From club to clinic: Complex cases and clinical tools

• An update on NPS • Clinical cases – Manchester, London, Brighton • NEPTUNE guidance • How to build a local response

An update on club drugs and novel psychoactive substances

Dr Owen Bowden-Jones Addiction Psychiatrist, Imperial College London, UK

Club Drugs

• Club drugs tend to be used by teenagers and young adults at bars, nightclubs, concerts, and parties

(NIDA) • E.g. Cocaine, MDMA,

Ketamine, GHB/GBL, methamphetamine

Novel Psychoactive Substances

• Psychoactive drugs which are not prohibited by the United Nations Drug Conventions but which may pose a public health threat comparable to that posed by substances listed in these conventions

(UK Home Office) • E.g. Cathinones, synthetic

cannabinoids, piperazines

EMCDDA 2015

Number of internet sites selling NPS

New generation, new access

How big is the problem?

UK population estimates Crime Survey England and Wales (2013/14)

Treatment demand is increasing

UK stimulant deaths (excluding cocaine)

Who are using these new substances ?

Depends where you are, and who you are !

• Clubbers and students - Major cities, University towns

• MSM- London, Manchester • Heroin users moving to mephedrone injecting

- Yorkshire, Lancashire, Nottingham, South Wales

• Ketamine-Squats and alternative communities • Ketamine and mephedrone ‘Kit-kat’ • ‘Bubble’ – generic white powder

Are we looking in the right place?

Perfect drugs for prisons? Cheap, potent, undetectable

Are services ready to identify and treat harms associated with NPS and

club drugs?

• New drugs – Little/no research into treatment – Harms still poorly understood – Other ‘club drugs’ are different to traditional

drugs e.g. Ketamine bladder – Rapidly changing profile

• New populations – Different context of use e.g. methamphetamine

and high risk sexual behaviours – Not ‘typical’ drug user. How to engage?

HEROIN CRACK

COCAINE

CANNABIS

ALCOHOL BENZOS

piperazines tryptamines

phenethylamines

synthetic cannabinoids

synthetic cathinones

new synthetic opioids

‘others’

Challenge for specialist drug services

• Clinical staff have poor knowledge of changing patterns of drug use

– ‘technical’ knowledge (what are the drugs, how

do they work) – ‘cultural’ knowledge (who is using, how are they

using) – ‘clinical’ knowledge (how to clinical manage

acute/chronic presentation) – ‘service’ knowledge (when and where to refer)

Six steps to meet the challenge • Step 1: Widen the front door

• Step 2: Support the frontline

• Step 3: Connect the frontline

• Step 4: Watch horizons for harm

• Step 5: Promote research into

club drugs and NPS

• Step 6: Empower users through education

www.rcpsych.ac.uk/pdf/FR%20AP%2002_Sept2014.pdf

Detection Assessment Brief Intervention

Complex Intervention (Acute)

Complex Intervention (Chronic)

Primary Care ✔ ✔ ✔ ✖ ✖

Emergency Room ✔ ✔ ✔ ✔ ✖ Sexual Health ✔ ✔ ✔ ✖ ✖ Mental Health ✔ ✔ ✔ ✔ ✖ Prison Health ✔ ✔ ✔ ✖ ✖ Specialist Drug Services ✔ ✔ ✔ ✔ ✔

Conclusions • NPS presents a huge challenge for treatment

services, both specialist drug services and other health settings.

• Limited knowledge on clinical harms, user profiles, engagement strategies and treatment approaches

• Responses require adaptation of existing evidence-based interventions supported by investment in training and further research

• Project NEPTUNE is a new approach to meet the challenge

Owen.bowdenjones@nhs.net

Clubdrugclinic.cnwl@nhs.net

www.clubdrugclinic.com

@ClubDrugClinic

Clinical cases