An event organised last week by the Criminal Justice Centre, School of Law, QMUL and DrugScience titled “New Psychoactive Substances (NPS): Science, Law and Policy” offered in-depth discussions of NPS by bringing together academics and practitioners from various backgrounds including science, health, law, market involvement, and drug policy advocacy.

Science

NPS can pose serious harms to health. For researchers working in the field of NPS, the limited accessibility to usage information poses a great difficulty.

Professor Rudi Fortson QC (left) and Professor David Nutt (right) chair an open discussion with conference attendees.

Dr John Ramsey explained that there are several traditional approaches to discern which NPS are being used, but each of them has serious shortcomings in terms of accuracy and completeness. Relying on self-reporting, questionnaires, and website monitoring is insufficient since users often do not know the specific compound they are taking. Similarly, police reports and hospital admission staff often fail to accurately record the consumed substances reported, making this data source unreliable. Death reports produced by coroners are also insufficient, partly because the role of the coroner is to exclude the possibility of crime rather than accurately report the cause of death, and also because the coroner’s report can take up to a year after the death has occurred, a delay unsuitable for responding to the ever-changing NPS market.

So how are researchers gathering reliable data on NPS? By collecting samples from wastewater (sewage) and pooled urine! There are, of course, limitations to these sources as well. The former can only provide information on commonly consumed substances, as there has to be a high level of drug use for it to be detectable in wastewater. Pooled urine collection allows detection of substances that would not arise in wastewater analysis; however, as one can imagine, the collections are primarily from male subjects.

Drug checking services were not discussed during the event, likely because the speaker was focusing on methods currently used in the UK. However, it is worth highlighting drug checking as a very successful initiative that allows people who use drugs to know which specific compounds they are taking, and therefore improves public health while also gathering critical data on what drugs are being bought, sold, and consumed. Such a scheme would increase researcher accessibility to information about NPS usage in the UK, and would empower people who use drugs to make informed decisions about their use.

Law

Many believe that there are no laws regulating the sale and use of NPS. However, there are several cases in which some “legal” highs may in fact be illegal. In order to develop a sensible legal scheme to deal with NPS, Professor Rudi Fortson QC explained that we must be aware of existing laws.

In the UK, there have been court cases in which NPS were prosecuted through the Misuse of Drugs Act. One such case found that some of the batches created by a chemist and intended to be NPS in fact produced substances banned under the Misuse of Drugs Act. Another case featured a chemist that, while producing NPS, had to go through various banned chemical compound structures.

NPS can also fall under the “medicines” legislation, which covers 1) any substance presented as having properties of preventing or treating disease in human beings; or 2) any substance that may be used by or administered to human beings with the view to restore, correct, or modify a psychological function. The first part of the definition explains why retailers present NPS as “bath salts” or “plant food”. The second part means that a product can be considered medicinal even if it has no medicinal value. Since the sale and consumption of unauthorised medicinal products is not permitted by law, if NPS are treated as medicinal products, their sale and consumption can be considered illegal.

Several other regulations can be used to prosecute the sale of NPS in the UK, many of which involve packaging deception (although the average consumer taking NPS usually intends to do so and is thus generally not deceived by the packaging). This was illustrated in Belfast, where the General Product Safety Regulations (which essentially ensures that no manufacturer puts unsafe products on the market) have been employed to discontinue the sale of NPS by all but one retailer – and this last retailer is on its way to court.

For retailers, the limitations on product safety labelling mean that they have to rely on users doing their research and using common sense. There are, however, several voluntary actions taken by in-store retailers to enhance NPS safety, including: lab testing, human testing (retailers and customer groups), single dose packaging, minimum age of 18 (verified via social media checks), refusing sale of excessive quantity, and daily monitoring of the internet for policy changes and other information.

Despite these precautions, within the current legal regulations, retailers are stuck between a rock and a hard place. On the one hand, they cannot present NPS as being for human consumption (and therefore provide all the necessary safety information) because the products may then be considered medicinal. On the other hand, they cannot simply label their products as “plant food” as they will then be violating several packaging deception laws, such as the General Product Safety Regulations. The laws must be revised to reflect a pragmatic solution to NPS that recognizes the existing demand for substances and prioritizes public health.

Conference attendees supported the legal actions taken in Belfast, as most believed that the use of existing legislation should be fully employed before the creation of any new law. Attendees agreed that a blanket ban on the sale of NPS until substances could be adequately tested and proven to pose low harm for human consumption was an appropriate strategy moving forward. However, previous experiences have shown that the banning of all substances is often accompanied with the emergence of their sale on the black market to meet demand, both online and offline. For consumers, this means having access to even less information about what they are purchasing – often resulting in greater levels of harms. Shutting down NPS retailers therefore does not equate to shutting down NPS sales. It is important to move harmful substances out of the marketplace, but without giving consumers viable alternatives, many will turn to the black market. This is what New Zealand has tried to do with their NPS legislation, which will enable the least harmful substances to be sold to meet demand. Such a regulatory framework should be considered in the UK.

This event was the first in a series of conferences exploring the future of pharmacological regulation. Look out for future events by following @Drug_Science, visiting http://www.drugscience.org.uk/, and keeping an eye on the IDPC events page

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