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New psychoactive substances (NPS): factsheet

Who is this factsheet for? classified by the Misuse of Act 1971. This This factsheet is aimed at professionals who do means they are illegal. Possession or supply can not work specifically in the drugs field, but who carry a prison sentence. As new drugs are being may encounter substance misuse as part of developed all the time, it has proved a challenge their role and who need information on current to keep up with them using this law. The UK substance misuse issues. It may also be of government responded to this by bringing in a interest to the general public. new law, the Psychoactive Substances Act 2016.

What are ‘new psychoactive This law, which came into effect on 26 May substances’? 2016, covers all psychoactive substances which are NOT already classified under the Misuse of ‘New psychoactive substances’ (NPS) is an Drugs Act 1971. The Psychoactive Substances umbrella term used to cover a wide range of Act 2016 says that possessing with intent to substances with a number of things in common: supply, supplying or offering to supply, producing, importing or exporting any psychoactive • they are psychoactive (they affect the user’s substance, all carry a penalty of up to seven years mental functioning or emotional state by and/or a fine, depending on the seriousness of stimulating or depressing the central nervous the offence. This means that it is against system (brain and spinal cord)); the law to supply anyone with one of these substances. • they are newly available in the UK or have seen a recent increase in popularity and public Possession of a psychoactive substance is not awareness; an offence and carries no penalty. However, if you are in a custodial institution (prison or young • they can pose a threat to health comparable to offender’s centre) and possess a psychoactive illegal drugs. substance, it is considered an offence, and carries a penalty of up to two years and/or a fine, It is often not clear what is contained within depending on the seriousness of the offence. individual products. The quality and content of such products varies enormously and the name It will be up to the police and courts to decide used may not bear any relation to their actual the quantifiable difference between personal contents. In addition, the huge variety of names, possession and possession with intent to supply. including chemical names, trade names and slang names, makes it very difficult to know exactly what Possession of a substance classified under exists. the remains an offence. Other terms sometimes use to refer to NPS include ‘research chemicals’ and ‘legal highs’. More information on those drugs banned under NPS and the law the Misuse of Act 1971 can be found at www.gov.uk/penalties-drug-possession- Many psychoactive substances are already dealing

www.publichealth.hscni.net What kind of substances are covered have ever taken an NPS. It also shows that use by the Psychoactive Substances Act is more common among males, with males three 2016? times as likely to use as females. The act covers “any substance which (a) is capable of producing a psychoactive effect in a person who However, it is known that despite the emergence consumes it, and (b) is not an exempted substance.” of these new drugs, , and ecstasy continue to be among the most commonly Exempted substances (those not covered by the used drugs here. The tables below show ‘lifetime act) include , and . prevalence’ of NPS use and ‘last year prevalence’ (alkyl nitrates, which cause lightheadedness and of NPS use in Northern Ireland. relax muscles) are not covered by the act because their effects are caused by increasing flow, Last year prevalence for all drugs is lower but is not by acting on the central , and are useful as it indicates more recent use. Lifetime therefore not classed as a psychoactive substance. prevalence includes people who may only have used a substance once or twice many years ago. How common are NPS? It is important to note that NPS may be most In 2014, 101 NPS were notified to the European commonly used by people who are vulnerable, Monitoring Centre for Drugs and Drug . such as homeless people, young people in care This compares to 81 in 2013, 74 in 2012 and 48 or people in prison. These are hidden populations in 2011. The most commonly reported substance who do not generally participate in surveys. These overall is synthetic . people may also be more likely to use NPS in high risk ways. This means that, while at a population The most recent statistics on adult use in level the numbers of users appears small, within Northern Ireland are from the Drug Prevalence certain hidden populations use may be much Survey 2014–2015, which shows that around 1 higher, as well as higher risk. in 45 people in Northern Ireland state that they

Lifetime prevalence of drugs 2014/15

30%

25%

20%

15% 7.4% Poppers Cannabis 24.6% Any illegal drug 27.7% Any Percentage %

10% Other opiates 22.2% Cocaine (including crack) 7.4% Cocaine (including crack) Anti- 23.7% Anti-depressants Cocaine powder 7.2% 6.1% Amphetamines LSD 5.7% Magic 5.7% 5% 3.1% 2.5% New psychoactive substances 2.2% New psychoactive Anabolic steroids 1.6% Anabolic 1.1% Crack 0.8% Crack 0.4% Ecstasy 9.6% 0% or tranquillisers 20.9% Drug type

(Source: Northern Ireland Drug Prevalence Survey 2014-15, Department of Health)

2 www.publichealth.hscni.net Last year prevalence of drugs 2014/15 16%

14%

12%

10%

8% Anti-depressants 14.0% Anti-depressants 6% illegal drug 5.9% Any Percentage % Cannabis 4.6%

4% Other opiates 10.0% Cocaine powder 1.8% 2% 1.8% Cocaine (including crack) Poppers 1.1% Poppers Ecstasy 0.8% Mephedrone 0.6% Anabolic steroids 0.6% Anabolic LSD 0.5% Amphetamines 0.5% Amphetamines Methadone 0.3% Magic mushrooms 0.4% Crack 0.3% Crack New psychoactive substances 0.3% New psychoactive Heroin 0.2% Sedatives or tranquillisers 10.3% 0% Solvents 0% Drug type

(Source: Northern Ireland Drug Prevalence Survey 2014-15, Department of Health)

Deaths linked to NPS • During 2013–2014 20 deaths were linked to 2 NPS have received a high media profile over the the 4,4’-DMAR. It is important to past few years, in part because of the difficulties note that in all reported cases, the death had in restricting access to these drugs using the law, taken place after the individual had consumed and also because of deaths in Northern Ireland two or more drugs (including alcohol), so we relating to NPS. cannot say that any of these deaths were caused solely by this substance. The most recent data published shows there was a total of 15 deaths here in 2013 where • During 2014 and 2015, there were 20 drug- the coroner declared that NPS contributed to related deaths in which ethylphenidate was “the deceased’s death (eg through poisoning or detected. In all but one case, other substances intoxication) or causing their powers of reasoning were detected, so for almost all these cases, and/or to be so affected as to induce we cannot say that the deaths were caused them to take risks which they would not have done solely by this substance. had they been sober”.1 • Mephedrone was detected in seven deaths in 3 Three specific NPS have been detected in a high 2014 and three deaths in 2013. number of deaths in Northern Ireland. It should be noted that when a drug is detected in a person Across the UK, 144 deaths were linked to NPS in 4 who has died, it does not follow that the drug 2014. caused the death.

3 www.publichealth.hscni.net While most NPS-related deaths here have drugs. include benzodifurans, been linked to stimulant-type drugs, there have PMA and PMMA, all of which are Class B illegal been deaths elsewhere linked to synthetic substances under the Misuse of Drugs Act 1971. cannabinoids. A 2016 alert highlighted 13 deaths in associated with the synthetic include mephedrone, MDMB-CHMICA.5 and MDPV. All cathinones are Class B illegal substances under the Misuse of Drugs Act 1971. Polydrug use Although specific risks depend on which include BZP and are Class C illegal substance or substances are taken, one of the substances under the Misuse of Drugs Act 1971. biggest risk factors is using more than one drug at a time (including alcohol). Recent reports on drug- The full extent of the risks of using these drugs related deaths show that in the vast majority of is not known, and because they have not been cases, at least two substances (including alcohol) available for very long, there is no understanding had been taken.1 Using more than one substance of the long-term risks of taking them. However, at a time (polydrug use) is increasingly common their general risks include both physical side among those who use drugs. effects (dizziness, tremor, headache, flushed skin, chest pains with palpitations, excessive What type of drugs do NPS include? sweating, vomiting, and abdominal cramps) and NPS can be categorised in a number of different psychological effects (agitation, hostility, panic, ways. For the purposes of this factsheet, they aggression, and suicidal ideation). Paranoia, are grouped into four categories: , sometimes accompanied by both auditory and , and visual , may also occur. depressants. Some substances fall into more than one category. For example, a number of Overdose can cause high fever, convulsions, drugs have both stimulant and hallucinogenic stroke, or heart problems like cardiac arrest, properties, eg MDMA (ecstasy – usually classed sometimes leading to death. Because stimulants as a stimulant) and AMT (usually classed as a affect the body’s cardiovascular and temperature- ). A drugs wheel that separates regulating systems, physical activity can increase substances into seven categories has also the risks. been developed and can be viewed at www. thedrugswheel.com There are numerous different types of stimulant NPS and the type of drug and the effects are Stimulants likely to differ from batch to batch. This increases the risk to the user. For example, someone might A stimulant is a drug that speeds up the central take a pill one week which contains ecstasy, and nervous system to increase neural activity in the an identical or similar looking pill the following brain. Stimulants tend to make people feel more week which contains PMA (or PMMA). Since alert and awake, and can produce feelings of PMA is slower to take effect, the user may think it . is weak ecstasy and redose, which could lead to fatal overdose as PMA is more toxic. Stimulants include phenethylamines, cathinones and piperazines, all of which are quite similar

4 www.publichealth.hscni.net In Northern Ireland, particular concerns have Synthetic cannabinoids can have significant been expressed over a substance known as effects on mental health, including ‘white’, which appears to be popular among some disorientation, , panic and . injectors. Anecdotal evidence suggests that Short-term memory can also be severely impaired. substances being sold as ‘white’ may include ethylphenidate and methiopropamine. As well as Researchers have concluded that synthetic the link between ethylphenidate and the deaths cannabinoids are potentially more harmful than mentioned above, ‘white’ has been linked to many cannabis. Tolerance develops quickly, and serious injecting-related harms, including an compulsive use and needing to use more and increase in wounds at injection sites. Users also more are reported frequently by users. There is report a strong desire to redose, and psychosis some evidence that links synthetic cannabinoid after only a small number of times using the use with acute injury. substance. A recent small-scale Irish study highlighted Synthetic cannabinoids the rapid development of tolerance, regular Often sold as herbal incense, synthetic dependent use within short timeframes and acute cannabinoids are a non-psychoactive withdrawal symptoms on cessation of use.6 base that has been sprayed with synthetic cannabinoids to mimic the . Through its early warning system, the Drug and Effects depend on the brand, with some Alcohol Monitoring and Information System producing euphoric or ‘stoned’ feelings akin to (DAMIS), the PHA receives regular reports of cannabis, while others produce effects more like synthetic cannabinoids causing serious adverse those of psychedelic or drugs. Their reactions in users in Northern Ireland, some effects can be much more potent than cannabis. requiring hospitalisation. There are 107 known synthetic cannabinoids on the European market. Brand names include Hallucinogens Spice, Doob, Sky Blue/Sky High and Psyclone. Hallucinogens affect perception, inducing a Some synthetic cannabinoids are illegal (Class distorted of sight, hearing and touch, B) to possess, while others are covered by the changing the user’s impressions of time and Psychoactive Substances Act 2016 and are only space and distorting reality. Users can find it hard illegal to supply. Because a user does not know to distinguish reality from illusion. what chemicals are in the products, they cannot know if what they are using is illegal to possess or A number of plant-based hallucinogens, with a range not. of effects, can be bought in the UK. These include kratom and . Unlike other NPS, some of these The physical effects of the more potent types can plant-based substances have been available for many be quite overpowering, with reports of breathing years, but have received increased attention recently. difficulties, tight chest, racing heart, palpitations, shakes and sweats, which can lead to severe Synthetic (manufactured) hallucinogens include panic. Other effects can include numbness in N-Bombs and AMT (both classified Class A under limbs, vomiting, collapse and unconsciousness. the Misuse of Drugs Act 1971.

5 www.publichealth.hscni.net The risks depend on the specific hallucinogen NPS and sexual health taken. For example, most physical harm resulting NPS have been linked to increased levels of blood from using salvia occurs as a result of people borne viruses (HIV, hepatitis B and C) in some injuring themselves when under the influence of the parts of the UK. In some cases, this has been drug, rather than the drug directly causing harm. attributed to ‘chemsex parties’ among men who There is, however, some concern that salvia could have sex with men (MSM). These are parties where trigger psychotic episodes, particularly in young people take drugs and then engage in high-risk people and people with previous history of, or a sexual behaviours, often with a number of partners.7 family history of, mental health problems. Some hallucinogens (eg N-Bombs) are powerful and can Where can I get more information or cause increased heart rate and blood pressure, advice? which can lead to heart failure. They may also lead If someone is concerned about their drug use, they to seizures. should speak to a GP, who can provide advice and direct them towards support services. Depressants Depressants include (‘laughing Information about local support available can be found gas’ or ‘NOS’), a gas used in catering, mostly in in the ‘services near you’ section of the Northern whipped cream aerosol cans to prevent the cream Ireland Drug and Alcohol Coordination Teams going off. Users tend to inhale from a balloon. (NIDACTS) website www.drugsandalcoholni.info When inhaled, it can make people feel euphoric, relaxed or giggly. Some people also experience This includes support for alcohol/drug users, both hallucinations. Nitrous oxide slows down your brain adults and people under 18, as well as support for and your body’s responses. It is one of the most family members. commonly used NPS in other parts of the UK. However there is no evidence to suggest that it is The PHA works with local DACTs’ ‘Connections’ widely used in Northern Ireland. service to provide information, advice and a range of awareness-raising sessions (including one The biggest risk from using nitrous oxide is if the focusing on NPS) for community organisations gas is used in an enclosed space or if it is inhaled or other stakeholders concerned about drug using a plastic bag which covers both the mouth or alcohol issues. Details can be found in the and nose. This can lead to nitrous oxide using up ‘NIDACTS’ and ‘connections’ sections of space usually taken up by oxygen, and can cause www.drugsandalcoholni.info unconsciousness or death. The PHA funds ongoing training of relevant Inhaling directly from a canister can cause frostbite staff across Northern Ireland, to ensure that the as pressurised gas is extremely cold. Inability to workforce has the knowledge and skills needed to control the speed at which the leaves the work with people who misuse NPS and achieve canister could damage the respiratory system if it positive outcomes. Information on training can be rushes into the lungs too rapidly. found at www.ascert.biz

6 www.publichealth.hscni.net The PHA provides public information on alcohol References and a wide range of drugs, as well as harm 1. Claridge, H & Goodair, C. Drug Related reduction information aimed at people who use Deaths in England, Northern Ireland, the stimulants or synthetic cannabinoids. This can be Channel Islands and the Isle of Man: January downloaded from www.publichealth.hscni.net – December 2013. St George’s University, London: National Programme on Substance More information on synthetic cannabinoids, Abuse Deaths including advice, can be found at 2. Cosbey S et al. Multiple fatalities involving http://www.drugwise.org.uk/ a new : Para-Methyl-4- Methylaminorex. Journal of Analytical For the report of the UK Expert Panel into the 2014: 1-2. effectiveness and issues of the UK’s current 3. Alcohol and Drug Deaths. Available from response to NPS, go to www.gov.uk/ www.nisra.gov.uk/demography/default.asp30. government/publications/new-psychoactive- htm Accessed 25 March 2016. substances-review-report-of-the-expert-panel 4. Home Office and Karen Bradley MP. Landmark law to tackle legal highs commences later A summary of UK drugs laws can be found at this month. Available from https://www.gov. www.gov.uk/penalties-drug-possession- uk/government/news/landmark-law-to-tackle- dealing legal-highs-commences-later-this-month Accessed 25 May 2016 The PHA coordinates an early warning system, 5. European Monitoring Centre for Drugs and DAMIS, to identify emerging substances of Drug Addiction. EU Early Warning System concern as soon as possible, and circulate that Alert 8 February 2016. information to anyone at risk. This service also 6. Van Hout, MC & Hearne, E. User Experiences provides harm reduction information, targeted of Development of Dependence on the at those who, despite strong warnings not to, Synthetic Cannabinoids, 5f-AKB48 and continue to use NPS. If you are aware of any 5F-PB-22, and Subsequent Withdrawal drugs of concern, you can email the Drug and Syndromes. Int J Ment Health Addiction. DOI Alcohol Monitoring and Information System at 10.1007/s11469-016-9650-x [email protected] 7. Public Health Wales: Chemsex linked to rising levels of HIV among . Pink For more information on specific NPS, go to News. 28 October 2014. Available from www.talktofrank.com http://www.pinknews.co.uk/2014/10/28/ public-health-wales-chemsex-linked-to-rising- levels-of-hiv-among-gay-men/ Accessed 6 March 2015

Last revised May 2016.

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