1. NPS injecting harms and harm reduction. Psychoactive Substances Health Workshop Friday 4 th March 2016 Emma Hamilton A national resource of expertise on drug issues

2. 2 Injecting NPS – what is being used? Who injects NPS? Patterns associated with stimulant injecting What are the harms associated with injecting NPS? NHS Lothian case study Wider harms of NPS use Concerns of frontline staff Contents:

3. 3 Stimulants: Amphetamine Cocaine Methamphetamine Mephedrone Mexedrone Methiopropamine (MPA) Ethylphenidate Dissociatives: Ketamine Methoxetamine

4. Who injects NPS? Homeless Mental health Opiate injectors MSM 4

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6. Injecting patterns Frequent injecting Bingeing High risk injecting – sharing, reusing, not filtering Higher levels of risk behaviours associated with injecting NPS can increase their harm ie.. High risk/ rough sex, missing medications, bacterial infection 6

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9. 9 Problem with NPS injecting since early 2014. Bacterial infection outbreak Sept 2014 – Oct 2015 TCDO – Ethylphenidate (April 2015) TCDO – Methiopropamine (Nov 2015) Now considered unlawful in Edinburgh for shops to sell NPS (Oct/ Nov 2015) Case study: NHS Lothian

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16. Harm reduction information for service users: 16 No need to add acidifyer to NPS prior to injection No need to heat Always filter substances New injecting equipment (needle, syringe, spoon, filter) Use water for injection or cooled boiled water Rotate sites Do not share or let others inject you

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18. 18 Poor mental health (low mood/ psychosis/ suicide) Physical dependency and withdrawal Social problems Financial problems Brain development in young people Wider harms of NPS use

19. Seeking out/ returning to illicit drugs Targeted Naloxone campaign Safer injecting advice! Already happened in Edinburgh... Burst How can we get in touch with this population? Do we have plans in place to deal with withdrawal? Should we prepare our services for more stimulant injecting? Are we asking our IPED clients about NPS? 19 Future considerations CHEMSEX IPEDs Stimulant Injecting WithdrawalStockpiling

20. 20 Mark Adley - The Drugs Wheel www.drugswheel.comwww.drugswheel.com EMCDDA – New Psychoactive Substances in Europe 2015 Public Health England – Shooting Up Report 2015 Katy MacLeod, Michelle O’Loughlin - Scottish Drugs Forum Con Lafferty NHS Lothian SDF, NHS GG&C, Frontier medical “Safer Injecting Basics for NPS” 2014. Available online: http://www.sdf.org.uk/news- and-media/sdf-news/injecting-nps-advice/ References and Thanks

21. Main Office Scottish Drugs Forum 91 Mitchell Street Glasgow G1 3LN t: 0141 221 1175 f: 0141 248 6414 e: enquiries@sdf.org.uk www.sdf.org.uk Edinburgh 139 Morrison Street Edinburgh EH3 8AJ t: 0131 221 9300 f: 0131 221 1556 e: enquiries@sdf.org.uk www.scottishdrugservices.com Scottish Drugs Forum (SDF) www.sdf.org.uk is a company limited by guarantee, registration no. 106295 with charitable status and is also a registered Scottish charity registered SC 008075. Registered Office: 91 Mitchell Street, Glasgow, G1 3LN Find drug services in your area: www.scottishdrugservices.com Hepatitis Scotland www.hepatitisscotland.org.uk Take Home Naloxone www.naloxone.org.uk