic Centre for Excellence

4.10 In response to some of the issues raised above, a consultation on NPS had been shared with an extensive range of stakeholders through the NPS Evidence Group, and others, including the Crown Office and Procurator Fiscal Service, Border Force and the National Crime Agency. The consultation covered three of the recommendations of the NPS Expert Review Group, these included; the development of a definition of NPS; proposals to establish a Forensic Centre for Excellence; and improving data collection and information sharing of NPS. A summary of the results was published on 18 February 2016^[14].

Key Observations and Conclusions

4.11 In considering the evidence presented on information sharing the CPWG acknowledged the significant challenges in this area, particularly within the NHS and A&E. It was agreed that further work was needed to improve communication in relation to NPS across each of the health boards in Scotland to assist clinicians and staff to better understand NPS, raise awareness of symptoms of patients who may have consumed NPS and to share this knowledge across the healthcare profession.

4.12 It was also acknowledged by the CPWG that further work needed to be done to improve data collection within the NHS both at a local and national level. It was recommended that the Scottish Government build on the work commenced by the NPS Evidence Group and engage further with stakeholders to consider how to improve data collection on NPS for Emergency Department attendances and hospital admissions.

4.13 The CPWG noted the impact of NPS on mental health and the associated complexities. Further engagement with mental health professionals was recommended to better understand the challenges in relation to NPS.

4.14 The CPWG also noted the potential the NPS Forensic Centre for Excellence could bring to alleviate some of the pressures and gaps experienced by the health and justice sector, particularly in relation to improving data collection and sharing, and improving access to reference standards to assist in the identification of psychoactive substances. Progress on the development of the Forensic Centre for Excellence should be monitored on a regular basis to ensure this work does not lose momentum.