New psychoactive substances: Pharmacology influencing UK practice, policy and the law

Abstract

This review covers the last 20 years of UK drug control policy leading up to the recent Psychoactive Substances Act. It explores policy decision made in relation to MDMA and mephedrone that not only were associated with increased drug harms overall but also had a significant detrimental effect on the UK research base. The new UK legislation on synthetic cannabinoids and other novel psychoactive substances threatens to do the same, showing that there is still much to learn from the decisions of the past. In future input from academic societies such as the BPS could help improve policy evaluation and policy development and so help avoid such problems in the future.

New psychoactive substances: a review and updates

“…However, the legislation has been criticised for the imprecise definition of psychoactivity, its blanket nature covering compounds with quite differing harm profiles, difficulties in enforcement, and exemptions that meant that popular NPS such as nitrous oxide can still be purchased. 4,12,13 Early evaluation of the Act suggested that whilst the availability of NPS had decreased, there was no evidence of a reduction in NPS-related harms. 14 By 2018, a total of 892 individual NPS, reported by 119 countries, were being monitored by the UNODC early warning system, 15 and by the end of 2018, over 730 NPS had been notified to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).…”

“…However, the legislation has been criticised for the imprecise definition of psychoactivity, its blanket nature covering compounds with quite differing harm profiles, difficulties in enforcement, and exemptions that meant that popular NPS such as nitrous oxide can still be purchased. 4 , 12 , 13 Early evaluation of the Act suggested that whilst the availability of NPS had decreased, there was no evidence of a reduction in NPS-related harms. 14…”

The challenge of the novel psychoactive substances: How have we responded and what are the implications of this response?

“…6,8,9 In addition, clinicians treating patients presenting with acute toxicity and dependence related to the use of NPS often have less confidence in treating those patients compared to those who present with issues related to the use of established illicit drugs, despite the commonality of the issues seen. [10][11][12] In the European Union, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has developed new monitoring tools alongside their existing indicators with the hope that these will provide a more complete picture on the risks related to NPS. These new monitoring tools include syringe residue analysis, data on hospital emergency presentations from the European Drug Emergency Network Plus (Euro-DEN Plus) project, analysis of wastewater, drug checking services, and expanded web surveys.…”

“…Previous data on the prevalence of use and harms associated with the use of illicit substances have traditionally focused on the frequency and volume of detection of substances in law enforcement and border seizures, drug‐related deaths, and utilisation of drug treatment services for drug dependency, along with data from animal and pre‐clinical studies . The exponential rise in the number and range NPS that have been detected and the rapidity by which substances become available has presented significant challenges in relation to our understanding of the prevalence of their use, how NPS are obtained by users, how we can detect the use of these substances, what the acute harms related to their use are, and how we respond to the potential public health risks posed by NPS . In addition, clinicians treating patients presenting with acute toxicity and dependence related to the use of NPS often have less confidence in treating those patients compared to those who present with issues related to the use of established illicit drugs, despite the commonality of the issues seen …”

“…Previous control mechanisms, both at national and international levels, have required evidence of the availability and use of an NPS together with harm associated with this use, before an individual NPS or class of NPS can be considered for control. These mechanisms are slow to respond when a new NPS is detected, with the required information to implement control taking many months or years, meaning that potential users remain at risk . In an attempt to deal with these delays, individual countries have introduced legislation that allows more rapid control of new NPS prior to more formal review and control under their own pre‐existing legislation.…”