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

5. Improving information sharing

Respondents were asked if they were aware of data or information being collected or shared on NPS that was not already represented in a mindmap attached as an annex to the questionnaire. A number of additional data sources were mentioned, ranging from local NHS services to international networks. An updated mindmap incorporating this information is provided at Annex C.

The next section of the questionnaire asked a series of questions on improving information sharing on NPS. In relation to forensic analysis of samples of suspected NPS, the following information was identified as being most useful to stakeholders.

5.1 Content of information

Contextual information relating to a sample

• Name of substance (including street name)
• Packaging/branding information
• Photographic details of substance and packaging
• Date of sample
• Geographical location of sample
• Demography of user
• Usage/dose consumed (if known)

Forensic identification of a sample

• Forensic identification of substance (linking brands with psychoactive ingredients)
• Purity of substance tested/potency and 'dangerous' levels
• Half-life
• Contaminants identified
• Chemical analysis and characterisation

Effects of a sample

• Specific effects related to the substances, need to be certain on isomeric form
• Effects on central nervous system/clinical effects
• Presenting symptoms/harms (physical and mental) - "this could be presented on the front page of TOXBASE for users to see" (individual)
• Contra-indications with other prescribed drugs
• Long term harms
• Information regarding dosage
• How substances are taken (e.g. use of cutting agents)
• Harms and dangers from any use and particularly when mixed with other medicines or other substances
• What to expect from behaviour of those under the influence
• Drug type by effect and associated harms

Information needed following identification of a sample

• Guidance on treatment pathways
• Harm reduction information
• Regional and national trends: availability of specific substances, and information on what substances are being used in what areas at what time, current local drug seizures
• Frequency of submission of particular substances (for implied prevalence), amongst younger age groups especially
• Legislation a substance is controlled under/legal status
• Linking up with other data sources - are there other reports of its use? (e.g. drug seizures/live toxicology)
• Availability of reference standards for a specific substance
• Are there any reference spectra available?
• Links to support services
• Alerts

5.2 Frequency of information sharing

There were a range of views about how frequently stakeholders would want to receive or access this information, and some stakeholders provided more than one response. The majority however indicated that it would be most useful to receive or access this information on a monthly basis (19 responses), followed by 'in response to critical incidents' (14 responses), quarterly (11 responses), and annually (four responses). Five respondents also thought it would be helpful to have constant or 'live' access.

5.3 Format of information sharing

It was suggested that links could be made with Toxbase, the service provided by the National Poisons Information Service:

"Link-up with TOXBASE so that clinicians had ready access to the latest advice on identification and treatment of patients" (health organisation).

The need to link in with schools was also mentioned by one respondent:

"A national electronic curriculum resource disseminated via Education Scotland and co-developed with young people…could equip teachers with more knowledge and confidence in developing early intervention and prevention work to better meet the challenges posed by NPS" (third sector organisation).

Other suggestions for disseminating information generated by forensic analysis included:

• A shared database or electronic portal (with restricted log in) or public facing website, frequently updated
• Phone line for direct enquiries
• Email (e.g. newsletter) and available to download
• Simple alerts/bulletins using picture and summaries as being done currently by Police Scotland - dissemination could be done jointly with current Police Drug alert bulletins
• Publications of reports
• Press publications
• Seminars
• Development of a smartphone app
• Considering good practice and lessons learned from FEWS and WEDINOS together with ADP and Police Scotland drug alerts and information sharing protocols already in place.

It was also suggested that different stakeholders may need different formats or levels of access to information, depending on their needs.

5.4 Alerts and warnings

The questionnaire asked stakeholders whether it should be the role of a Forensic Centre for Excellence to manage and disseminate alerts on new and potentially harmful NPS. Forty-nine respondents agreed, one neither agreed or disagreed and two did not know (Figure 10).

Figure 10: It should be the role of a Forensic Centre for Excellence to manage and disseminate alerts on new and potentially harmful NPS

There were 24 responses that provided further detail about the management and dissemination of alerts on new and potentially harmful NPS. The key themes are summarised below.

Coordination role

Responses highlighted the need for a two way process of information exchange, involving local partners feeding information in to a Forensic Centre, as well as coordinated outputs (four respondents). It was also argued that by coordinating information and improving communication, a Forensic Centre for Excellence could reduce 'disinformation':

"It is disturbing for families and unhelpful for authorities for wild speculation and assumption to occur following a drug related death" (health organisation).

Timing of alerts

The issue of timing of alerts was also raised by two respondents, in relation to the potential delay between information being received and subsequently issued. Another respondent identified that there was potential to share detailed toxicology and autopsy information with National Records of Scotland to allow better interpretation of mortality data. However, it was noted that this would require sign-off from the Crown Office and Procurator Fiscal Service, and that there would have to be caveats around the significance of a substance in the cause of a death.

Sharing information with members of the public

There were different views about whether information on alerts should also be issued to members of the public. Two respondents suggested that information could be disseminated via public information websites. However, four respondents urged caution about releasing information to members of the public:

"We have noticed that mass media coverage of a particular substance, even if it's connected to a death, can drive curiosity and use of the substance, thereby increasing the potential for harm. It would be extremely important to ensure that alerts were managed sensitively and appropriately" (third sector organisation).

Quality control of information disseminated

Practical issues about quality control were also raised by three respondents. It was noted that ADPs often encounter information about NPS from various sources. However, it was argued that it could be challenging to assess whether or not this information should be disseminated due to:

• A lack of confidence in the veracity of the data
• Lack of confidence about whether the data is relevant to a local area
• Concern about the workload and risk of fatigue from too many reports
• Concern about 'so what' questions - i.e. what do we expect services to do with this new information? How might it change their practice?
• Concern about not accurately reflecting local situations, and 'normalising' NPS use if messages are exaggerated.

Building on existing systems and processes

Seven respondents also highlighted the need to build on existing systems or processes. This included dissemination of alerts in collaboration with NHS, National Poisons Information Service, Police Scotland, organisations such as Health Protection Scotland, and in line with wider UK and international arrangements.

In addition to these themes, two respondents also raised concerns about a focus on NPS distracting from other issues of concern, and suggested that any alert system should be for all substances of misuse and not restricted to NPS only:

"Ultimately alcohol and illegal drugs are the greatest concern in Scotland and we must be careful not to generate an unnecessary moral panic about NPS that diverts attention away from alcohol and other drugs" (health organisation).