Impact case study database
Reducing the harms associated with Novel Psychoactive Substances: informing policy, improving practice, and raising public and professional knowledge and understanding
1. Summary of the impact
Interdisciplinary research from the Substance Use and Associated Behaviours (SUAB) group has resulted in a reduction of the harmful effects of novel psychoactive substances (NPS) on society’s most vulnerable populations. The research has fed into the development of an internationally-recognised ‘Manchester Model’ that equips law enforcement and other front-line agencies with the data to act quickly in the event of drugs-related emergencies, safeguarding lives and reducing costs. The research has influenced the direction of national policy through the Advisory Council for the Misuse of Drugs and the Home Office Review of the Psychoactive Substances Act. The approach was praised in Parliament by the Minister of State, Nick Hurd MP and identified as an example of best practice by Her Majesty’s Inspectorate of Probation. The ‘Manchester Model’ has been adopted by a growing number of Local Authorities and has informed efforts to combat NPS internationally.
2. Underpinning research
NPS has been referred to by Police and Crime Commissioners as ‘one of the most severe public health issues we have faced in decades’ with ‘dangerous and devastating effects on users and communities’. The SUAB research group was one of the first in the world to focus on NPS and is at the forefront of research and knowledge exchange on NPS, particularly synthetic cannabis (aka ‘Spice’). Since 2015, criminologists Ralphs, Gray and Askew, and forensic chemist Sutcliffe (returned to A3 Allied Health Professionals), have undertaken a body of research that seeks to increase the understanding of NPS. Their focus is on improving the response to the use of NPS, especially amongst the most vulnerable and problematic user groups, including prisoners and the homeless.
In May 2015, Ralphs and Askew were provided access to HMP Forest Bank to carry out research in order to establish the nature and prevalence of synthetic cannabis use and markets in the secure prison estate. The research, published in the International Journal of Drug Policy, was the first study of its kind anywhere in the world. It highlighted epidemic levels of synthetic cannabis use, the detrimental impact of synthetic cannabis on users’ physical and mental health, and the strain on the prison regime (in terms of violence and emergency medical responses to overdoses). It also highlighted that there was a thriving drug market, and identified the innovative ways in which synthetic cannabis was entering the prison estate [1].
In October 2015, Ralphs and Gray were commissioned by Manchester City Council’s Public Health Team to undertake a study of the use of NPS in the community. The research was commissioned in response to escalating NPS-related crime and disorder, increasing demand on the emergency services, and a steep rise in A&E and psychiatric admissions. The resulting report from the research recommended a shift in the service-user engagement strategy, increased multi-agency working and information-sharing, and bespoke training for front-line workers and practitioners [2]. The findings from this research were also included in a subsequent journal article that addressed the question of whether specific services are needed to deal with NPS. It outlined a significant shift in the substance use behaviours of the homeless and ‘men-who-have-sex-with-men’ (MSM). The article concluded that clearer referral pathways are needed, both into - and between - different services, such as treatment, the criminal justice system, and mental health services [3]. A further article presented the first in-depth qualitative study of the use of synthetic cannabis within the homeless population. It highlighted the distinct set of motivations for the use of SCRA (synthetic cannabis receptor agonists) within this population, along with the specific harms associated with their use [4].
In January 2017, Ralphs and Gray continued their influential research on NPS, this time undertaking the first, and only, study to assess the impact of the 2016 Psychoactive Substances Act on the availability of synthetic cannabis, drug markets, users’ health, and the burden on the emergency services [5]. Significantly, this research was interdisciplinary, with Sutcliffe undertaking chemical analysis of street samples of synthetic cannabis and other NPS. The chemical testing was the first of its kind in the UK.
In March 2018, Ralphs and Gray returned to HMP Forest Bank to investigate the impact of the smoke-free prison policy, introduced in 2017, on the nature and use of synthetic cannabis within the prison. This research identified how the reduction in tobacco availability had resulted in an increase in the use of paper-based (rather than plant-based) synthetic cannabis. The use of e-cigarettes to vape paper-based synthetic cannabis led to an increase in ‘Spice’-related medical emergencies, which led to an increased demand on staff and resources, and further restrictions on prisoners [6].
Throughout this research, Ralphs, Gray, Sutcliffe and Askew have adopted the epistemological position of prioritising the voices of marginalised drug users, through interviews with 128 homeless people and 43 prisoners. Askew’s three-year ESRC project on Drug Policy Voices (G2) will ensure the often-neglected voices of people who use drugs will continue to be heard in future discussions around drug policy.
3. References to the research
Ralphs, R., Williams, L., Askew, R. and Norton, A. (2017) ‘Adding Spice to the Porridge: The development of a synthetic cannabinoid market in an English prison’. The International Journal of Drug Policy, 40: 57-69. [16,206 views, 66 citations, Altmetric score 122] https://doi.org/10.1016/j.drugpo.2016.10.003.
Ralphs, R., Gray, P. and Norton, A. (2016) New psychoactive substance use in Manchester: Prevalence, nature, challenges and responses. Report to Manchester City Council’s Community Safety Partnership Board.
Ralphs, R. and Gray, P. (2018) ‘New psychoactive substances: new service provider challenges’. Drugs: Education, Prevention and Policy, 25(4): 301-312. [814 views, 20 citations, Altmetric score 35] https://doi.org/10.1080/09687637.2017.1417352.
Gray, P., Ralphs, R. and Williams, L. (2020) ‘The use of synthetic cannabinoid receptor agonists (SCRAs) within the homeless population: Motivations, harms and the implications for developing an appropriate response’. Addiction: Research and Theory. [2,028 views, 2 citations, Altmetric score 51] https://doi.org/10.1080/16066359.2020.1730820.
Ralphs, R. and Gray, P. (2018) The Impact of the 2016 Psychoactive Substances Act. Report to Manchester City Council’s Community Safety Partnership Board.
Gray, P. and Ralphs, R. (2020) ‘Harm reduction or a catalyst for new harms? The impact of smoke-free prison policy on prisoners and the prison regime’. Prison Service Journal. ISSN 0300-3558 (In Press)
Funding:
Manchester Community Safety Partnership Board, Manchester City Council Public Health Team, and Greater Manchester Combined Authority (GMCA)-funded projects, 2015 – 2020, total funding GBP267,591, PI: Ralphs
‘Does UK drug policy require reform? Engaging drug takers into the debate’, ESRC, (ES/R007225/1), GBP300,000, PI: Askew
4. Details of the impact
SUAB’s research has led to the creation of a ‘Manchester Model’ that collectively includes a drugs early warning system, ongoing monitoring of substance use trends and a partnership that enables SUAB to provide chemical analysis of substances seized by Greater Manchester Police. This approach has had a demonstrable impact on policy and practice, significantly reducing harm, and raising wider public awareness about NPS and ‘Spice’.
Building the ‘Manchester Model’
The Drugs Early Warning System (DEWS) was launched in March 2017 by Police and Crime Commissioner, Tony Lloyd on the basis of research recommendations from Ralphs.
This system facilitates real-time information-sharing that provides up-to-date harm-reduction advice and information to 700 frontline professionals. The system links into a panel of experts (including Ralphs and Sutcliffe) who monitor information and provide ‘early warning’ alerts where necessary. To date, this information system has issued ten alerts in response to drug-related emergency incidents. As noted by GMCA’s lead for Criminal Justice and Rehabilitation, ‘ The Drugs Early Warning System has been instrumental in ensuring that the right information is shared at the right time in relation to drug-related incidents and hospital admissions’ [A]. DEWS is supported by a partnership between the Manchester Metropolitan and Greater Manchester Police called MANDRAKE (led by Sutcliffe), which rapidly tests samples for public health purposes when incidents occur. According to GMP’s Chief Superintendent with responsibility for the DEWS, “ this rapid non-evidential testing function is the first of its type available within a UK police force, and has not only in-part safeguarded lives, but had significant positive policing outcomes both locally and nationally” [B].
The local drugs information system is supported by two ongoing interdisciplinary substance-use monitoring projects: the ‘Manchester Emerging Substance Use Survey’ and the ‘GM Trends Survey’. These annual surveys are funded by Manchester’s Community Safety Partnership Board and the Greater Manchester Combined Authority. The surveys provide unprecedented insight into the region’s drug-taking behaviour, habits and attitudes, as well as the nature of the products themselves. They are currently the only surveys of their kind in the UK and provide Greater Manchester with one of the most comprehensive local intelligence systems in the world. Since their launch, the surveys have played a key role in the identification, awareness-raising and training of practitioners in relation to novel Benzodiazepines and opiate-based drinks (aka ‘Lean’). The Deputy Mayor of Greater Manchester for Policing, Crime, Criminal Justice and Fire, said: “ I welcome the GM TRENDS project. The research undertaken will help to provide insight into drug-taking trends in the city-region on a scale we have never had before. Participants in the survey could help to save lives and I hope people across Greater Manchester will get involved” [C].
The Greater Manchester Drug and Alcohol Strategy 2019-21 commits to ongoing support of DEWS, and highlights national recognition of its significance: ‘ A consistent approach for reporting on emerging drug trends and sharing our understanding of local drugs issues is crucial to reducing drug related harms. That is why we have developed and will build on Greater Manchester’s Drugs Early Warning System, which is recognised nationally as best practice’. The strategy highlights GMCA’s commitment to ‘ conducting research with key informants and routine testing of substances to monitor purity levels, adulterants and the emergence of new drugs’ [D].
Changing Substance Use Policy
Ralphs and Gray have worked with commissioners to implement research-led recommendations. This resulted in a strategic decision to create a homeless outreach substance-use team, increased dual diagnosis (substance use and mental health) provision, and supported housing substance-use policies. Manchester’s Public Health Strategic Commissioning Manager stated: “ The research … has had a positive impact on the city … [and] has resulted in an improvement in public health and community safety. … If the research hadn’t been commissioned, … I feel that the Community Safety Partnership wouldn’t have been as prepared to respond to a number of challenges” [E].
Ralphs and Askew used a Manchester Metropolitan Chancellor’s Fellowship (see REF 5b) to collaborate with drug policy think tank ‘Volteface’, and delivered two high-profile national symposia, each attended by over 100 delegates, including ministers, civil servants, policy experts, and commissioners. The first symposium (May 2017) resulted in a change in prison policy regarding how the secure estate responds to and detects the use of NPS [F]. The second symposium (July 2017) was opened by the Mayor of Greater Manchester, Andy Burnham, who used it to support his pledge to reduce the number of rough sleepers in Manchester: “I give you my full commitment, whatever comes out of this conference, if it has the broad support of you all, I will back it and put my weight behind it.” The symposium resulted in a number of local and combined authorities in England and Wales (including Doncaster, Sheffield, Nottingham, Teesside, Cumbria, Lancashire, Wrexham and Cardiff) adopting elements of the Manchester approach, along with the recommendations for training, service-user engagement and harm-reduction practices [G].
The research has consistently informed national policy, prominently featuring in an All-Party Parliamentary Group review for the Home Office of the 2016 Psychoactive Substances Act [H], and two reports from the Advisory Council on the Misuse of Drugs (ACMD): one on ‘drug-related harms in homeless populations’ and the other on ‘custody-community transitions’ [I]. The ACMD report on homelessness included the SUAB recommendation for bespoke training for frontline staff working with homeless users of NPS. Subsequently, the Government committed to delivering this training to all frontline staff between August 2019 and March 2020. The ‘Manchester Model’ was also identified as a model of best practice in Her Majesty’s Inspectorate of Probation thematic review into NPS [F]. The multi-agency approach, inspired by the recommendations from the research, was also praised by Minister of State, Nick Hurd MP in the UK Parliament “ Another very good example of multi-agency working has taken place in Manchester... the multi-agency approach there appears to be working … I commend the work in Manchester’ “ J].
The researchers have also ensured that their work represents the full range of perspectives, providing a platform for the marginalised voices of prisoners and the homeless to be heard in a parliamentary debate on the reclassification of synthetic cannabis to a Class A drug [J]. This debate resulted in synthetic cannabis remaining as a Class B substance, thereby reducing the further criminalisation of vulnerable users. In November 2020 the ACMD published an updated review of synthetic cannabis receptor agonists (SCRAs) and their harms, which cites SUAB research more than 20 times, including a section on MANDRAKE, indicating the primary importance of the research and its impact on national policy [I].
Improving practitioner knowledge and effectiveness
The research team have developed an outstanding knowledge exchange portfolio, presenting the research findings and recommendations to a diverse range of local, regional, national and international audiences, in a series of practitioner-focused workshops delivered to well over 1,000 practitioners and policy-makers during the assessment period. Workshops have helped professionals to improve their responses to NPS-related incidents. For example, Ralphs and Gray developed a customised synthetic cannabinoid training workshop, which has been delivered to over 700 frontline professionals across the Greater Manchester region. As Manchester’s Public Health Strategic Commissioning Manager noted: “ We received excellent feedback about this training… Agencies reported that staff felt more confident and supported, and the number of blue light callouts has reduced” [E]. Furthermore, as HMP Forest Bank’s Resettlement Manager detailed: “ We invited all Sodexo’s prisons (5 in total) to an NPS event [delivered by the research team] to share information across sites. This was extremely beneficial”. Identified benefits included use-monitoring, prisoner-safeguarding, and harm reduction [K] *. Similarly, following a presentation by the research team, a practitioner from Greater Manchester Mental Health NHS Trust reported that the research had been “… instrumental in refining mental health approaches … and ultimately improving the engagement with service users” [L] .
The research team has collaborated with Manchester Health and Care Commissioning to create professional and public guidance on responding to those under the influence of ‘Spice’. This guidance was disseminated across the UK, and internationally. For example, professionals in New Zealand have drawn upon the guidance when developing their own information briefings. Additionally, the research regularly informs UK and EU drug trend reports [M], and the recommendations have led to an action plan from the Ministry of Justice to improve information, training and multi-agency working for frontline probation and substance misuse workers [F].
Counteracting sensationalism in public understanding
Ralphs and Sutcliffe have played a key role in raising public awareness and understanding of NPS, and in helping to counterbalance the often sensationalist media reporting of NPS. Since 2017, the research findings have consistently been in the media spotlight (over 200 media articles), with multiple appearances on regional, national and international TV and radio (reaching an estimated audience of 85,000,000). For example, the articles ‘What is Spice and why is the drug so dangerous?’, and ‘Early signs show legal high ban is pushing sales from the high street to street dealers’ in The Conversation have been read over 370,000 times, and the documentary ‘The Dark Side of Britain: Spice’ has been viewed over 2,500,000 times on YouTube [N].
5. Sources to corroborate the impact
Testimonial from the GMCA lead for Criminal Justice and Rehabilitation.
Quote from GMP’s Superintendent Chris Hill GMP. Manchester Metropolitan University, Seized drugs tested in city centre police station with University expertise. [Online] Wednesday, 8th August 2018.
Greater Manchester Combined Authority press release https://www.greatermanchester-ca.gov.uk/news/innovative-research-will-provide-unprecedented-insight-into-drugs-habits-and-trends-in-greater-manchester/
https://greatermanchester-ca.gov.uk/media/2507/greater-manchester-drug-and-alcohol-strategy.pdf
Testimonial from MCC’s Strategic Commissioner for population health and wellbeing.
See pages 8, 13, 29, 33, 41, 44 and 46 of the thematic review undertaken by HMIP and the Care Quality Commission on ‘New Psychoactive Substances: the response by Probation and Substance Misuse Services in England’.
Mayor Burnham quote: https://volteface.me/spice-developing-integrated-response/ ; Testimonial from Andy Maddison, Public Health Improvement Coordinator for Doncaster Borough Council.
Pages 20, 29, 52 and 67 of the Home Review of the ‘2016 Psychoactive Substances Act’.
Pages 12, 14, 30 and 54 of The Advisory Council on the Misuse of Drugs (ACMD) report on ‘Drug-Related Harms in Homeless Populations’, and pages 11, 27 and 28 of the ACMD report on ‘Custody/Community Transitions’. See also pages 4, 9, 10, 11, 21, 23, and 24 of the ACMD report on ‘Synthetic Cannabinoid Receptor Agonists’ (SCRA).
‘Synthetic Cannabinoids: Reclassification’, 6 November 2018, Hansard Volume 648, Column 476WH – also see Parliament TV video clip - Reclassification of synthetic cannabinoids, Westminster Hall. Tuesday 6 November 2018 [10:24:45 – 10:35:00].
Testimonials from Deborah Chadwick (Resettlement Manager) and Sharon Berry (Recovery Manager) HMP Forest Bank.
Testimonial from Dr Mark Holland, Manchester Dual Diagnosis Liaison Service, Greater Manchester Mental Health NHS.
Evidence of informing drug trend reports (See pages 7 and 10 of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) report on ‘New Psychoactive Substances in Prison’).
Collated media appearance figures.
Additional contextual information
Grant funding
Grant number | Value of grant |
---|---|
G1 | £267,591 |
ES/R007225/1 | £300,000 |