New Psychoactive substances (NPS): results of a questionnaire on the definition of NPS, proposals to establish a forensic centre for excellence, and improving data collection and information sharing

4. Identifying and detecting NPS

4.1 The functions of a Forensic Centre for Excellence

In the second section of the questionnaire, stakeholders were asked about potential functions of a Forensic Centre for Excellence. It was noted that this could be embedded as part of (or distinct from) any infrastructure put in place by the UK Government as part of arrangements to implement the Psychoactive Substances Act. Possible functions included in the questionnaire were:

• leading on the forensic detection and identification of NPS amongst agencies where testing relates to a criminal or potentially criminal case
• testing for psychoactivity by establishing the effects of substances on the central nervous system
• making links between identification of NPS and potential harms and treatment
• leading on developing national reference standards
• linking in with other data sharing systems, for example the UK Forensic Early-Warning System (FEWS) and the Welsh Emerging Drugs and Identification of Novel Substances Project (WEDINOS)^[8]
• acting as a central resource for enforcement agencies, and potentially the NHS, by sharing information with relevant partners and services, for example on emerging trends.

The vast majority of respondents (45) agreed that these functions would address the most pressing gaps in knowledge about NPS (Figure 4).

Figure 4: If a Forensic Centre for Excellence carried out the functions suggested in Section 4.1, it would address the most pressing gaps in knowledge about NPS

Thirty-two respondents provided further detail, or made suggestions about other opportunities that could be capitalised on that were not covered by the original proposals. The key themes from these responses are presented below.

Priorities: enforcement and health

The importance of a Forensic Centre for Excellence in terms of enforcing the Psychoactive Substances Act was mentioned by four respondents. In addition, the need to link forensic testing of specific NPS with information on harms, and ultimately treatment for people using NPS, was strongly emphasised by 16 respondents:

"Working collaboratively with the NHS should be integral to [forensic testing]…the drive for our better understanding of NPS should not be confined to the purposes of prosecution but [also] to support improving the general health of the public" (health organisation).

Testing for psychoactivity

Seven respondents raised concerns about the process of testing for psychoactivity, and how this testing would be carried out. There were questions about whether this would require phase I or II clinical trials, and whether testing for psychoactivity in terms of effects on the central nervous system could be carried out using the same laboratory analysis facilities needed to identify particular compounds. The point was also made that it was important to clearly distinguish between bulk drug analysis and toxicology, given the different expertise required. One respondent also noted that in order to pursue a successful criminal conviction, it might be necessary to augment information about psychoactivity with expert testimony about the effects and harms caused by ingestion of an NPS from a clinical toxicologist.

Practical issues were also raised, for example whether a single facility would be capable of delivering all of the proposed functions. In particular, whether testing for psychoactivity in terms of effects on the central nervous system could be carried out using the same laboratory analysis facilities needed to identify particular compounds.

Importance of building on existing structures

The issue of resources was also raised by three respondents:

"It would be good to have investment in substance misuse but the question should be asked about whether current structures could be built on to do this work" (health organisation).

It was suggested that it might be more cost effective to incorporate the proposed functions into existing arrangements, rather than "reinvent the wheel" (enforcement organisation). An additional benefit cited was that this could help to ensure a more integrated approach to NPS and other substances.

"The wider drug related harm in Scotland does not come from NPS. I would wonder whether the Centre should look at wider drug harms too" (health organisation).

Other potential functions

Other potential functions of a Forensic Centre for Excellence that were proposed included:

• providing harm reduction advice to professionals and the public (2 respondents)
• an alert function (4 respondents)
• education and support for other laboratories or teaching students at University level (2 respondents)
• a strong research capability (3 respondents)
• a source of drug reference standards to enable testing in other laboratories (2 respondents).

4.2 Capacity amongst stakeholders to support a Centre for Excellence

Stakeholders were asked whether they would be able to deliver or support functions such as the identification and detection of NPS, testing for psychoactivity, making links between identification of NPS and potential harms and treatment, or linking in with other data sharing systems. Fifteen respondents said yes, 17 said no, and 14 did not know (Figure 5).

Figure 5: Would your organisation be capable of delivering any of the potential functions suggested above?

Of those who said 'yes' or 'don't know', 16 gave further information about the different types of support they could offer. This ranged from chemical analysis including isometric ID and toxicology analysis, to collating local intelligence to feed into a central hub of information. See Table 2 below.

Table 2: Organisations and type of support that could be provided for identifying and detecting NPS^[9]

Organisation	Type of support
Forensic Toxicology Service, University of Glasgow	We currently carry out research into identifying NPS substances causing harm. The Head of School of Chemistry at UoG and possibly other Universities across Scotland may be interested in synthesising reference standards. There are well established research groups in Universities which we should make the most of.
Pathology Service, Forensic Medicine and Science, University of Glasgow	Forensic Pathologists could potentially advise on potential harms of NPS
National Poisons Information Service	Linking with harms
Scottish Police Authority	Chemical analysis including isomeric ID; tox analysis
Scottish Prisons Service	Working collaboratively with key stakeholders SPS could play its part
NHS and Alcohol and Drug Partnerships (4 responses)	Collating local intelligence and information to share with a Centre for Excellence (e.g. collating user feedback on the effects of the substances consumed) Issuing and marketing customised harm reduction advice based on forensic analysis
Scottish Families Affected by Alcohol and Drugs	We already provide information to ADPs and Police Scotland at a national level and would continue to contribute
Royal Pharmaceutical Society	Some of our members are substance misuse specialist pharmacists who would be capable of inputting expertise into any national standards and must be included in any expert working groups
NHS Health Scotland	NHS Health Scotland could support the forensic centre in disseminating information & learning - potentially through existing mechanisms we could share best practice and contribute emerging evidence, and could support via ADPs and other agency relationships to facilitate knowledge sharing and planning.
Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee	CAHID is one of the leading centres for Forensic Science research in Europe. We produced the United Nations recommended methods for the testing of cathinones, one of the main chemical templates for NPS. We hold a Home Office license allowing us to synthesise and characterise NPS materials which will create the required database of compounds. Moreover we have the technological capabilities to fully chemically characterise the resultant compounds and have a strong track record in this regard. This coupled with cutting edge technologies in neurotoxicity and medicine through Ninewells hospital can lead in the understanding of the short and long term health implications of NPS. CAHID has strong collaborative links with the SPA Forensic Science, Police Scotland, UNODC and EMCDDA, the US DEA and Law enforcement agencies across Europe, South East Asia and China and as such has a global perspective of the challenges of NPS, their international trafficking and the challenges they pose. CAHID staff have acted as expert witnesses for the courts including in the analysis and characterisation of controlled substances.
WHO Collaborative Centre for International Child and Adolescent Health Policy, University of St Andrews	Our WHO Collaborative Centre for International Child and Adolescent Health Policy would be able to assist in survey work with NPS questions in research projects, especially with young people.
CREW 2000	By acting as a central, trusted resource for housing agencies, GPs, care staff, looked after children and young people staff, youth professionals and school staff by sharing relevant information on harm reduction and sources of help…by linking in with e.g. FEWS, DEWS and TIC TAC

4.3 Key priority areas for submitting NPS samples for identification

In the questionnaire, the Scottish Government proposed a list of organisations that could potentially submit samples of NPS for testing. This included:

• Police Scotland
• Crown Office and Procurator Fiscal Service (live and post-mortem toxicology)
• Scottish Prison Service
• Local Authority Trading Standards Services
• Border Force

Respondents were asked if these should be the key priority areas for submitting NPS samples for forensic testing. The majority agreed with the proposed list (42 out of 52 respondents who answered this question). Enforcement stakeholders in particular emphasised the importance of prioritising any forensic testing to identify NPS for the purposes of prosecution, given that criminal proceedings could not be raised until there is sufficient evidence. However seven individuals disagreed that these should be priority areas (Figure 6).

Figure 6: The organisations listed [in Section 4.2] should be key priority areas for submitting NPS samples to a Forensic Centre for Excellence

There were different reasons given by those who disagreed. Two respondents disagreed on the basis that it was not necessary for all of the proposed organisations to submit samples for testing. It was argued that existing processes for post mortem toxicology analysis were already in place, making it unnecessary for these samples in particular to be submitted to a Centre for Excellence. It was also suggested that more support could be given to toxicology labs within hospitals to conduct toxicology testing. In contrast, four respondents who disagreed did so on the basis that greater priority should be given to testing samples from NHS organisations, including mental health services. One respondent also suggested that informal networks should be targeted as they would be more likely to produce samples than the organisations listed.

Respondents were also asked whether in addition to the organisations listed above, NHS Emergency Departments should also be able to submit biological samples for testing. There were high levels of agreement, with 44 respondents agreeing and three disagreeing (Figure 7).

Figure 7: In addition to the organisations listed in Box 1, NHS Emergency Departments should also be able to submit biological samples for testing

Twenty-eight respondents provided further details of other organisations that would represent priority areas for submitting NPS samples for testing. These are discussed below.

Health and drug treatment services

Responses to the open question about organisations that would represent priority areas reinforced the strong support for health and treatment services being able to submit samples for identification^[10]. This point was raised by 17 respondents. It was argued that this could potentially increase the pool of substances tested and knowledge of these. In turn, respondents felt that this could accelerate learning, and be used to issue alerts and harm reduction advice, as well as increasing understanding of clinical effects of specific substances. This would be particularly beneficial if a substance was linked to a critical incident. However, two respondents also noted the potential illegality of agencies seizing or holding substances in order to submit them for analysis, and queried whether this would preclude agencies such as third sector substance misuse services from doing this.

Members of the public

Five individuals suggested that there should also be a public access mechanism for submitting samples:

"We understand the risk management implications for the public and Government, however we see value in offering a public access mechanism for collecting NPS e.g. like WEDINOS" (third sector organisation).

In addition, it was suggested that the National Crime Agency and local authorities could potentially be added to the list of organisations that could submit samples.

4.4 Collecting data on harms associated with NPS

In relation to the issue of collecting data on harms associated with NPS, the questionnaire asked if it would be useful if NHS Emergency Departments captured and held data on harms associated with specific NPS. Forty-nine respondents agreed, and no respondents disagreed (although one neither agreed or disagreed, and two did not know) (Figure 8).

Figure 8: Where possible, it would be useful if NHS Emergency Departments captured and held data on harms associated with specific NPS samples

Thirty-five respondents provided more detail about how this could work. Key themes are presented below.

Improving data capture systems

Nine respondents raised the issue of NHS Scotland patient recording systems, which do not currently capture NPS related attendances at Emergency Departments:

"This would require changes to national coding systems. [It is] currently very difficult to obtain any reliable data on drug or alcohol use never mind NPS from systems" (health organisation).

However, eight respondents flagged up potential challenges to improving data capture on the harms associated with specific NPS samples. These challenges can be summarised as follows:

• The need for refinements to data capture systems
• The need to coordinate data collection within and across services and health boards
• Getting buy in from already stretched Emergency Department services
• The need for increased resources/capacity within Emergency Departments for staff to capture this information
• Recognition that currently obtaining information about proscribed drugs and alcohol from Emergency Department presentations is also difficult, regardless of the specific issues relating to NPS
• Gaps in knowledge about some NPS and their effects on different individuals
• The challenge of knowing whether symptoms are NPS related or not.

Building on existing processes

Practical suggestions were made about how these data could be captured by building on existing processes, for example as part of the Identification of Novel Psychoactive Substances (IONA) project^[11] or replicating processes for biochemistry investigations, which require clinicians to record symptoms when requesting analysis of samples. Three respondents suggested that any data on harms could be shared with the National Poisons Information Service TOXBASE database^[12], or the Medicines Information database.

The importance of appropriate information governance arrangements

It was stressed that appropriate information governance structures would need to be in place if these data were to be collected and shared. It was also suggested that there would need to be a national directive to ensure that protocols and procedures were consistent across different services.

4.5 Sharing data on harms collected in NHS Emergency Departments

Following on from this, the questionnaire also asked whether (once anonymised) data on harms relating to specific NPS should be shared with other stakeholders. As shown in Figure 9 below, there were high levels of agreement, with 50 respondents agreeing. One respondent neither agreed or disagreed, one did not know, but none disagreed.

Figure 9: Once anonymised, these data on harms relating to specific NPS should be shared with other stakeholders

Thirty-seven respondents provided more detail about the specific stakeholders that would benefit from sharing data on harms relating to specific NPS. A wide range of suggestions were made, including health, enforcement, third sector, local authority stakeholders and members of the public amongst others. A full list is provided at Annex B.