It is important to emphasise that our focus was explicitly on new compounds and not on the use of established drugs. Indeed one of the implicit conclusions that emerged from both workshops was that it was important to differentiate policies appropriate to different drugs and different groups of users. A significant source of unintended harm and confusion arises as a result of the attempt to lump all drugs and all users into the same category.

This is an anonymised list of the participants who attended the first workshop:

·    a civil servant (enforcement)
·    a civil servant (health)
·    a civil servant (young people)
·    a police officer
·    a police officer
·    a director of medical research, leading charity
·    a parent (affected by their child’s use of a ‘legal high’)
·    a director of a leading reformer charity
·    a pharmacologist
·    a frontline worker, charity focusing on the club scene
·    a frontline worker, London borough charity
·    a peer support worker, London borough charity

Why do young people use drugs?

Participants in the first workshop agreed that most young people do not use drugs. Those that do, do so for a variety of reasons. For some it is fun, curiosity, exploration, and there are some who just like the effects. Others may explore drugs but then decide they do not like the effects. Teenage years are characterised by boundary testing, experimentation, rebelling and trying something just because it is new. Some use drugs as a way to escape stresses of family, work or the boredom of day-to-day life. Only a small minority of young people who try drugs end up running into difficulties. This minority are often but not always from disadvantaged backgrounds or otherwise in a high-risk group.

The participants with experience of working with young people who run into trouble with drugs agreed that for many of them the use of drugs was a symptom of other problems, not a cause. The same young people were likely to be in trouble with anti-social behaviour, crime and promiscuous sex. Members of this group were not hard to identify and the workshop participants, particularly civil servants and frontline workers, felt that the best approach was to devise ways of enabling them to make less risky decisions. This could be done, in part, through education and providing parental and community support services. Laws about drugs were going to be as ineffective as laws about sex with this group, and ‘legal highs’ posed simply another risky opportunity.

Participants agreed that there were many influences and environmental factors acting on young people that may have an effect on drug use and experimentation, including family pressures and attitudes to drug taking, community cultural norms, risk-taking behaviour, youth culture, music and the media (‘social norms’). Personality traits including potential genetic influences are also significant, including being prone to thrill seeking, anxiety and depression. All participants argued that identifying these young people and working with them to address those underlying factors that can be changed early on (which could happen at school) could reduce drug use later.

However, although a range of factors was identified as likely to be significant, there was still no proven evidence known to participants explaining why drug and alcohol use among school pupils has been steadily declining for the last decade.128 There is clearly scope for improving our understanding and using this to provide guidance and advice to those groups at greatest risk. One proposed way forward is to analyse why some young people do not use drugs (particularly those in a high-risk group), rather than to ask why those who do use them do so.

Box 13    Positive drug experiences

It is estimated that over one-third of 16–59-year-olds in England and Wales have used an illicit drug at some point in their life. This does not of course make it right or beneficial. But many will have got some pleasure, at least initially, and sometimes over a longer period.

There are a number of benefits that people derive from psychoactive substances. The first area is that of mood enhancement, which is said to improve openness, reduce inhibitions and increase social bonding. This is the basis of the ‘having fun’ aspect of drug use and is very similar to the benefits obtained from the social use of alcohol. The second area of benefit is the reported increase in creativity experienced by many people using drugs such as cannabis, hallucinogens and cocaine. This use of drugs has a long history in human culture and accounts for the popularity of many drugs with artists, musicians, poets and people working in the creative industries.129

The third area of reported positive experience arises as a result of enhanced sensory perception and experience, particularly associated with listening to music, watching films and sexual experiences. The fourth domain was promoted as the basis of the cultural revolution in the 1960s and is the reported expansion of consciousness or awareness associated with many, but not all, illicit drugs. Many young people report highly significant spiritual and psychological experiences with drugs, events that can often be interpreted as shaping their lives for the better. The famous ‘Good Friday experiment’ carried out at Harvard in 1962 has recently been repeated as a double-blind clinical trial to test the effect of psilocybin with 36 volunteers who had never used hallucinogenic drugs. The authors concluded, ‘The most striking finding... is that a large proportion of volunteers [67 per cent] rated their “psilocybin experience” as among the most personally meaningful and spiritually significant of their lives’.130
Many of the reported positive effects of drug use appear to depend on the relaxation of perceptual, cognitive and sensory filters that normally condition experience. However, those relaxations can also be the source of difficulties for vulnerable groups, since a similar process can result in the psyche being overwhelmed by paranoia and psychoses. Finally, the fifth domain of positive experience for drugs is the role the play in facilitating the all-night dancing which characterises the club and rave culture that emerged in the 1990s and continues to this day in the UK and across Europe.

For any drug control policy to be more effective at controlling new substances it will, at some point, have to acknowledge this reality.

What is the aim of drug policy for young people?

There was some debate in the workshop about what the goal should be for drug policy for young people. Participants felt that there was an expectation among parents and the media that laws that prohibit the distribution and use of drugs can invariably protect young people. Nearly all of the participants agreed that it was unrealistic to aim to prevent all drug use among young people, and yet this aim is the source of much of the demand for tougher legislation and enforcement. While some argued this was not even desirable, the majority agreed that while it may be desirable it was not a feasible aim. A recent estimate indicates that customs and the police intercept about 1 per cent of heroin and crack cocaine entering the UK, an indication of the impossibility of effectively enforcing drug laws .131 With over a third of the adult population reportedly having used an illicit drug at least once, including over 20 per cent of school pupils in the UK population, drug control legislation apparently does not prevent use of illicit substances.

Nevertheless the need for protection, especially for young people, was clearly recognised throughout the workshop debates. Participants agreed that in an ideal system, the aim of drug policy would be to enable young people to make informed and responsible choices about substance use before they risk becoming regular drug users in order to enable them to realise their full potential as adults.

This required:

·    providing accurate, accessible and relevant information, combined with education and development of skills, to young people, parents and communities
·    targeting the information, education and skill development particularly to at risk groups (recognising that different groups require the material to be presented differently)
·    providing mentoring services to offer extra one-to-one support

The importance of information on new psychoactive substances

Participants agreed that the best foundation for reducing harms to young people was to provide accurate, relevant and helpful information and advice. Information about the nature and effects of new substances was considered to be crucial for everyone involved in the drugs field for the following purposes:

·    effective drug education to enable young people to make informed decisions about whether or not to use drugs
·    development of strategies to encourage young people who choose to use drugs despite knowledge of dangers to make less risky choices
·    treatment of those who have problems as a result of drug use
·    understanding the extent and nature of use and making decisions on appropriate control measures
·    enforcement of relevant controls

In this context it was also recognised that at the very least there were three separate groups to be targeted:

·    youngsters who have not yet tried any drugs; the aim would be to provide information to enable these young people to make an informed decision about the health and legal risks weighed against the potential benefits of taking drugs
·    those who had already used drugs and would continue to do so; the focus would be to provide this group with information on how to use drugs safely and the warning signs of imminent trouble
·    those who were already experiencing difficulties in the form of dependency, paranoia or excessive use; the focus would be on providing information on self-help and treatment options

It was recognised that providing information to these different target groups could pose problems, especially when giving messages about avoiding use to one group and how to use drugs safely to another group.

There was a serious problem with assembling reliable information on new psychoactive compounds – effects, dosage and hazards – especially when combined with other intoxicants. Some participants felt that our knowledge about new substances becoming available is very poor and that controlling a substance under the Misuse of Drugs Act (MDA) makes collection of the necessary information more difficult. This was seen by the participants as one of the many unintended effects of classification and scheduling.

Legality and classification: unintended consequences

Workshop participants recognised that there were a number of potentially important unintended harms that resulted from current drug legislation. Participants, particularly the police, saw one of the biggest harms of classification as the criminalisation of large numbers of young people. In a system as complex and varied as the supply and use of hundreds of different psychoactive compounds, there will inevitably be unintended consequences of any control regime. Although it is impossible to devise a perfect system, most unintended consequences could be anticipated, and they should be considered in framing new regulations for new compounds.

The frequently repeated view that the MDA had passed its sell-by date was based partly on the poor relationship to levels of harm,132 and also related to the number of unintended harms it created. Some participants – particularly reformers – noted that there has been a steady move toward de-penalising and decriminalising substances for personal use (see review in chapter 2) in other countries. Although not explicitly stated at the workshops, this suggests that the consideration of unintended harms should be part of the remit of the Advisory Council on the Misuse of Drugs (ACMD) in considering its recommendations to government.

It was also felt that drug policy and the classification of drugs were of little significance to those using drugs (though it may inhibit some from starting to use them). Legality was felt to have a greater impact on sellers than buyers: high street shops and domestic internet outlets were unlikely to persist once a compound was classified, leaving the only sellers on the streets and the profits financing organised crime. The issue of legality was also tied up with the purity of drugs. It was reported that while new compounds were legally available they were very pure; once they became illegal then the purity was variable. The loss of purity and labelling meant that users of the compound were less able to gauge dosage. Also as one compound was made illegal, users were likely to switch to another – one that might be more toxic and on which there may be even less information available within the user community.

There was general agreement that it was difficult to establish whether making a drug illegal increased or decreased the harm to young people. On the one hand it might deter some, but the illegality may also make it more attractive to others (some concluding that it must be good if government bans it). The loss of purity and user information – both arguably consequences of MDA classification – increased the risks among those using the drugs. The classification of drugs is currently unsatisfactory, with some widely used drugs still legal (poppers, nitrous oxide and GBL).

Improvements to drug policy to better protect young people

The Coalition Government is committed to looking at new ways to influence people’s behaviour in order to encourage them to make less risky choices and act more responsibly. This emphasis on influencing choices around risky behaviour was in evidence throughout the workshops we conducted. While legislation can impact on drug use prevalence, there are a number of issues relating to drug education and availability of information that suggest current approaches are not effective at influencing behaviour. As noted above, influencing less risky behaviour is especially important for young people who display background factors that predispose them to greater risk taking.

It was generally agreed that broader intervention initiatives delivered in schools and communities, such as Strengthening Families, could have more of an impact on drug use than interventions that were drug-specific. These broader initiatives helped to build emotional resilience among young people to withstand the pressures and influences around drug use that they are inevitably exposed to. In a recent meta-review of evidence by a team of international scientists from a variety of fields, it was argued that family, community and school-based interventions in the USA that focus on a ‘broad set of mental, emotional, and behavioural disorders as well as drug use’ have been shown to have more impact than ‘purely didactic prevention programmes’.133

Workshop participants agreed that addressing the problem of a lack of information was the most useful way forward to improve the protection of young people from new psychoactive substances.134 Key activities identified by workshop participants included:

·    creating a framework that allows better information sharing between frontline workers, users and the government
·    providing support for testing facilities in clubs and other venues where synthetic drug taking is prevalent

Creating a framework for better information sharing between frontline workers, users and the government

One route identified was to establish ways in which front-line organisations and charities working with drug users could collate information and provide it to a coordinating body, possibly the ACMD. The Coalition Government is planning an early warning system but it was felt that government and agencies needed to make better use of the potential data that are and could be made available (eg the Mixmag surveys), but also initiate more comprehensive information-gathering initiatives and processes. Frontline workers felt there was a wealth of information about new drugs available, through their work and myriad drug user forums on the internet, pharmacists, A&E and research literature. However, at present, no systematic framework existed to collect this information and disseminate it to the Government, the ACMD, public health and police bodies, other charities or to young people.

Creating this type of framework (partly envisaged in government plans) was seen as key to anticipating the arrival of new compounds, rather than continually playing catch-up. Three specific ways this could be achieved were identified:

·    searching internet chat rooms where users exchange information on new substances and their effects
·    approaching (largely Chinese) manufacturers of ‘legal highs’ to enquire what compounds they were researching or preparing
·    using the commercially available pharmacological testing procedures used for assessing new medicinal compounds, which would give reasonably accurate data on how the compound functioned pharmacologically, its likely effects and toxicity, all essential information in preparing any regulation strategy

It was also felt that Government and the ACMD needed to develop a minimum data set of information, and that approaches cannot be substance-specific. According to our eminent pharmacologist participant, a full trial of mephedrone could take five years, so there is a need to be pragmatic and develop an approach that can deal with a variety of new and emerging substances. It was argued that in vitro testing can provide a rough profile of effects of new substances.

While policy makers and ministers are playing catch-up they will always be prey to media campaigns and political pressures at critical junctures demanding action on new substances. If they can garner better intelligence they may be in a better position to respond to or be in advance of media and political concerns. Such approaches combined with complementary control approaches (along the lines we set out in chapter 5) could offer novel approaches to control new substances.

Provide support for testing facilities in clubs and other venues where synthetic drug taking is prevalent

One of the most significant problems facing enforcement and drug users alike is growing deception in drug markets. Mephedrone is being sold as cocaine, BZP is being sold as mephedrone, and some pills contain a mixture of illicit and licit substances. This deception about dosage and strength levels makes it difficult for individuals to make informed decisions about the risks they would take by consuming an illicit substance. Providing them with reliable and accurate information can allow them to make less risky choices (including to use less or no drugs) and act more safely and responsibly. Providing financial support for these activities is not necessarily something that the Government need do. However, as a principle, funding should not be withdrawn from charities and organisations that are providing these services.