Mark Napier talks to DDN about the emergence of the complex problem of novel psychoactive substances, and some responses that commissioners and providers can adopt to tackle this issue
Health needs assessments
The Centre for Public Innovation (CPI) has been involved in research and supporting the commissioning of substance misuse services since its inception in 2000. The company is a social enterprise with more than a decade of experience working in the field of substance misuse, both with commissioners and providers, helping them to understand their clients and provide better services.
Recently, we completed a series of health needs assessments (HNAs) for a number of prisons, on behalf of NHS England. As with all HNAs, there was much interest among commissioners and prison staff with regard to substance misuse – in terms of the need for treatment and the profile of the drug-using population in prison.
CPI were able to bring together a mix of specialist knowledge of substance misuse treatment, along with in-depth knowledge of how prison healthcare works, alongside robust research skills to help explore the issue of substance misuse.
Novel psychoactive substances
Having completed prison HNAs on many other occasions, the CPI research team were struck by a pronounced shift in the findings on this occasion, as compared to work we had done previously.
From the outset, it was clear that the use of novel psychoactive substances (NPS) was an issue that the HNAs needed to cover. NPS is the catch-all term for a raft of new and emerging drugs that cover ‘legal highs’ to recently banned substances and club drugs.
Prison staff reported concerns about the impact of NPS on the health of prisoners, citing a rise in aggression and other behavioural changes among inmates. Healthcare providers were concerned about the demands that NPS were perceived to be putting on their services as well as the need to send prisoners to A&E following apparent adverse reactions to NPS.
Prison professionals were united in their assessment that the use of NPS was a significant and growing problem that had yet to be fully understood.
The prisoner’s perspective
In consultation with prisoners, there was a clear consensus that NPS were now the ‘drug of choice’ and that their use had overtaken that of other drugs, including cannabis.
Some prisoners interviewed by CPI researchers reported that use of NPS was driven partly by mandatory drug testing. Knowing that NPS could not be detected via existing tests, using NPS enabled them to consume drugs whilst working around the prison system.
What was striking was that, while prisoners were well aware of the use of NPS, they were as unclear about the nature of NPS as prison professionals. Whilst prisoners referred to ‘Spice’ it was clear that this was being used as a catch-all term to describe a range of new drugs with a variety of properties and effects. In essence, prisoners were consuming unknown and untested psychoactives.
Defining the problem
The picture that emerged from the HNAs was of a rapidly changing shift in the use of drugs in the prison but with little hard evidence to determine the impact that NPS were having. Existing systems were not geared to collecting data on NPS. In the absence of data, responses were ad hoc, driven by anecdotal assessments, and lacked a basis upon which to determine what was and what was not effective.
The National Offender Management Service is aware of the issue of NPS and is undertaking research to create a substantive evidence base for use in the prison system, but this work will take some time to report.
What can be done?
Until the NOMS research is available, CPI determined that a number of steps could be undertaken immediately to start responding to the problem:
- Prison healthcare providers should record any health incident in which NPS is felt to be a causal or associative factor – either where use of NPS is self-reported or determined by health staff
- Prison healthcare providers should follow Public Health England guidance advising that the appropriate response is to address symptoms rather than the specific drug
- Substance misuse treatment providers should seek to understand the extent to which their clients are using NPS
- Substance misuse treatment providers should determine the extent to which existing provision can be adapted to meet the needs of this group of drug users
Understanding about the nature of NPS and how treatment should respond to these drugs is still emerging. The work of CPI can provide some immediate steps that commissioners and providers can consider, while the evidence base develops to determine the nature of the issue and how best to manage it.
Mark Napier is managing director of the Centre for Public Innovation (CPI). For more information about how CPI can help your organisation, visit www.cpi.org.uk or call 020 7922 7820