Impact case study database

The use of NPS can have devastating and far-reaching consequences for the health of individual users, both through NPS’s own effects and through their acting as a gateway to other drugs. The effects can also be felt by families and communities, as a result of the increased anti-social behaviour and crime associated with NPS use. It also has implications for social and health services which have to deal with these detrimental effects. The research conducted by Opacka-Juffry ( R1) has influenced changes in UK policy around NPS, namely amendments to the 1971 Misuse of Drugs Act, which were consequently associated with a decrease in the use of NPS in the UK. The body of work ( R1- R5) has also informed professional practice of frontline clinicians and major drugs charities and organisations regarding NPS in the UK, EU and USA.

In November 2013, the Advisory Council on the Misuse of Drugs (ACMD), an independent expert body that advises government on drug-related issues in the UK, provided a report to the Home Secretary reviewing the evidence of misuse and harm in relation to benzofuran-type substances, entitled Benzofurans: A review of the evidence of use and harm. This ACMD review used the research finding that 5-APB has potential addictive and hallucinogenic properties ( R1), which was first published online in September 2013, following Opacka-Juffry’s presentation of R1 data at the Festival of Neuroscience in April 2013 and related global press coverage. The research findings ( R1) were used by ACMD to demonstrate that benzofury has affinity to DAT (in brain tissue in vitro) and 5HT₂ receptors ( in vitro and in vivo), establishing its potentially addictive and hallucinogenic nature ( IMP1). Among the 17 research publications, original reports and reviews constituting evidence used by the ACMD, R1 was one of only two benzofuran papers in the Pharmacology section. The research was therefore instrumental scientific evidence in the recommendation to permanently ban benzofury and related compounds as class B substances under the Misuse of Drugs Act 1971.

The Misuse of Drugs Act 1971 can be amended by a parliamentary order. The ACMD request to the Home Secretary in 2013 that benzofuran compounds become permanently controlled as Class B substances ( IMP1), based upon evidence including the research co-led by Opacka-Juffry, resulted in Amendments to the Misuse of Drugs Act. Statutory Instruments No 1274/2014 were made on 16th May 2014, laid before Parliament on 20th May and came into force on 10th June ( IMP2), bringing benzofuran compounds (including benzofury) under permanent control as Class B drugs under the Misuse of Drugs Act in England, Scotland and Wales. The same applies to the Statutory Rules of Northern Ireland 2014 No. 158 on The Misuse of Drugs (Amendment No.2) ( IMP3). These legislative changes paved the way, in May 2016, for a further Act of Parliament, the Psychoactive Substances Act 2016, which was introduced to ban all new NPS in the UK, restricting their production, sale and supply. This new act was the governmental response to the growing body of evidence of harmful effects of NPS and their prevalence, derived from both practice and research.

Following the legislative changes, reductions in NPS use have been reported by the Drug Misuse Statistics branch of the Home Office since 2014, evidencing the reach of the impact: from 8.4% in 2014/15, down to 7.7% in 2015/16 and 4.2% in 2016/17 (as a percentage of adults using NPS). Furthermore, a Home Office Review of the Psychoactive Substances Act 2016 published in 2018 indicated the significance of the impact, demonstrating that as a result of the introduction of the Act there was a fall in the number of individuals in treatment for NPS, particularly for NPS with a predominantly stimulant effect. There was a 29% reduction in England in the number of adults (aged 18 or over) presenting to treatment citing NPS, from 2,042 in 2015/16 to 1,450 in 2016/17 ( IMP4).

Opacka-Juffry's research on benzofury ( R1) has also influenced professional practice in the UK and the EU. It was used in March 2015 as evidence of the harmful effect of benzofurans in the Novel Psychoactive Treatment UK Network (NEPTUNE) report Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances ( IMP5). The NEPTUNE report provides guidance to practitioners in the UK on the clinical management of NPS use. This guidance has also reached other countries in the EU as it is promoted by The European Monitoring Centre for Drugs and Drug Addiction. In addition, the UK Government 2017 Drug Strategy (July 2017) was informed by, refers to and endorses the NEPTUNE Guidance which cites R1, along with other national clinical guidance and policy documents, including Drug misuse and dependence: UK guidelines on clinical management (Department of Health, July 2017). By informing targeted, setting-specific, evidence-based resources produced by NEPTUNE, the research has contributed to changes in the way health professionals across the UK are being advised to treat problems associated with NPS ( IMP5). This research has also had impact outside the UK and Europe. Rehabilitation centres in the USA have used the research findings to warn vulnerable people against benzofury use as it can lead to dependence and addiction. For example, patient advice ‘What Is Benzo Fury? ’ issued by Lasting Recovery rehabilitation treatment centre in San Diego, USA, 2016 cites the research ( R1): ‘”The risk of addiction is very real,” Professor Jolanta Opacka-Juffry of Britain’s University of Roehampton says, “Pure hallucinogens are not addictive as such because they do not cause an increase in dopamine release, unlike amphetamine or cocaine. But benzofury with its mixed properties is a trap, as its repetitive use for the hallucinogenic effects could lead to dependence”’ ( IMP6).

In 2016, Opacka-Juffry was awarded a place in The Royal Society Pairing Scheme and spent a week in Westminster carrying out knowledge transfer of the underpinning research on NPS ( R1- R3), which she shared with civil servants by invitation from the Home Office Drugs and Alcohol Unit . In March 2017, the Head of the Home Office Drug Legislation visited the University of Roehampton to meet with Opacka-Juffry, collaborators and the Chief Executive and staff of Blenheim CPD, a major charity that supports approximately 11,000 people each year who suffer from drug and alcohol misuse. This facilitated further discussion of NPS research outcomes ( R1- R3) and enhanced the stakeholders’ understanding of health risks associated with NPS. The research was shared with the Home Office and Blenheim ( IMP7). The UK Government 2017 Drug Strategy was informed by the research and the NEPTUNE report .

Opacka-Juffry has also used the body of research on NPS ( R1- R5) to raise awareness amongst practitioners in professional support services, who use this knowledge to prevent vulnerable communities from using NPS and to inform existing NPS users of their addictive properties. The significance of Opacka-Juffry's research is demonstrated through her sustained engagement with Blenheim, with whom she delivered five annual workshops to training staff between 2015 and 2019. These events were attended by more than 90 Blenheim ‘trainers’ who together instructed approximately 400 staff and volunteers, who worked directly with some 11,000 people affected by drug misuse. In Spring 2019, Blenheim became part of a UK-wide charity, following a merger with Humankind, focused on addressing health and social inequalities across the country. Blenheim regards the Knowledge Transfer (KT) sessions with Opacka-Juffry as a key development and innovation activity ( IMP8). As Blenheim’s Lead Trainer attests: ‘Prof. Opacka-Juffry’s body of research and evidence of the addictive properties of NPS has helped us work more effectively with our service users; the KT sessions have been of enormous value in helping our workers and volunteers understand the functions of the brain and the short and long term effects of various drugs on brain function *.*’( IMP9).

Blenheim has utilised the research to challenge preconceptions about the ‘safety’ of NPS amongst users. For example, the research findings demonstrating that mephedrone’s stimulant effects are similar to those of amphetamine ( R2) have been used in staff training and practice, as mephedrone is commonly misused. In their words: ‘As some clients still think of mephedrone as a “safe” or “clean” drug, this research helps us to demonstrate to clients that the harm of their drug use may be comparable to amphetamine, which many see as a more harmful or “dirty” drug. This information is extremely useful in helping us to motivate clients towards change. ’ ( IMP9). Blenheim described the sessions on the research on DAT ( R3) as being very valuable for training and updating practitioners: ‘NPS are often regarded as “safe” and non-addictive so it is very useful to be able to refer to research that shows that these substances do have very addictive qualities ’ ( IMP9). Blenheim further confirmed the impact of the research findings on their practice related to dissociative NPS (ketamine substitutes) and their interactions with DAT ( R4, IMP9). The recent study ( R5) has also been translated into Blenheim practice: ‘In 2019 Prof. Opacka-Juffry presented her findings on the dopamine involvement in the addictive potential of 2-DPMP (aka Ivory Wave)… imparting this information to our service users can help them understand the potential unpredictable impact of their own substance use and, for some, can act as a motivating factor in eliciting positive behaviour change .’ ( IMP9).

In addition, Opacka-Juffry worked with Blenheim to develop online training materials ‘The Brain Toolkit’, which includes elements based on the NPS research ( R1- R3). The first stage was launched in July 2017 ( IMP10). These materials have directly informed Blenheim practitioners and their training, and their service delivery to people with addiction. More than 120 Blenheim trainers have used the Brain Toolkit so far; they cascade their knowledge to people who misuse drugs. As the Lead Trainer at Blenheim attests: ‘This knowledge and training can only improve the quality of information and services that our service users receive *.*’ ( IMP9).