NPS Toolkit in Prison England. Lessons for Young People and the Criminal Justice System

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1 NPS Toolkit in Prison England. Lessons for Young People and the Criminal Justice System Kieran Lynch Criminal Justice Alcohol, drugs and tobacco division Public Health England

2 Overview Background Prisons Who uses NPS? Preventing harm Tackling NPS problems Acute problems Drug treatment Supporting local authorities The importance of information sharing 2 Presentation title - edit in Header and Footer

3 There s a lot of NPS around 3 Presentation title - edit in Header and Footer

4 Neptune Aims to raise standards in clinical management of club drugs including NPS across the health system A comprehensive review of treatment research literature for NPS and club drugs Evidence-based clinical guidance Where evidence is lacking, uses expert consensus Neptune II is producing a range of clinical tools to support the main guidance 4 Presentation title - edit in Header and Footer

5 Treating NPS - categories Stimulants Sedatives/ Dissociatives Hallucinogens Synthetic cannabinoids 5 Presentation title - edit in Header and Footer

6 Background Design of a Prison-specific NPS Toolkit to supplement the generic PHE NPS Toolkit 32 training events across English regions- [650+ attendees-numbers limited in order to make the training more interactive] November 2015 to May 2016 Attendees from a range of secure environments and from community services in addition Training events became increasingly discursive and a rich source of information-supported by the use of a questionnaire Training events identified numerous issues, many examples of good practice and a number of key themes in addition All of the findings were heavily nuanced and there were numerous subtexts to the headline findings 6 Responses to NPS use in prisons and how these might be applied in custodial and community settings

7 PHE Toolkit - NPS in Prisons For custodial, healthcare and substance misuse staff Provides information about: extent of use properties of various NPS how to manage from medical, psychosocial and regime perspectives Psychoactive Substances Act 2016 makes possession of NPS in prison an offence Ministry of Justice introducing targeted testing for NPS and measures to combat supply (drones and phones) 7

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9 Who uses NPS? Prisoners It is clear that a large part of this violence is linked to the harm caused by new psychoactive substances which are having a dramatic and destabilising effect in many of our prisons synthetic substances, often known as Spice or Mamba, were becoming ever more prevalent in prisons and exacerbating problems of debt, bullying, self-harm and violence HM Chief Inspector of Prisons for England and Wales Annual Report Presentation title - edit in Header and Footer

10 Who uses NPS? People who use other drugs CSEW tells us that the majority of last year NPS users had also used another drug in the last year Among 16 to 59 year olds who had used an NPS, 85% had used another drug in the last year. Similar proportion for young adults (85.2%) 10 Presentation title - edit in Header and Footer

11 But how many people are actually using NPS? Compared to traditional drug use, NPS use is pretty low The Crime Survey for England and Wales gives us some insight. NPS use is low (0.7% adults used them in the past year) Use is mainly among young adults (2.6% in the past year) For young people, the Smoking, Drinking and Drug Use survey tells us: Half of pupils have heard of legal highs 6% say they have been offered them 2.5% of pupils said they d taken legal highs this includes 2% who had taken them in the last year and 0.9% who d taken them in the last month 11 Presentation title - edit in Header and Footer

12 Nature of the problem

13 Where do people get NPS from? The CSEW tells us that people got NPS from: - 25% a shop (down from 34% the year before) - 35% a friend, neighbour or colleague - 9% a known dealer - 8% internet - 9% an acquaintance, stranger or dealer not known personally From the 2016 Global Drugs Survey - 50% internet - 24% shop - 29% friend - 15% dealer 13 Presentation title - edit in Header and Footer

14 Preventing NPS harm Building resilience Target generic risk factors (truanting, unstable home environments, offending) Build resilience and social capital (good social networks, stable homes) Increase the likelihood of preventing people from using drugs and becoming dependent on them. Give people opportunities for alternative, healthier life-choices, improving their skills, decision making and social capital. Information and campaigns Good education alongside accurate, relevant and accessible information Resources PHE summary of international evidence on prevention of drug use 14 Presentation title - edit in Header and Footer

15 What happens when people get into trouble with NPS? A&E Primary care Sexual health services Mental health services Drug treatment services 15 Presentation title - edit in Header and Footer

16 Dealing with acute NPS problems The dependence-forming potential of NPS is still largely unknown If people do need help, it s most likely acute NPS-related problems like agitation, palpitations, and seizures They will probably go to A&E first A&E staff need to be armed with better knowledge about NPS and know where to go for further information Needs to be good pathways to help people to get further help for NPS problems if they need it Areas with good clinical networks will be able to respond more effectively to acute NPS problems 16 Presentation title - edit in Header and Footer

17 What s coming into A&E? The largest increases in activity relate to synthetic cannabinoid receptor agonists (SCRAs) for which telephone enquiries increased more than 13-fold (from 10 to 131 enquiries), making these substances the second most common drug of misuse encountered in telephone enquiries after cocaine. National Poisons Information Service 17 Presentation title - edit in Header and Footer

18 Treating NPS problems Numbers in treatment are low, but have increased in recent years. club drug users respond well to treatment and successful completion is relatively high. Drug services need to be competent treat and provide harm reduction for specific health problems They also need to make themselves accessible to new groups of NPS users, and to develop good care pathways They should adapt current approaches to existing drugs rather than invent new ones. The key is to focus more on individuals and their symptoms than the specific drugs they are taking 18 Presentation title - edit in Header and Footer

19 Tackling NPS in prisons Staff should respond in a proportionate and relevant way to the behaviour or symptoms they re faced with, whether or not the prisoners are under the influence of NPS Prison healthcare providers, like all other treatment staff, should address the symptoms rather than focusing on the specific drug Each prison needs an integrated response between custodial, health and psychosocial care staff This response needs to be underpinned by a campaign directed at prisoners and visitors, describing the consequences and sanctions for possessing and using NPS 19 Presentation title - edit in Header and Footer

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21 The importance of information sharing 21 Presentation title - edit in Header and Footer

22 Local information sharing Information needs to be shared locally to help inform commissioning and provision of NPS interventions Local authorities need to determine NPS use and harm in their area, so they know how to respond Many local areas have existing networks that can share NPS information 22 Presentation title - edit in Header and Footer

23 Key local information includes Local NDTMS data reports from ndtms.net Formal and informal clinical networks Data on local sub-populations that may be at risk from NPS (e.g. MSM, vulnerable young people) Data and reports from A&E departments on NPS-related admissions Local police data and other intelligence on NPS-related incidents, Drug-related death information from local coroners Schools data on drug-related exclusions and other relevant incidents Other monitoring, such as incidents at local festivals and events Other relevant information, such as local surveys 23 Presentation title - edit in Header and Footer

24 National information sharing There are a number of existing systems with regularly gather relevant NPS information, including Early warning systems, such as the Drugs Early Warning System (DEWS), which makes specific requests for local NPS intelligence to feed back to central government Intelligence gathering like PHE s National Intelligence Network (NIN), which collects information on drug-related health harm, including NPS Patient data systems such as NDTMS National surveys, such as the CSEW Research reports and studies BUT PHE is trying to improve national information sharing. 24 Presentation title - edit in Header and Footer

25 New psychoactive substances intelligence system The overall aim is to reduce the length of time between drug-related health harm emerging and effective treatment responses We re doing by developing two main things: A national system for reporting the effects of NPS and other drugs, in a similar way to the MHRA s Yellow Card Scheme A NPS clinical network to analyse the data coming from this and other existing drugs intelligence systems, to identify harms, patterns and agree appropriate clinical responses 25 Presentation title - edit in Header and Footer

26 NPS clinical network Set up by PHE in early 2015 Brings together clinicians, other front-line experts and policy makers from across government. Specialisms include: Psychiatrists Psychologists Toxicologists A&E doctors CAMHS specialists Sexual health doctors and experts Homelessness experts GPs Meets every two months Discusses new information about NPS and its relevant for frontline practice 26 Presentation title - edit in Header and Footer

27 ACMD Home Office Forensic Labs FEWS DEWS Drugs Intelligence Systems NPS Clinical Network Proposed yellow card scheme Drug Alerts System PHE Drug Harms Depository National Level NPIS Regional Level PHE Centres Local Level Local Authority Co-ordinator/DPH DrugWatch National Forum Focal point NIN EMCDDA/ EWS Coroners Clinicians Trading Standards Local Network Treatment Police Other health services CCCG YOT HWB Schools Prisons

28 NPS Intel System Existing Drugs Intelligence Systems Analysis Proposed NPS reporting pilot Clinical reporting ALERTS Targeted comms: ( s) re acute health harms WARNINGS Website: Chronic and subacute health harms posted as necessary INFO Website: Briefings/newsletters on clinical management/ guidance etc. Clinical front line

29 RIDR( formerly IDRRIS) Report illegal Drug Reactions Joint project with MHRA Uses the architecture of the Yellow Card Scheme, but separately branded Information inputted, collated and analysed Alerts flagged Feeds into NPSIS for reporting to frontline 29 Presentation title - edit in Header and Footer