New PsychoactIve Substances - Evidence Review

7 Evidence Gaps

Key Findings

The following are needed in order to inform future policy responses to NPS (both in Scotland and more widely):

• A full assessment of what is known about the scale and patterns of NPS use.
• Exploration of the nature of the relationship between the new drugs market and the established market in controlled drugs.
• An examination of the short and longer term health impacts of using NPS, and other outcomes.
• A systematic review of the outcomes of the various control systems.
• Analysis of how current interventions to prevent substance misuse and harms may be used for NPS, and consideration of possible new approaches.
• Evidence of what constitutes appropriate psychosocial treatment for NPS users.

7.1 Despite recent concerns about the growth in the number and use of NPS, there remain significant gaps in our knowledge about these drugs that need to be addressed to inform future policy responses. The need for further research into NPS was highlighted in the 2011 report of the Advisory Committee on the Misuse of Drugs, and reflected in the Action Plan of the UK Government's 2012 Annual Review of the Drug Strategy. In terms of more specific information gaps/ research needs, the following are identified in the literature:

Prevalence of use

7.2 There are large gaps with regard to prevalence data which need to be addressed to improve the basis for decision making (UNODC, 2013b). An assessment is needed of what is known about the patterns of use of NPS in the UK, including the scale and types of use, demographic patterns of use, predictors of use, motivations and pathways to use, use with other substances, settings of use, concurrent health-related and other behaviours, and outcomes of use, particularly of acute harm or toxicity, and dependence. It is important, where possible, that self-reported use should be confirmed with objective measures (e.g. wastewater analysis (Archer et al, 2012) and data from Accident and Emergency records/ poison information services , with content of NPS confirmed with analytical data (NIHR, 2013).

Supply

7.3 There is a need to analyse and respond to the interplay between the new drugs market and the established market in controlled drugs (EMCDDA, 2013a).

Health and other implications

7.4 Research on the health implications of most NPS is very limited. The ACMD (2011) recommended that resources are provided for research on the chemistry, pharmacology, acute harm (toxicity) and social harms of NPS. There are no comprehensive scientific studies on their toxicity and most studies are based on work in animals, fatal poisonings in humans, or observations in intoxicated patients. Toxicity, abuse liability and risks associated with long term use in particular remain unknown. Further research is needed on the short and long term health risks and addiction potential of these substances (UNODC, 2013a).

7.5 Regular data and information are needed from a range of sources (including GPs, drug services, the ambulance service, Emergency Departments, in-patient wards, NRS death records) to understand the characteristics of those using and suffering adverse health consequences, as well as trends in NPS used and how they are used (Corkery, J., 2013). However, there is an issue with data not being routinely collected by these sources, or in a standardised way. Often these problems are caused by a lack of local resources to collect the data, the absence of protocols, legal/ ethical issues about sharing data between agencies, and insufficient resources for those investigating NPS characteristics - neurobiologists, pharmacologists, toxicologists, etc; and those monitoring adverse health consequences (Corkery, J. 2013).

Regulation

7.6 A systematic review of the outcome of various systems should be made with a view to improving the control system at the international level (UNODC, 2013b). The Home Office is currently leading a review of the UK's legislative response to maximise its impact and improve the operational response to the NPS market. This will draw on expertise from law enforcement, local authorities, academia, media and social science. The review will be informed by international approaches as well as other evidence, and is due to report in 2014.

Prevention and Treatment

7.7 Analysis is required of how current interventions to prevent substance misuse may be used for NPS, and consideration of possible new approaches (NIHR, 2013).There is also limited information on what constitutes appropriate psychosocial treatment for this group. (EMCDDA, 2012). There is also a need to better understand how to deal with users who become unwell in recreational settings and when to call an ambulance (EMCDDA, 2012). The NIHR (2013) states that there is a need to bring together current knowledge, possibly supplemented with further research, to build understanding of different target populations for interventions. Possible interventions, and approaches to preventing uptake and reducing use and harm of novel psychoactive substances should be considered.