The use of synthetic cannabinoid receptor agonists (SCRAs) within the homeless population: motivations, harms and the implications for developing an appropriate response

Abstract

Background: Synthetic cannabinoid receptor agonists (SCRAs) have become increasingly associated with a range of physical, mental health and societal harms. In response, several countries have introduced legislation aimed at restricting their supply and use. While these legislative changes have led to a decrease in SCRA use within the general population, SCRAs remain popular within vulnerable populations, in particular the homeless. This article presents the findings from the first in-depth qualitative study of SCRA use within the homeless population. It makes an important and timely contribution to the current evidence base and discourse on how governments and service providers should respond to SCRA use within the homeless population. Methods: The research on which this article is based was undertaken in Manchester, UK. Qualitative interviews were undertaken with 53 homeless users of SCRAs and 31 stakeholders. Results: The motivations for SCRA use are broadly similar to those associated with traditional drugs; namely to escape from the reality of life on the streets, and to provide relief from the physical conditions of a street-based lifestyle. However, the combination of their low cost, the ease with which they can be accessed, their high potency, and their non-detectability explains their particular appeal to the homeless population. Alongside these motivations, the research identified a range of physical, mental health, and societal harms that were directly attributable to SCRAs. Conclusions: The most appropriate way to address the continued use of SCRAs within the homeless population is through the development of a more appropriate service response rather than further legislative change.

Deaths from novel psychoactive substances in England, Wales and Northern Ireland: Evaluating the impact of the UK psychoactive substances act 2016

“…However, significant prevalence in some vulnerable sub-groups remains, particularly homeless individuals and those imprisoned who continue to use SCRAs due to their accessibility and difficulty in analytical detection ( Blackman and Bradley, 2017 ; Brunt et al, 2017 ; Felvinczi et al, 2020 ; Ford and Berg, 2018 ; Norman et al, 2020 ; Peacock et al, 2019 ; Scourfield et al, 2019 ; Weinstein et al, 2017 ). Indeed, a major driver for SCRA use is their lack of odour during consumption, and lack of appearance on standard drug screens – factors that are well documented in the use of cannabis itself ( Gray et al, 2021 ). Furthermore, SCRAs are reportedly both cheaper and more readily accessible than cannabis, with SCRA dealers actively approaching users, negating even the need to seek them out ( Gray et al., 2021 ).…”

“…Indeed, a major driver for SCRA use is their lack of odour during consumption, and lack of appearance on standard drug screens – factors that are well documented in the use of cannabis itself ( Gray et al, 2021 ). Furthermore, SCRAs are reportedly both cheaper and more readily accessible than cannabis, with SCRA dealers actively approaching users, negating even the need to seek them out ( Gray et al., 2021 ). SCRA use also appeals to these individuals due to their strongly intoxicating effects: they have been described to provide release from insufferable circumstances by enabling disengagement with reality ( Blackman and Bradley, 2017 ; Csák et al., 2020 ; Ellsworth, 2019 ; Gray et al, 2020 ).…”

Producing gender-blind drug knowledge and representations in prison spaces

“…Yet, the HMCIP did not mention any short-or long-term harms observed in women from exposure to NPS specifically, including any physical or mental health effects suffered by women from exposure to NPS. This is despite limited, but relevant evidence that suggests that there may be gendered harms dimensions to NPS use (Public Health England, 2017, p. 38;Grace et al, 2020;Gray et al, 2020).…”

“…Qualitative studies on the subject of NPS among marginalised populations (including with formerly incarcerated women) have noted gender specific use patterns and harms manifestations, but have also registered a lack of knowledge with regard to the scope of and harms linked to NPS within the female prison estate (Grace et al, 2020;Gray et al, 2020). The lack of knowledge about women's NPS use in prisons is not surprising and it reflects wider knowledge gaps about women and drugs more generally.…”

The metabolism of the synthetic cannabinoids ADB‐BUTINACA and ADB‐4en‐PINACA and their detection in forensic toxicology casework and infused papers seized in prisons

“…[4][5][6] SCRAs have been implicated in many non-fatal poisonings and drugrelated deaths worldwide, 7,8 and in some jurisdictions, their prevalence is particularly high in vulnerable groups such as rough-sleepers and prison populations. [9][10][11][12][13][14][15][16] To date, SCRA production has been based primarily in the People's Republic of China, from where substances are distributed to other jurisdictions via international mail and freight distribution networks. Legislative controls in China are known to have a significant influence on the appearance of specific SCRAs on the global illicit drugs market, and the most prevalent substances often emerge simultaneously in different jurisdictions.…”