‘I quit heroin for meow’: A qualitative study of the use of new psychoactive substances among problem drug users in South Wales MARIAN BUHOCIU A submission presented in partial fulfilment of the requirements of the University of South Wales/Prifysgol De Cymru for the degree of Doctor of Philosophy June 2018 Abstract New psychoactive substances (NPS) appeared on the drug market in 2005/2006 reportedly in an attempt to circumvent existing drug legislation. At first, they appealed mainly to young, recreational drug users. However, in the second half of 2012, reports from a few countries around Europe indicated that NPS had also started to make their way into the repertoires of long-term users of heroin, amphetamines and cocaine (often referred to as ‘problem drug users’). In the UK, the first reports of NPS use among problem drug users came from South Wales, in the autumn of 2012. Albeit anecdotally, drug agencies, local newspapers and the police in this area reported that long-term heroin users had switched to injecting a stimulant NPS – mephedrone, which was previously only popular among recreational drug users. Little is known about NPS use among ‘problem drug users’ as research has tended to focus on recreational drug users. The thesis fills this gap in knowledge by investigating the motivations and characteristics of NPS use among a sample of problem drug users in South Wales. Three qualitative research methods were used, in combination, to investigate NPS use at initiation, during periods of persistence and at desistance. This involved: (1) in-depth interviews with 26 problem drug users, 17 of which were repeated after an average of six months, (2) in-depth interviews with 11 experienced drug professionals, and (3) a 13-month microethnography at a busy drug treatment service operating in South Wales. Zinberg’s (1984) classical drug, set, setting theoretical framework, not previously used in relation to NPS use, was adopted to disentangle the findings of this study. The analysis revealed that setting factors were most important in terms of initiation. Yet, a complex interplay of set, setting and drug were important for persistence and desistance. Stigma and ‘recovery capital’ played a particularly important role in explaining desistance. The results of this study have implications for policy and practice in the field of substance misuse, most of which relate to access to, content and delivery of substance misuse treatment programmes. In addition, the findings can inform drug policy, drug legislation, criminal justice interventions, prevention and harm-reduction initiatives. 1 Acknowledgements This thesis would not have been possible without the brilliant support and guidance I received from my supervisors, Katy Holloway and Fiona Brookman. Their profound and sincere advice helped me navigate through what turned out to be a quite difficult five and a half years of my life and for that I will always be grateful to them. They are my angels, my inspiration, and having been able to work so closely with them was an incredible experience. Thanks also extend to Trevor Bennett, who, along with Katy, encouraged me to apply for the PhD in the first place and who supervised the doctorate in the early days. I must also acknowledge Mike Maguire whose sound advice during the MPhil to PhD transfer examination inspired me to refine and extend the scope of my thesis. I must also thank the University of South Wales for awarding me a three year Centenary Scholarship from 2013, which greatly assisted in paying the fees and associated expenses for this doctorate. This allowed me to quit my job as a pizza delivery driver in Pontypridd (which often involved delivering food to my own students) and concentrate on completing a PhD in the field about which I am so passionate. My thanks also extend to the group of PhD students at University of South Wales, with whom I shared some of the most challenging moments in my academic life so far. I apologize to all of you for having to put up with numerous and long conversations about new drugs, methodology, structure, findings etc. Your input has been invaluable not only for the thesis, but also for my mental wellbeing throughout this doctorate. Importantly, I wish to express my immense gratitude to all the men and women who agreed to be interviewed and shared their experiences and took part in this research. I also want to thank all the service managers, key workers and all the other drug professionals who took from their precious time and accepted to be interviewed for the study or facilitated access to participants. Also, I want to thank my family (my Dad – Aurel, my Mum – Zanica, my brother – Adrian), my in-laws (Dan and Lidia), my former colleagues and old friends from back home, and my recent friends from my adoptive country – Wales, for believing in me and giving me the confidence and strength to keep going in moments when I thought finishing this thesis would not be possible. Lastly, but most importantly, I want to thank my beautiful wife Mihaela, who has been my rock throughout this entire time. Thank you so much for your unconditional love and support! 2 Contents Abstract ................................................................................................................................................... 1 Acknowledgements ................................................................................................................................. 2 CHAPTER ONE - Introduction .................................................................................................................. 6 Background ..................................................................................................................................... 6 Research context ............................................................................................................................. 7 Research focus and approach ......................................................................................................... 8 Research questions ......................................................................................................................... 9 Research methods .......................................................................................................................... 9 Structure of thesis ........................................................................................................................... 9 CHAPTER TWO - Deconstructing NPS: Definitions, classification and supply ....................................... 12 Introduction .................................................................................................................................. 12 Terms and Definitions ................................................................................................................... 13 Classes of NPS ............................................................................................................................... 18 Supply of NPS ................................................................................................................................ 22 Conclusion ..................................................................................................................................... 26 CHAPTER THREE - NPS: Origin, geographical spread, emergence and prevalence of use ................... 28 Introduction .................................................................................................................................. 28 Origin of NPS ................................................................................................................................. 28 Geographical spread of NPS .......................................................................................................... 30 Emergence of NPS ......................................................................................................................... 33 Prevalence of NPS use ................................................................................................................... 36 Conclusion ..................................................................................................................................... 42 CHAPTER FOUR - The use of NPS .......................................................................................................... 44 Introduction .................................................................................................................................. 44 Initiation into NPS use ................................................................................................................... 45 Persistence in the use of NPS ........................................................................................................ 52 Desistance from the use of NPS .................................................................................................... 59 Conclusion ..................................................................................................................................... 62 CHAPTER FIVE - Methodology ............................................................................................................... 66 Introduction .................................................................................................................................. 66 Access ............................................................................................................................................ 67