New psychoactive substances in Ireland following the criminal justice (psychoactive substances) act-why all the pessimism?

Abstract

The recent review paper on new psychoactive substances (NPS) by Reuter & Pardo 1, and the subsequent commentaries, outline the multiple and complex policy challenges posed by this phenomenon. They critique the Psychoactive Substances Bill, recently enacted in the United Kingdom. They are sceptical that it will have any real impact on demand, use and harms. They note that Ireland was the first country to proceed with this type of legislation, enacting the Criminal Justice (Psychoactive Substances) Act in late August 2010. This Act was focused primarily at vendors of NPS. It states that ‘a person who sells a psychoactive substance knowing or being reckless as to whether that substance is being acquired or supplied for human consumption shall be guilty of an offence’. The vast majority of the head shops in Ireland closed within weeks of its arrival, and the remaining head shops ceased sale of NPS. The number of head shops in Ireland had already dropped from their peak of May 2010, following the addition of over 100 NPS to the pre-existing Misuse of Drugs Act in that month. What is the evidence from Ireland on NPS use and harms following those developments? First, there is now good evidence of a decline in population use of NPS. The National Drug Prevalence Survey occurs every 4 years. By good fortune, it occurred in 2010/11, so questions on past-year use overlapped with that period of time when head shops were active and widespread 2. Past-year use of NPS among 15–24-year-olds was 9.7% and among 25–34-year-olds was 4.6%. The survey was repeated in 2014/15 and the corresponding prevalence rates were 1.9 and 1.3%, indicating a very dramatic decline 3. There is also evidence of declines in NPS-related substance use disorders presenting to addiction treatment services. A small study at one clinic for adolescents in Dublin found that one in three presentations involved problematic use of NPS in early 2010, while the head shops were open 4. There were no cases of problematic NPS use during the same period 1 year later. The proportion of clients reporting any NPS use in the preceding 3-month period dropped from 82 to 28%. Among young adults aged 18–34 years attending addiction treatment in Ireland, there was also a substantial change in NPS-related presentations during this period 5. They rose very steeply from early 2009 to the first third of 2010. The closure of the head shops coincided with the onset of a significant and steady decline in NPS-related addiction treatment episodes during the following 2 years. The 12-month moving average rate of NPS-related presentations fell by 48% from 2010 to 2012. Unfortunately, most of the international discussion about the experience of Ireland following the NPS inspired legislation has suggested that it was largely ineffective. The reality appears to be very different. Any suggestion that the NPS landscape was largely unchanged in Ireland following the closure of head shops seems entirely contradicted by the data above. Obviously, causality cannot be attributed, but the pessimism seems premature. Ongoing monitoring will be required to see if the observed reductions during these first 2–3 years persist into the future. It would also be premature to read too much into the experiences of a single country. However, informed debate will hopefully be assisted by the dissemination of accurate information. None.