'Legal highs': where do we go from here?

“When ethylphenidate was there, we saw incidents where the council wardens would clear out houses after people had vacated and they would clear out 2,000 needles,” says Nick Smith, Joint Programme Manager, Edinburgh Alcohol and Drug Partnership. “It wasn’t just one person – it was a house that was being used by a lot of people who were injecting together.”

Edinburgh has been at the centre of the current battle against new psychoactive substances (NPS) – often misleadingly dubbed ‘legal highs’ – as delegates heard at Holyrood’s recent policy conference on the topic.

The capital has been somewhat unique within Scotland in that a significant cohort of people has been injecting NPS. In fact, the number of needles distributed for such substances between April last year and March of this doubled.

“We didn’t see many new injectors registering at needle exchange services so we knew this was amongst our existing injecting population, previously injecting heroin, or injecting heroin and other substances alongside these [new psychoactive] substances,” says Smith.

Figures for April and May of this year showed a dip after health professionals and police went to the Advisory Council on the Misuse of Drugs in April, leading to a 12 month banning order for five substances, including ethylphenidate.

Whilst this has seen some of the “chaos” previously commonplace at treatment services reduced – “people using ethylphenidate weren’t able to sit down” – risky behaviours around injecting are still there. “We have a real challenge now,” adds Smith.

“We’ve been doing harm reduction for a long time, we’ve been doing it well, but all this advice, all this information that is going out, all these needles that are going out, when people actually get into the situation where they’re injecting, some of this information doesn’t always land where it needs to and even the availability of needles isn’t quite making the difference that we have made in the past.”

A central part of the awareness-raising work is focused on moving away from the ubiquitous term ‘legal high’ and hence the perception that such substances are safe. However, Suzanne Gallagher, Helpline Development Officer at Scottish Families Affected by Alcohol and Drugs, indicates there is still much to do.

“Although there are substances that are now illegal and have temporary banning orders on them, folk don’t recognise the legality of a substance,” says Gallagher. “They’ll still refer to it as a legal high when they’re coming through our helpline.”

So far this year, NPS has been the second most commonly mentioned substance by helpline callers. It was fifth in 2014-15, 13th in 2013-14, and didn’t even register the year before that, Gallagher tells delegates.

Perhaps most worrying, though, 72 per cent of NPS users previously had no problematic drug or alcohol use, according to reports from ‘concerned significant others’ – the term used for those who call in.

A blanket ban on all psychoactive substances, which was first outlined in the Queen’s Speech earlier this year, will have a “knock-on effect” for services, acknowledges Vicki Craik, NPS and Training Coordinator for Edinburgh-based sexual health and drug charity Crew.

Individuals presenting at services could continue to use such substances – either bought through a much more difficult to regulate online market or via street dealers – or switch to other drugs, which could increase harm, she says.

“Because so many people have switched to using stimulants, we might also have an increased appetite for stimulants and I would be very surprised if we didn’t see levels of amphetamine use and cocaine use rise after the ban,” adds Craik.

“Almost overnight as drugs become illegal they quadruple in price and halve in quality, so people aren’t going to get as much good drugs and a big one for a lot of services is the overdose risk. If somebody has been on opiates and they move to stimulants and back to opiates, they’re at a high risk of overdose.

"So we need to take the time between now and next April to make sure all our staff are trained in first aid and the administration of naloxone.”