Dear all, For the service user survey:

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1 Dear all, I wanted to touch base about research I have been commissioned to do by Scottish Government that I am doing in conjunction with Glasgow University looking at New Psychoactive Substances Prevalence, Harms and Motives for Use in Scotland amongst vulnerable groups. The research is now in Phase two which is two short surveys, one aimed at service users/clients and the other at frontline staff. A summary of the research along with ethical approval for the study follows this letter. Ethical permissions are now in place for all services including third sector, NHS and social work services in your area- please contact me if you require a copy of the R and D permissions for your area. For the service user survey: We are looking to recruit from target populations: 1. adult homeless 2. injecting drug users 3. mental health service users 4. men who have sex with men (MSM) 5. at-risk young people, including a. Looked after and accommodated young people b. Care leavers c. Young homeless d. Young people not in employment, education or training (NEETs). The survey is available both electronically and it can also be researcher administered in person. The latter involves one of our trained researchers attending your service or a local drop in and supporting clients to fill in the survey on an Ipad. Whilst the research with service users is keen to capture experiences of people who have used NPS, this is not essential criteria to participate in the research so it can be disseminated to any clients. If you think your service would be willing to have peer or staff researchers attend to collect responses please get in touch with Katy MacLeod on katy@sdf.org.uk or If people wish to self administer the survey, they can complete at:

2 A poster advert that can be displayed in services is attached at the end of this document- please let me know if you would like me to send you printed versions. For the staff survey We are looking to recruit staff involved in frontline work with people who use substances. This can include services such as homeless/housing, drug services, young peoples services, mental health, sexual health, social work. The survey is available electronically at the link: It takes only a short time to complete and has been tested on both NHS and council systems for access. If you do have any issues completing please don t hesitate to contact me directly. Many thanks for reviewing this information and please feel free to circulate to workers you feel would be able to assist either with service user recruitment or who are working with NPS users in their role. Apologies in advance for any cross posting. Kind Regards, Katy Katy MacLeod National Training and Development Officer Tel: Mobile: katy@sdf.org.uk Scottish Drugs Forum (SDF) is a company limited by guarantee, registration no with charitable status and is also a registered Scottish charity registered SC Registered Office: 91 Mitchell Street, Glasgow, G1 3LN.

3 Method Summary Understanding the Prevalence, Motives and Harms of New Psychoactive Substances (NPS) Use in Scotland Dr Lucy Pickering, Ms Katy MacLeod, Phone mobile This is a mixed-methods study on New Psychoactive Substance (NPS) use in Scotland. Following extensive literature searching (Fraser 2014), the Scottish Government has commissioned this piece of research in order to progress understanding of the ways in which at-risk populations make choices about whether to use NPS, how to use them and manage any harms which may emerge as a result of NPS use in order to help inform Scottish Government policy making in this field. In order to address the gap in current published work on NPS use identified by the Scottish Government, we will be asking the following research question: What is the prevalence, motivations for and harms of New Psychoactive Substance use in Scotland? This is explored through the following sub-questions: 1. What is the prevalence of use of different categories of NPS amongst target populations in Scotland? 2. What are the stated motivations for experimenting with and continued use of NPS among target populations in Scotland? 3. How are the harms associated with the use of NPS understood by those who use them and those who provide specialist services to target populations in Scotland? Emerging from the Scottish Government s review of the literature, it has identified the following populations as the focus for this study: 1. adult homeless 2. injecting drug users 3. mental health service users 4. men who have sex with men (MSM) 5. at-risk young people, comprised a. Looked after and accommodated young people b. Care leavers c. Young homeless d. Young people not in employment, education or training (NEETs).

4 To identify the prevalence, motivations for and harms of NPS use among at risk groups in Scotland both qualitative and quantitative methods are required. The methods of data collection and analysis are outlined for the three research stages below: STAGE 1: IDENTIFYING HARMS AND MOTIVATIONS 1a) Harms and Motivations among Users The first component of Stage 1 focuses on qualitative data collection with users of NPS in the target populations (adult homeless; injecting drug users; mental health service users; men who have sex with men; and, vulnerable young people (accommodated and looked after children; care leavers; young people not in education, employment or training; young homeless). Given the potentially sensitive nature of data collection, motivations and harms will be explored using semi-structured one-to-one interviews. This semi-structured interview approach allows interviewers to ensure that key areas are covered (such as first trying, modes of acquisition, negative effects and future intentions) while remaining open to the narrative as presented by the participant, which emphasises the factors they consider important to understanding their motivation and their understanding of associated harms. This interview approach further enables participants to control the tempo of the encounter and to minimise bragging or distress triggered by other participants as may occur in, for example, a focus group setting. A stratified purposeful sampling method will be used to identify participants across the five target populations in order to maximise diversity of life histories within the target populations, enhancing the range of responses, necessary to build the survey tool. These samples do not seek to be representative of the Scottish population at large, but rather to ensure a breadth of experience in order to enhance the robustness of the survey tool. Six interviews with each of the adult populations (adult homeless drug users, injecting drug users, mental health service users and men who have sex with men) together with two interviews with each of the youth groups (looked after and accommodated children, care leavers, young homeless people and NEETs) results in a total of thirty two interviews exploring the factors that contribute to motivations for use and experienced (and anticipated) harms. Saturation is an important tool in qualitative research, and we anticipate having reached the point at which no new factors emerge in interviews (saturation) after these thirty two interviews. However, if this has not occurred we have costed for up to twelve interviews with young people to ensure that we achieve saturation across this diverse population which will bring the interview total to thirty six. Participants in this stage of the project will take part in a sixty minute one-to-one semistructured interview exploring their experiences of NPS use and related harms. Each interview will allow ample time for consent processes and discussion after the interview, particularly if participants seek further information about sources of support, details of which the interviewer will bring with them and provide on request. They will be reminded before and after the interview that their participation is voluntary and they are free to withdraw from the study or redact any answers. All Stage 1a participants will receive a 10 high street voucher to thank them for their contribution. 1b) Harms and Motivations as Identified by Associated Professionals Complementing this, we will organise a series of focus groups with workers in services, providing specialist youth services, mental health, homeless services, needle exchange, drug services and sexual health in urban and rural Scotland to identify the motivations for use and harms that they see in their work. Given the less sensitive and personal nature of these disclosures, and the importance of drawing out commonalities and differences across services, focus groups are the most appropriate data collection method. In line with the

5 interviews, a topic guide will be used by the facilitator to ensure that key issues are discussed while creating space for participants to raise unanticipated factors. Focus groups will comprise eight to ten multi-disciplinary professionals: we will host four focus groups to ensure a representative geographical spread. STAGE 2: QUANTIFYING PREVALENCE, HARMS AND MOTIVATIONS Generating Estimates from Existing Data Sets We will use data on the proportion of NPS users in treatment from the survey as a multiplier and apply it to SDMD NPS treatment data to produce a basic estimate of NPS use this will be contextualised with relevant Scottish Crime & Justice Survey, NDRDD and HEs data. Needle exchange data from the NEO harm reduction management database will be used to produce estimates of injecting NPS use for at least two NHS Board areas (Greater Glasgow & Clyde and Lothian). The Truncated Poisson method will be applied to service usage data in order to produce these estimates of more high risk NPS users. Developing the Survey Tool A drug and alcohol use survey will be administered to members of the five target populations in order to identify prevalence rates of NPS use, and among those who claim NPS use, the motivations and harms they identify with. The categories for inclusion in the survey tool will be identified out of thematic analysis of the Stage 1 data. Both common and uncommon themes will be identified and included on the survey, together with free-text boxes for any effects not covered by the survey tool. 2a) Survey with Target Populations The survey tool will be a short self- or peer researcher-administered questionnaire containing elements common to all target populations including demographic data, recent drug use (of both NPS and non-nps substances; NPS will be broken down into types of NPS), motivations for use, and negative experiences and support solicited or desired. There will be further sections which will only be activated if participants answer yes to certain signposting questions, such as Have you ever injected NPS?, which will activate detailed questions on injecting practice, or, for male participants, Have you ever had sex with a man? which will activate questions on NPS use in the context of MSM sexual activity. Where appropriate the survey will be electronic, and participants who are likely to have easy access to the Internet (e.g. men who have sex with men) will be provided with a web address at which to access the survey; given the targeted nature of the survey, the web address of the survey will not be advertised to the general public. In addition, the survey will be administered by trained peer-researchers recruited from the pool of peer-researchers at the Scottish Drugs Forum. Many peer researchers will have previous research experience and all will receive training in survey interview skills, equality and diversity, child and vulnerable adult protection and also in advanced NPS awareness prior to data collection. We anticipate receiving back a minimum of two hundred completed surveys, which will provide a sufficient basis from which to quantify the motivations and harms thematically identified in Stage 1. Participants in Stage 2b will complete the survey either alone or with a peer-researcher. Although the exact form of the survey is not yet known, in order to enhance completion rates, the survey is expected to take ten to fifteen minutes to complete. The use of peer-researchers will enable us to access participants who lack sufficient literacy to complete the survey alone and to ensure they are included and represented in research. All participants in Stage 2b will be invited to participate in a draw for 100 vouchers from a selection of shops, e.g. Boots, Amazon etc, which cannot be used to buy tobacco or alcohol; all participants who wish to enter

6 the draw will have their contact details for the draw stored separately from their survey responses. 2b) Survey with frontline staff A second survey, structured around the same themes as the survey for NPS users, will be administered to front line staff working with NPS users in Scotland. The survey will be electronic and self-administered to enhance participation. We anticipate a minimum of 75 will complete the survey but will aim to get as large a sample size as possible. Again, although the exact form of the survey is not yet known, in order to enhance completion rates, the survey is expected to take ten to fifteen minutes to complete. Both Stages 1 and 2 will be piloted with two interviews and ten survey participants prior to being rolled out. In both pilots participants will be asked for feedback on the questions, and questions will be revised in the light of their feedback. At the same time, the Advisory Group will be asked to provide feedback on both sets of questions to maximise the utility of the questions for these populations. STAGE 3: ANALYSIS AND DISSEMINATION Qualitative analysis will have already been undertaken at the end of Stage 1 to inform the survey design. Stage 3 analysis will consequently focus on statistical analysis of survey data, and thematic qualitative analysis. Survey data will be collated and entered into SPSS for analysis; qualitative data will be entered into Quirkos for analysis. The analysis will focus on identifying NPS prevalence among the target populations. Through the use of descriptive statistics we will examine NPS use by substance used, region, gender, age and population. The survey data will also allow us to explore any differences between the target populations with regard to risk behaviours, methods of purchase/access, onset of use, perceptions of use, frequency of use and poly drug use. The use of regression analysis will allow us to test any statistically significant correlations by controlling for demographic or other factors. These findings will be further explored using the qualitative data to unpack causation in support of the identified correlation. Qualitative analysis will be thematic. At Stage 1 transcripts will be coded in relation to two primary codes, motivations' and harms, to identify categories for Stage 2 survey design. At Stage 3, the coding will be more inductive, whereby Greenwood will code any sections of text which help answer the research question in the broadest sense. 15% of transcripts will be simultaneously coded by Pickering for member checking to ensure consistency of coding. After analysis, findings will be reported, highlighting both typical and non-typical responses: both are significant in informing policy and service delivery.

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