'Legal Highs or Legal Killers' Conference Presentations

Legal highs or legal
killers?
Tackling the spread of New
Psychoactive Substances

Tackling the spread of New Psychoactive
Substances
Welcome & introduction from the chair
Michael Lawrence, CRI

Substances
Doing nothing is not an option: a parent’s
perspective
Maryon Stewart, Angelus Foundation

PARENT’S PERSPECTIVE
MENTOR CONFERENCE
Nottingham Conference Centre – 18th September
2014
Maryon Stewart
Founder of The Angelus Foundation

Focus Groups and Surveys
Our schools programme was delivered to over 1,200 young
people
Our data shows:
Before viewing the film 50% of young people believe legal
highs are not safe at all to not safe
After viewing the film 91% of young people believe them to
be not safe at all to not safe
96% of young people said that watching the film has put
them off experimenting with legal highs
71% expressed feelings of being misled by so-called
“legal” highs

25 Festivals blackout their website

The Real Deal
• Online challenge - The Real Deal
www.yourvine.com/realdeal

Parent’s Films
Website for parents:
www.angelusfoundation.com
To download parents handbook:
http://www.angelusfoundation.com/parents-handbook/

Contact details
www.angelusfoundation.org
www.whynotfindout.org
Email: contact @angelusfoundation.com
Or
maryonstewart@angelusfoundation.com
Tel: 02037007185
Mobile: 07973713139
Angelus Foundation is a registered charity
(number 1139830)

Substances
A brief tour through the world of legal
highs
Ricky Bhandal, Public Health Birmingham

A VERY Brief Tour Through The World Of Legal
Highs: What challenges Do They Pose?
Ricky Bhandal
@ranjitbhandal
Ricky Bhandal
Birmingham Public Health
Ricky.Bhandal@birmingham.gov.uk
Copyright Ricky Bhandal
Please do not reproduce without permission

Ricky Bhandal
@ranjitbhandal
Legal Highs, is it new?

Ricky Bhandal
@ranjitbhandal

Ricky Bhandal
@ranjitbhandal
Definitions: NPS, legal highs, club
drugs
• ‘New psychoactive substances’ (NPS) are drugs which mimic, or are claimed to
mimic, the effects of illegal drugs. They are either ‘new’ or ones that until
recently were little used in the UK.
• ‘Legal highs’ – see above. Although marketed as legal, this doesn’t mean that
they are safe or approved for people to use. They are still normally considered
illegal to sell under medicines legislation. Some drugs marketed as legal highs
actually contain some ingredients that are illegal to possess.
• ‘Club drugs’ is a collective term for a number of old (e.g. ecstasy, ketamine,
methamphetamine and GHB/GBL) and new drugs (e.g. mephedrone) typically
used by people in bars and nightclubs, at concerts and parties
• ‘Blah, Blah, Blah’: All these terms are often used interchangeably even in official
reports

Ricky Bhandal
@ranjitbhandal
My History
NPS That have made it

Ricky Bhandal
@ranjitbhandal
Mephedrone

• BZP Benzylpiperazine – De-worming for animals
• MPTP - Parkinson's
• Neo Dove 3
• Neo Malt
• Methadrone – Similar to Mephedrone
• Khat
• MDPV – focused > Cocaine > annoying
• Methylone (M1) – More Ecstasy feel £16 and £20 per gram
• Butylone – Similar to other Cathinones
Ricky Bhandal
@ranjitbhandal
Past / Present Topical Legal Highs

Ricky Bhandal
@ranjitbhandal
Google Trend

Ricky Bhandal
@ranjitbhandal
Google Trends

Ricky Bhandal
@ranjitbhandal
The Perfect Storm
Profit
Users
Experiment

Ricky Bhandal
@ranjitbhandal
And don’t forget the media!

Ricky Bhandal
@ranjitbhandal
Google Drugs

Ricky Bhandal
@ranjitbhandal
Do it Yourself

Ricky Bhandal
@ranjitbhandal
NRG-1 Prices
•1 grams - £20
•2 grams - £30
•10 grams - £100
•100 grams - £550
•500 grams - £1500
•1kg - £2800

Ricky Bhandal
@ranjitbhandal
Herbal Highs

Ricky Bhandal
@ranjitbhandal
Raz in Detail

Ricky Bhandal
@ranjitbhandal
Mary Jane

Ricky Bhandal
@ranjitbhandal
New Website

Ricky Bhandal
@ranjitbhandal
All about Recovery!

Ricky Bhandal
@ranjitbhandal
JWH-018

Ricky Bhandal
@ranjitbhandal
Lets Buy Some!

Ricky Bhandal
@ranjitbhandal
Who’s to blame? Social Media
• Twitter
• Facebook
• Youtube
• Erowid
• Bluelight
• Drugs Forum
• http://youtu.be/VMZngerFxjs

Ricky Bhandal
@ranjitbhandal
Silk Road

Ricky Bhandal
@ranjitbhandal
Dark Net

Ricky Bhandal
@ranjitbhandal
Agora

Ricky Bhandal
@ranjitbhandal
Headshops

Ricky Bhandal
@ranjitbhandal
New psychoactive substances –
stocktake
• New psychoactive substances (NPS) are emerging at an unprecedented rate, though
treatment numbers are small
• NPS (typically sold as ‘legal highs’) may contain substances that are not legal or even
safe. The availability of these substances, especially over the internet and in
‘head shops’, has radically changed the nature of the drugs market.
• UK purchases 4 x more NPS than any other European country (EMCDDA 2012)
• Increasing public and government concern
• Heavy use can lead to acute health harms and dependency
• Little information on new NPS and their associated health risks – surveillance
data takes time to catch up
• Problems can be treated, but treatment/GUM services need to be vigilant and
adapt
54

Health risks and dependence-forming
Ricky Bhandal
@ranjitbhandal
potential
• Users also tend to binge on NPS. As a result, they are more likely to
show up at A&E or their GP surgery reporting acute health effects such
as heart irregularities or feeling paranoid.
• Evidence suggests a minority will use compulsively and develop a
psychological dependence that requires treatment. We don’t yet
understand why some people develop problems and others don’t
• NPS can kill, very risky when used with alcohol/other sedatives.
• Injecting: NPS mostly not injected, but increasing concern about the
injection of mephedrone and methamphetamine
• Heavy use can develop into a dependency

Ricky Bhandal
@ranjitbhandal
Treatment
• Treatment should typically involves psychosocial interventions, which
address basic motivation and prevent relapse.
• Promote reliance on core drug working competences, dealing with the
individual and HR advice that fits the main 'clusters' of drugs (e.g.
encourage services to focus on people not the drugs they are using)
• Support improvements in needs assessment, commissioning and provision
for NPS
• Commitment to disseminate NPS clinical guidelines (NEPTUNE)
• Encourage better links between treatment, health and sexual health

Ricky Bhandal
@ranjitbhandal
6 Ways to Deal with NPS
• Acknowledge ignorance
• Work symptomatically
• Share Knowledge
• Cluster Drugs
• Keep sight of skill sets
• Get tech savy

Ricky Bhandal
@ranjitbhandal
Both sides of Ignorance

Substances
Open forum for questions
followed by coffee

Substances
Integrating legal highs into wider education &
prevention interventions
Professor Harry Sumnall
Liverpool John Moores University

Substances
The role of the criminal justice system
D.Supt. Jason Hudson, TITAN

Substances
Open forum for questions
followed by lunch

Substances
Public health messages & working with
young people
Andrew Brown,Drugscope

NPS Education
and Prevention
A tricky balance
Photo by Flickr user stephenjohnbryde

Awareness, knowledge and general attitudes
towards “legal highs” amongst UK students
• Survey of 446 students
between ages of 13 and 30 in
UK (mean age 19, median 18
years) carried out online, late
2010.
• 82% said they had heard of
‘legal highs’, of which 79%
offered correct definition (5%
wrong)
• 31% lifetime use
– 41% mephedrone,
– 20% salvia,
– 11% ‘spice’,
– 16% “don’t know”
• Over half (51%) knew ‘some’
contain illegal or controlled
components
• Three in four (74%) said they
didn’t consider them safer
than illicit drugs
• Of those who had used a ‘legal
high’ over half (53%) said the
legal status makes no
difference to their likelihood
of using the drugs, one in four
said it would make them less
likely to use, and 4% said it
would make it more likely.
Source: Corazza, O. et al. “Legal highs”: safe and legal “heavens”? A study on the diffusion, knowledge and risk awareness of novel
psychoactive drugs among students in the UK, Riv Psichiatr 2014; 49(2): 89-94

What do we know about young
people’s use of NPS
• Crime Survey for England and
Wales found young adults,
aged 16 to 24:
– 7.6% had taken nitrous oxide in
the last year
– 1.8% had taken salvia in the
last year
• Global Drug Survey
– 20.4% had taken nitrous oxide
in the last year
– 10.9% had taken ‘mystery
white powder’ in the last year
– c.13% said they had taken a
legal high/research
chemical/synthetic cannabis &
electronic THC Photo by Flickr user Yaniv Golan

Young People in Treatment for ‘Club
Drugs’
2500
2000
1500
1000
500
0
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
Ketamine Ecstasy Mephedrone
Source: Young People’s Statistics from the National Drug Treatment Monitoring System (NDTMS), Public Health England (2013)

DrugScope’s Street Drug Survey 2013
• Mephedrone-type stimulant drugs were popular with older teenagers;
• Younger teenagers were more attracted by the synthetic cannabinoids substances
with lurid names such as Clockwork Orange and Exodus Damnation;
• Few young people bought drugs online, but were able to buy not only from head
shops, but a range of high street outlets including petrol stations and take-away
food shops, especially in the north of England;
• While few young people were coming forward to treatment services, outreach
workers told a different story about patterns of use and of young people at risk of
serious health consequences.

But remember it’s
NOT JUST ABOUT YOUNG PEOPLE
Other groups and settings to think about:
• LGBT – especially MSM
• Complex needs clients (mental health,
homelessness, criminal justice
• Prisons
• Students
• Clubs & some clubbers

WHAT SHOULD WE DO?
Photo by Flickr user Ian Page-Echols

A life course approach
Source: Davies, S.C. “Annual Report of the Chief Medical Officer, Volume One, 2011, On the State of the Public’s
Health” London: Department of Health (2012)

And for NPS specifically?
• Increase our understanding of prevalence
– use, harms and at risk groups
• Ensure NPS covered in wider personal social and
health education
• Think beyond schools and universities
– Environment, Community, Family, Workplace
• Tailored messages to reduce harms
• Develop and learn from evidence
• Understand routes into specialist services

And things we might want to avoid
• Messages that focus on the most extreme
outcomes
– May work for least likely to use, but it boomerangs
for contemplators and dabblers
• Harsh and inconsistent punishment
• Knowledge on its own
– Skills and character essential

Thank you
Andrew Brown
Director of Policy, Influence and Engagement
DrugScope
@andrewbrown365
andrewb@drugscope.org.uk
www.drugscope.org.uk

Substances
The Club Drug Clinic
Dr Owen Bowden-Jones

Substances
Quick tea break

Substances
Working towards a safer nightline
Marc Blanchette
B Chilled – Phoenix Futures

B-Chilled
‘Supporting a Safer Nightlife in Birmingham’

B-Chilled
The B-Chilled team
Marc Blanchette - Community Health Champions Project Manager
Olivia Hemsoll – Outreach Support Worker
The project is also supported by a large group of Community Health Champion volunteers who
are selected and trained especially for the service

B-Chilled
Background to B-Chilled
There has been a decline in the traditional treatment cohort of heroin and
crack users, and a rise in the use of ‘club drugs’, ‘legal highs’, ‘recreational’
or ‘party drugs’.
This has highlighted fresh challenges to those involved, and working, in the
night-time environment and traditional treatment services, as a result there
has been a need for new approaches to tackle these changes.
In response, Phoenix Futures working in partnership with Public Health
England, developed the Community Health Champion’s B-Chilled Project. The
project’s aims are also supported by Birmingham City Council and the West
Midlands Police.
Since the project’s commencement it’s remit has widened to include
alcohol, sexual health and personal safety.

B-Chilled
The identified areas of focus of the B-Chilled project are:
• Digbeth
• Southside (Arcadian and Hurst Street)
• Northside (Broad Street)
B-Chilled provide the following services:
• Club & Pub Interventions – providing harm reduction guidance to help people
access information, support and advice on recreational drugs, alcohol, sexual health
and personal safety.
• Superclub & Festival Work – creating ‘Chill-Out Spaces’ and providing welfare
and harm reduction services to help people access drug information, advice and
immediate support.
• Health & Community Fairs – providing information stalls at open days and
community events.

B-Chilled
B-Chilled Volunteers
•Volunteers are known as Community Health Champions
•We have 70 trained volunteers so far, with more coming through
•Volunteers undertake a minimum of 16 hours intensive training in drugs,
alcohol, sexual health and outreach & engagement skills
• Volunteers are supported and supervised by paid staff whilst delivering
outreach sessions
• Longer term volunteers are now taking on the role of Lead Volunteer
and will soon be supervising teams themselves

B-Chilled
How does B-Chilled operate?
• Outreach sessions in clubs & pubs, community events and festivals
• Professional, friendly, relaxed and experienced outreach teams
• Targeted interventions – drugs (particularly ‘legal highs’), alcohol, safe
sex, personal safety
• Quality referrals into treatment providers & ongoing support – one to one,
telephone, via social media

B-Chilled
How does B-Chilled operate?
• A regular outreach sessions in NTE
• ‘Chill Out’ space in venues
• Works with Universities and Student Guilds
• Partnerships with key NTE stakeholders
• Brief interventions & quality referrals
• Via training and on-going support from
the B-Chilled project, venue managers
and event promoters can better prevent
and manage drug related incidents.

B-Chilled
B-Chilled benefits venues in Birmingham's
night time economy by providing....
• Free service
• Proactive approach to customer safety
• Staying up to date with changing drug trends
• Extra staff who contribute to monitoring and maintaining safety
• Enhancement of customer experience in Birmingham's NTE
• Prevention or reduction of incidents and risk
• Confidentiality
• Assistance in developing a bespoke and workable drugs policy
• Training for door and venue staff
(Source:http://www.safernightlife.org/pdfs/digital_library/uk_safer_nightlife_guideline.pdf)

B-Chilled
Training for Professionals
The project offers up to date in-depth training around drug use
aimed at professionals who work within the night-time economy.
These include:
• Door supervisors
• Security Staff
• Bar and club staff
• Club and pub managers
• Event/club promoters
• Street & Taxi Wardens

B-Chilled
Training for Professionals
The training covers:
• The rise in use of ‘Legal Highs’ and other new drugs
• Descriptions of products that are used to bypass current legislation
• Recent changes in legislation with regard to these emerging substances
• An over view of the effects and risks posed by the use of new drugs and
other legal substances
• Statistics on current usage across the UK
• Developing workable drug policies to help deal with the use of these
substances in clubs and pubs
• Responding to emergencies that involve the use of these substances
The training can give workers valuable information to help them understand the issues and engage
with clubbers. This will help reduce the risks posed to them by their use of substances whilst out
enjoying the night-time economy. Ultimately this intervention could even save lives

B-Chilled
Club Drugs/NPS
• Anything used to “party” – pubs, clubs, parties, raves,
festivals, events, private
• Not ‘traditional’ drug service presentations (e.g. heroin and
crack)
• Established drugs: ecstasy, cocaine, ketamine, speed, crystal
meth
• Newer drugs: GBL, mephedrone
• ‘Legal highs’: ‘Ivory Wave’, ‘Spice’, ‘Benzo Fury’

B-Chilled
Why are we concerned?
• Small number experiencing significant harms
• Use of NPS can result in acute toxicity and serious harm. It can also
result in people putting themselves in situations where they may be
vulnerable or at risk of other harms (e.g. through collapse,
intoxication, etc) including accidents and being victims of crime (e.g.
sexual or physical assault).
• Numbers in treatment increasing
• Concern of ‘time-lag’ between using and problematic use
• ‘Legal highs’ – no evidence base
• The harms of NPS are multi-faceted and may be physical (intrinsic
to the drug) or social in nature.

B-Chilled
‘Supporting a Safer Nightlife in Birmingham
New challenges
• New drugs, with less information
• Different (greater) harms
• Dependence
• At risk behaviour
• Delivered in club drug-specific, or club drug-aware
locations
• Ever changing substances

B-Chilled
‘Supporting a Safer Nightlife in Birmingham
Who are B-Chilled engaging with?
• Typically different profile to traditional drug
services
• Higher functioning
• Less likely to have criminal record
• Students & Urban clubbers
• Respond well to treatment – ‘recovery capital’
• Triggers include arrest & negative experience
whilst using

B-Chilled
Further information …..
Marc Blanchette - Community Health Champions Project Manager:
07966 874776 or marc.blanchette@phoenix-futures.org.uk
Olivia Hemsoll – Outreach Support Worker:
07817 423963 or olivia.hemsoll@phoenix-futures.org.uk
Office: Phoenix Futures, 2nd Floor, Ruskin Chambers, 191 Corporation Street,
Birmingham, B4 6RP.
Tel: 0121 212 1122
Facebook page: B Chilled Birmingham
Twitter: @BChilledBham
Web: www.phoenix-futures.org.uk

Substances
Key actions going forward
Simon Claridge, Mentor

Alcohol and
Drug Prevention
Creating positive change for
children and young people Photo by Flickr user Jon McGovern

“Societies tend to make a small
investment in prevention and,
on average, they reap a small
return.”
Drug and Public Policy Group
Drugs and Public Policy Group (2010), Drug Policy and the Public Good: a summary of the book. Addiction, 105: 1137–
1145. doi: 10.1111/j.1360-0443.2010.03049.x

Why we need early interventions
Early Childhood Adulthood
Level of Problem Behaviors
Source: PriceWaterhouseCoopers
Age 21, cost per
person already =
£91 - £121k
£827,000
Lifetime cost of male
problem drug user

between the ages of 10 to 17 years
associated with:
• 80,640 violent offences per year, and
• 27,200 property offenses per year
between the ages of 15 to
16 years is associated with:
• 195,000 accidents or
injuries per year,
• 39,000 hospitalisation or
admissions to A&E per
year, and
• 104,000 cases of
unprotected sex per year
Young people’s drinking
behaviour
57,616 14-16 year olds
have truanted 5 or more
times in their lifetime
because of excessive
alcohol consumption
39,000 15-16 year olds
performing poorly or badly
at school as a result of their
drinking behaviours
Source: Jones, L. et al: A review of the effectiveness and cost-effectiveness
of interventions delivered in primary and
secondary schools to prevent and/or reduce alcohol use by
young people under 18 years old (ADDENDUM Additional
economic evidence prepared for the Public Health Interventions
Advisory Committee (PHIAC)) (2007)

The Life Course Approach
CMO annual report: 2011 ‘On the state of the public’s health’

What
we do
What we
know
works
What we
do that
we know
works
What
we do
that we
know
doesn’t
work
The Olive of
Prevention
Adapted from Harry Rutter, director of
the National Obesity Observatory

Traditional perspective on
prevention
• Emphasising the harms
(health and social) will
disincentivise use.
• Young people given enough
information will make rational
decisions about their health.
• One off interventions are
enough.
• Prevention = school drug and
alcohol education/posters/TV
adverts.

We need to change our perspective
Research has shown
• Cautionary stories
• Information
• Focus on harm or fear
• Harsh or inconsistent
punishment
Don’t work

Case study –
Scared Straight
• Programme assumes that by
showing ‘reality’ of the criminal
justice system young people will
want to avoid it
• Unfortunately trials of the
interventions have shown:
the ‘Scared Straight’
programme actually increased
the risk of offending in the
juveniles in the intervention
group compared with
juveniles in the control group
• The Social Research Unit
calculated that for every child it is
delivered to (£55) it costs a
further £14,268 to put right.
Scared Straight and Other Juvenile Awareness Programs for Preventing Juvenile Delinquency: A Systematic Review of the
Randomized Experimental Evidence, The ANNALS of the American Academy of Political and Social Science September 2003 vol.
589 no. 1 41-62

Settings
Environment Family School Community
Photo by Flickr user Collin Key Photo by Flickr user adwriter Photo by Flickr user loop_oh

Setting and Systems
Environment
Family
School
Community
Photo by Flickr user Australian Govt.

Universal vs. Targeted
Photo by Flickr user Collin Key Photo by Flickr user CliffMuller
Photo by Flickr user Ian Freimuth
Delivered to all regardless of risk.
Examples include:
• school prevention programmes
• public health media campaigns
Delivered to higher risk groups.
Examples include:
• Family and parenting
programmes
• Screening and brief intervention

Case Study –
Preventure
• Two or three session
targeted programme
based on personality
type; sensation-seeking,
impulsivity,
anxiety-sensitivity, and
hopelessness
• Outcomes
– 40% decreased risk of
alcohol consumption in
the intervention group,
55% decreased risk of
binge-drinking.
• Need to Treat of two
Photo by Flickr user Micah & Erin
O’Leary-Barrett M, Mackie CJ, Castellanos-Ryan N, Al-Khudhairy N, Conrod PJ. Personality-Targeted Interventions Delay
Uptake of Drinking and Decrease Risk of Alcohol-Related Problems When Delivered by Teachers. J. Am. Acad. Child
Adolesc.Psychiatry, 2010;49(9):954 –963

So why not just target?
Low Risk – 10% chance
Medium Risk – 40% chance
High Risk – 60% chance

Case Study –
Good Behaviour Game
• Classroom strategy for 6 – 8
year olds. Programme
assumes that early
socialisation into school is
protective.
• Outcomes:
– Doing well in school
– Good behaviour
– Not using substances
– Not depressed
– No suicidal ideation
• SRU benefit to cost ratio
shows for every £1 invested
£26 is returned. Photo by Flickr user Philippe Put

Nuffield Foundation: The wisdom of the crowd - 65 views of the NHS at 65 (2013)

Contact Details
Mentor
1st Floor, 67-69 Cowcross Street
London EC1M 6PU
020 7553 9920
Simon.claridge@mentoruk.org
@SiClaridge; @MentorTweets;
@MentorADEPIS
www.mentoruk.org.uk

Substances
End of conference
Please hand in your badges and feedback
forms as you leave
Thank you and have a safe journey home

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