Dima Abdulrahim talks about meeting the treatment challenges of novel psychoactive substances
When it comes to managing substance misuse, there is an existing – and substantial – body of research evidence, as well as a number of clinical guidelines. Can we apply this guidance to club drugs and novel psychoactive substances (NPS)? To a large extent, we can, and should. The principles underpinning treatment are the same. Good practice is transferable.
However, it would also be wrong to ignore the particular challenges posed by club drugs and NPS, and the need to address them specifically. It is also widely acknowledged that professionals require support to improve their knowledge and confidence in the assessment and management of the acute and chronic harms resulting from the use of these substances.
With generous support from the Health Foundation, project NEPTUNE has responded to the gap in knowledge and addressed the challenges of club drugs and NPS by developing guidance based on the best available evidence and clinical consensus.
The challenges include those resulting from the drugs themselves: what are they and how do they work? There is a rapidly changing profile and ever increasing numbers of substances available for recreational use. More than 450 NPS are currently monitored in Europe, with more than half reported in the last three years alone and 101 reported for the first time in 2014. The potential harms of the NPS are still poorly understood, particularly their long-term impact. The evidence base for treatment remains limited.
NPS appear to be attracting a new group of younger users. Engaging them is a particular challenge for drug services, which are historically orientated towards opiate and/or crack users. Clinicians require improved knowledge of who is using club drugs, and how. Services generally have limited understanding of the diverse ‘cultural’ contexts of club drug use (clubbing, festivals, LGBT venues, sexual context, psychonautic use), or context of use, risk and harm. One particular challenge to drug services is the link between drug use and high-risk sexual behaviours and the use of drugs in a sexual context, particularly by gay men.
There are new challenges associated with the clinical management of club drugs and a need to improve ‘clinical’ knowledge of how to manage acute/chronic presentations. For example, the management of GBL can be complex in emergency departments, as well as in drug recovery services, as acute intoxication and withdrawal syndrome can be severe and potentially fatal. The overlap of substance misuse harms with other harms has also compelled drug treatment professionals to develop knowledge and clinical pathways in uncharted territories. For example, ketamine is associated with severe urinary system damage and management may therefore require collaboration with urology and competencies in pain management in the context of ulcerative cystitis.
NEPTUNE has responded to the fact that the management of the harms of club drugs and NPS is not only about drugs services. Guidance is therefore also aimed at emergency departments, primary care and sexual health clinics. Not only do these services manage the harmful effects of club drugs, but they also provide a good access to populations with high levels of club drug use. This makes for a strong opportunistic approach to access people who may be in need of drug treatment, but reluctant or unwilling to contact services.
Although the number of people currently in drug services for club drugs is still small, there is a growing demand for treatment. The NEPTUNE guidance and forthcoming clinical tools have been developed to support clinicians to provide effective and safe treatment and care.
Dima Abdulrahim is NEPTUNE programme manager and lead researcher