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September 2014 |
drinkanddrugsnews
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Awareness|
New drugs
There are a number of problems with this definition, not least that some of the
compounds are not that new. Nitrous oxide has been around since the latter half
of the 19th century, 4-mmc was first synthesised in 1929 and a lot of the benzo-
type drugs doing the rounds at the moment were first synthesised in the 1960s. It
also creates the small problem that as soon as the drug is controlled by the UN
drug conventions, it ceases to be a novel psychoactive compound (NPC).
More problematically for me, the term has little or no relevance to end users. A
resource, service or awareness session referring to NPCs will not register with key
target groups. Asking people, ‘what NPCs have you used in the last month?’ won’t
elicit the information that I am looking for. It’s akin to when the language switched
from talking about ‘glue sniffing’ to ‘volatile substance abuse’. The language may
be more accurate, but what it gains in accuracy it loses in comprehension.
The other thing that is interesting about all the widely used phrases – ‘novel
psychoactive compounds’, ‘legal highs’, and ‘research chemicals’ is that the word
‘drugs’ is absent. According to Rick Bradley from KCA, presenting at a recent
seminar, about 85 per cent of NPS users do not recognise themselves as drug
users. The language we have all adopted contributes to the sense that these are
somehow distinct from other drugs.
In turn, this linguistic sleight of hand has, to my mind, disempowered drugs
workers. The recurrent theme from training sessions is a sense of not
understanding this new world of NPS, and these are often experienced workers
who can deal with the full spectrum of ‘traditional’ drugs. Reminding these
workers that these are still drugs, much like ones they can and have worked with,
does much to overcome this sense of disempowerment.
So, over time, I have tried to find a language that works to address these
problems. I found that the phrase ‘newer unregulated drugs’ worked reasonably well
– except when the law changes. What’s important is that we have the discussion
and explore the role language and terminology plays in constructing paradigms.
LANGUAGE OF ASSESSMENT
What we call our emerging drugs also has a bearing on the assessment process.
If we don’t ask and prompt about newer drugs, we may not get this information
volunteered. And when it comes to newer drugs, this brings with it some very
specific challenges.
1
Not perceiving substances to be drugs
As highlighted earlier, there’s some evidence that some people may not
consider their ‘legal’ substances to be drugs, so if they are asked about
other drugs they may not volunteer emergent drugs.
2
Unfamiliar with collective terms
We want to try and avoid the term ‘legal highs’ for reasons mentioned, and
use of phrases such as novel psychoactive compounds may not have a high
recognition factor with young people.
3
May not be familiar with drug families
Routinely we would ask people about (for example) their benzodiazepine use.
But asking this doesn’t automatically mean that the respondent will link their
etizolam use to the use of benzos, and volunteer this as a response.
Similarly, although we ask about cannabis use, the respondent may not
volunteer that they are smoking synthetic cannabinoids.
4
May not know what they have used or have misidentified it
The emergence of generic slang such as ‘legals’ could cover a wide range of
drugs. Regionally, slang such as ‘monkey dust’ or ‘bubble’ could refer to a
specific compound such as mephedrone or any unknown white powder. In
turn ‘mephedrone’, once referring to 4-mmc, could now be used
interchangeably for other white powder drugs. So assumptions both by user
and worker as to what a person is actually using could be both misleading
and dangerous.
5
We don’t want to give people a shopping list
Especially when working with younger, naïve users, it is important that the
assessment process doesn’t end up introducing the client to a whole list of
substances with which they were unfamiliar. So while initially tempting, an
assessment form that either lists or illustrates a wide range of different
products is risky. It is still unlikely to be comprehensive – there are so many
brands on the market now. But it also risks introducing substances to a client
who was hitherto unaware of that compound or family of drugs. We need to
prompt, but without exposing the respondent to still more compounds.
PROMPTING, NOT PROMOTING
After a numerous training sessions and a number of false starts, a screening
process emerged which addressed all my key concerns. It sits alongside an
existing standard screen and looks specifically at newer drugs.
Rather than exploring specific substances it looks at types of compound and
routes. So for example by asking about smoked substances it can elicit synthetic
cannabinoids, kratom, or salvia without naming the substances. Even vague
references to ‘I smoked something, I’m not sure what it was…’ can be incorporated.
Likewise, by asking about ‘white powders’ we can explore all the different
brands and unbranded substances again, without having to give names. Using
the same format, the tool asks about pills and pellets, and other substances
(swallowed, inhaled etc) to cover other drug groups.
Another key aspect of the assessment tool links back to the idea that we
don’t know what the person has used, and a lot of the time, neither do they. The
respondent says that they have used ‘mephedrone’ but we can’t be sure that this
is the case. It is important to be able to hear their experience of what they used
rather than imposing an assumption of how this substance should have felt.
In training we use the drug map to explore the relative location of different
drugs. We can use it to explore potency, duration and effects. In the context of
assessment it is left blank, so the respondent can describe how the substance
affected them – strong stimulant effect, very hallucinogenic, drowsy and so on.
This is useful, not least because it ensures that the client can articulate their
experience of the substance. It can also highlight where there’s a high chance
they have used something other than their named substance – where the effects
described are at variance with typical reports of that drug.
The assessment tool goes on to explore key issues stemming from use and
develop an action plan, and can be downloaded free from the KFx website.
(Feedback on its use is very welcome and will help me to revise it.) Ideally use of
the tool will be combined with staff training to increase awareness and
confidence in responding to newer unregulated drugs.
DDN
Kevin Flemen runs KFx, offering drugs information and training. For more
information and free resources visit www.kfx.org.uk
‘...about 85 per cent of
NPS users do not recognise
themselves as drug users.
The language we have all
adopted contributes to
the sense that these are
somehow distinct from
other drugs.’