'Not so legal – Not so high' Report

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES (NPS) SURVEY REPORT 2017 .

Authors: Becky Hancock, WCADA. Catherine Lewis, South Wales Police Claire Fauvel, Public Health Wales. Clare Price, DASH. Emma Griffiths, ABM Healthy Schools. Toni O’Hara, Drug Aid Cymru.

Key Contributors: Angela Cronin, Bridgend CBC. Corinne Fry, Neath Port Talbot CBC. Lisa Shipton, WCADA. Special Acknowledgement: Neath Port Talbot Youth Council.

IN ASSOCIATION WITH

Contents Executive Summary................................................ 3 1. Introduction.......................................................... 9 2. Response Profile............................................... 12 3. ‘Psycho What?’.................................................. 15 4. ‘I forgot what it means...’................................20 5. ‘Knowledge = Power’......................................24 6. Who you going to call?.................................. 27 7. Who’s doing it?..................................................29 8. To use or not to use........................................ 31 9. What were you thinking?...............................33 10. Crossing the thin blue line..........................49 11. Drug use & the bigger picture....................50 12. The ‘lawful’ truth.............................................53 13. ‘Drugs literally scare me’..............................54 14. Help!....................................................................56

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary Drug and alcohol use among young people is always a cause for concern.

The use of substances at a young age is associated with a variety of negative consequences. It can affect their health and wellbeing, their education and family life. It can reduce life chances and compound a trajectory of poor outcomes. Some young people will experiment and then stop without major problems. For a small proportion however, it will become a significant problem; it is generally a symptom of wider issues in their lives and could lead to serious substance misuse in later life.

The Welsh Government’s substance misuse strategy for Wales, ‘Working Together to Reduce Harm’, has four action areas. One of these areas is to prevent harm from substance misuse and aims to prevent children and young people from engaging in substance misuse.

The Prevention, Education and Training subgroup of the Western Bay’s Area Planning Board is responsible for developing the regional strategy around this action area. An inquiry was undertaken with young people about new psychoactive substances to establish what can be done to enhance substance misuse preventative strategies across the 11-25 age range. The following report sets out the findings of the inquiry and makes recommendations for inclusion in the prevention strategy.

SITUATION Primary1 and secondary2 substance misuse prevention strategies are inadequate, uncoordinated and inequitable across the Western Bay region3. There is little evidence of quality or efficacy. There is some evidence of unintended harm.

There is a need for the Area Planning Board (APB)4 to exert greater strategic and management 1 Primary prevention is an approach for responding to substance use among young people before they start using substances (World Health Organization; 2017).

2 Secondary prevention consists of uncovering potentially harmful substance use prior to the onset of overt symptoms or problems.

3 Western Bay is the name given to the region that comprises of Bridgend, Neath Port Talbot and City and County of Swansea local authority areas.

4 The Area Planning Board is the regional commissioning board developed to assist responsible authorities to discharge their statutory responsibilities for formulating and implementing a strategy for tackling substance misuse.

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control over education and information services.

The APB, in partnership with the Community Safety Partnerships (CSP)5, also needs to strengthen their governance arrangements on how messages regarding substance misuse are conveyed to the general public.

While substance misuse among young people is declining6,7, experimental substance misuse among some young people living in the Western Bay region begins younger than we are comfortable to acknowledge. Our current approach to uncovering potentially harmful substance misuse among young people is unsophisticated and obstructed by unnecessary blockages.

Universal services are our only means of identifying young people that are vulnerable to misusing substances early. There is a need for these services to accept their responsibility and their role in reducing the harm of substance misuse among the young people they work with.

There must be greater clarity and interaction between primary and secondary prevention services. There is an over reliance on information provision. The APB, with its partners, must do more to unify prevention services and reduce the technical minefield that substance misuse has become.

The Psychoactive Substances Act has been successful in its objective of reducing the 5 Community Safety Partnerships were established across Wales and England as statutory bodies, following the publication of the Crime and Disorder Act 1998. Their aim is to work together to reduce crime and disorder, fear of crime, anti-social behaviour and substance misuse in the local area.

6 http://gov.wales/docs/caecd/research/2015/151022-healthbehaviour-school-children-2013-14-key-findings-en.pdf 7 http://content.digital.nhs.uk/catalogue/PUB17879

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary availability and promotion of New Psychoactive Substances (NPS)8, but harm from substance misuse still prevails among a small population of young people.

What is unequivocally apparent is that universal services must be made more capable in limiting the harm of substance misuse among young people. There needs to be a comprehensive re-examination of substance misuse education provision for young people as a priority. There needs to be greater quality assurance of secondary prevention services and these services must be equitably provided across the region.

BACKGROUND Exposure to substance misuse is one of the many challenges young people will face in their lives. There are many strategy teams that work hard to support young people to negotiate the risks posed with experimental substance misuse.

The emergence of NPS added another dynamic to this already complex area of work. What was not understood was how young people interacted with these types of drugs which were available on the high street up until May 2016.

Across the Western Bay region, there was mounting evidence of increased harm with experimental NPS use. This exploratory inquiry was developed by the APB to strengthen primary prevention strategies aimed at young people under the age of 25.

During the implementation of the inquiry, the Psychoactive Substances Act came into force.

This new legislation had a dramatic impact on the availability of these substances and ensured that the flagrant and inaccurate marketing of ‘legal’ drug consumption had been stamped out.

A significant decline in NPS availability was observed, however it was deemed necessary to continue the inquiry to support the continued development of the APB prevention strategy.

There were two key assumptions that were 8 New Psychoactive Substances is a generic term for substances produced to mimic the effects of traditional illegal drugs. Prior to the introduction of the Psychoactive Substances Act 2016 the term ‘Legal Highs’ had also been used to describe many of these substances however this expression is inappropriate as many NPS were controlled under the Misuse of Drugs Act 1971 (Home Office; 2014).

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tested as part of this inquiry. The first was that young people use the regulatory system to appraise risk. The second, was that the overt availability of NPS was normalising drug taking among young people. While there were other theories circulating across the Western Bay region, the two above mentioned were the dominating perspectives which had underpinned information and education campaigns until recently.

The project group set a broad exploratory frame to the inquiry and gathered diverse insights from almost four thousand young people. The following report provides an analysis of the data that was gathered, and makes recommendations to the APB and wider partners.

FINDINGS ~~All survey responders recognised that any drug use carried risk.

~~There is some evidence that in the absence of a regulatory framework, there was a tiered approach to negotiating risk.

~~There was no evidence that the availability of NPS was normalising drug taking among young people.

~~There is strong evidence that substance misuse information and education directed at young people has become too convoluted.

~~Very few responders were familiar with the term NPS. Legal highs were the term that young people were familiar with despite information and education campaigns.

~~There was little evidence that young people actively sought information regarding NPS. Preferred sources of information varied across age groups.

~~Information needs varied across the age groups. Young responders requested a duplicate of the information they had already received.

~~The information sources that young people are exposed to post age 16 become less secure. However, young people generally favour more official sources for information and advice about substance misuse.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary ~~There is strong evidence that young people will approach universal service staff, after parents, for information and advice regarding substance misuse.

~~Experimental substance use does start early for some young people and appears to be concentrated between the age of 14 and 16.

There is some variation by gender; males appear to experiment earlier than females.

~~Initial experimental use is always a rewarding experience and a social event for young people. Greater negative effects emerge from prolonged NPS use. The greatest intention to use an NPS again is observed among the 14-16 age group.

~~There were very few levers that services could have harnessed to prevent first time NPS use among young people that already misused substances generally.

~~There is no evidence that the availability of NPS on the high street promoted the use of these substances among young people naive to drug use.

~~There is some evidence that ‘hot thinking’9 led individuals, previously naive to substance misuse, to use an NPS when in the company of friends who had unexpectedly made NPS available.

~~There was a strong indication of greater use of drugs controlled under the Misuse of Drugs Act than NPS among young people.

~~Well over half of responders that had used an NPS had experience of using drugs controlled under the Misuse of Drugs Act.

~~Data from the survey suggests that 1 in 5 young people knew of someone that had tried an NPS. A friend was the most common person implicated by over half the responders. There was a 15% increase in exposure to substance use observed between the ages of 14 and 19.

~~There is some evidence that there are groups of young people that are regularly exposed to substance misuse through others and therefore accept this as normative behaviour.

~~There is some evidence that the administration of drugs for malicious and exploitative purposes, by people they know, is a reasonable concern for young people.

~~Over half of survey responders that had used an NPS required immediate assistance from a service.

~~Responders that had begun using NPS demonstrated very little insight as to why they initially engaged in this type of drug use.

~~Responders generally accessed NPS through their friends. The 14-16 age group were the group most likely to access NPS from a dealer.

~~The use of tobacco was a common feature among young people using NPS.

~~Older responders were more knowledgeable of the legislation surrounding NPS post May 2016.

~~There is modest evidence to suggest that those who use controlled substances familiarise themselves with the law that surrounds them.

~~There is strong evidence that knowledge about the ease of access to NPS caused anxiety among young people.

~~There is strong evidence that broad messaging about substance misuse in the community is undermining perceptions of community safety.

~~There is moderate evidence that the introduction of the Psychoactive Substances Act 2016 served to reassure young people that the harm posed by NPS was under control.

9 Hot thinking is when a person’s thinking is influenced by their emotional state. It is associated with cognitive and physiological arousal when a person is more responsive to environmental factors. It is rapid and emotionally laden thinking. Biased and low-quality decision making can result from ‘hot thinking’.

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary RECOMMENDATIONS EDUCATION Improving the quality, consistency and efficacy of education provision, ensuring that young people have a meaningful understanding about substance misuse.

~~Following endorsement by the APB, the PET10 group undertake a comprehensive evidence review regarding substance misuse education. ~~In partnership with the All Wales School Liaison Core Programme (AWSLCP)11, the Area Planning Board review the continued relevance and applicability of the term NPS in the context of substance misuse education and information. ~~Substance misuse education services are standardised, equitable and consistent across the region. This provision should complement the AWSLCP, the PSE curricula and the Healthy School Scheme 12 to ensure that education provision is unified across the region. ~~Primary prevention substance misuse initiatives are maintained until the age of 16. ~~Parental engagement should be a key consideration in the development of universal prevention and education services that target young people below the age of 16. ~~Substance misuse education provision for 11-16 year olds is reviewed and service specification developed by the APB. ~~A comprehensive review of substance misuse information and education services is undertaken across the region with particular regard to content, learning outcomes and intended audience. ~~The PET to undertake evidence review to establish how to enhance primary prevention strategies targeting the 11-13 and 14-16 age groups. ~~Substance misuse education is reviewed to ensure that key messages do not cause unintended harm to children and young people. ~~Substance misuse education provision rationalises knowledge based sessions in favour of affective based learning for all young people aged 16 and under.

10 PET is the Prevention Education and Training sub-group of the Area Planning Board and is responsible for substance misuse primary and secondary prevention strategies across the life course.

11 The All Wales School Liaison Core Programme approach is mainly a preventive, generalised and broad-based one that is focussed on formal lessons delivered by uniformed police in the classroom, together with supportive policing activities.

12 The Healthy Schools Scheme is a national scheme that all ABM schools are engaged with. The purpose of the scheme is to ensure that health promotion is a core function of the school setting. The Healthy School Scheme is a standardised programme.

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary RECOMMENDATIONS QUALITY ASSURANCE Mechanisms are in place to maintain the quality of information resources that are directed at children and young people; ensuring that messages regarding substance misuse are consistent and do not cause unintended harm.

~~In partnership with the AWSLCP, primary prevention substance misuse interventions are agreed and endorsed by the PET group prior to implementation. ~~All primary prevention information resources, regarding substance misuse, are subject to endorsement by the Area Planning Board and AWSLCP prior to their use with young people. ~~The PET group develops an internal check list to ensure that all primary prevention interventions do not cause harm and contribute to the Western Bay’s APB prevention strategy. ~~Any emergent information, disseminated via the All Wales School Liaison Core Programme, is quality assured by the Programme Coordinator prior to dissemination across schools. ~~A quality assured, and relevant, substance misuse information resource is sought and promoted among the 17-25 age group.

INTERVENING AT UNIVERSAL LEVEL Infrastructure enhancements are made at universal level to respond to the needs of children and young people that are using substances; ensuring that children and young people receive the appropriate interventions to meet their needs.

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~~We acknowledge that a small proportion of young people begin to misuse substances early. Strategies in universal services should be in place to identify and respond to the needs of these young people. ~~School and college staff have sustained support to identify young people that are at risk of substance misuse. ~~Measures are put in place to ensure that school and college staff are competent to respond to the needs of young people regarding substance misuse advice. ~~Broad education services are not an effective or adequate intervention for young people already identified as misusing substances. ~~Young people that are identified as misusing substances require tailored secondary prevention services for their substance misuse; this should also include the use of nicotine products. ~~Smoking among young people is a strong indicator of further substance misuse and an indication that secondary prevention services are required. ~~School staff initiate brief interventions for substance misuse when smoking or alcohol use among pupils is detected. ~~Children and young people’s substance misuse services provide sustained support to school and college staff and primary care services. ~~An explicit intervention criteria is developed to support universal service staff to intervene when alcohol, tobacco or substance use is suspected among young people. ~~Substance misuse support services, support universal school staff to deliver education around substance misuse, ensuring that primary prevention strategies are of high quality and access to secondary prevention services are integrated and explicit.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

Executive Summary RECOMMENDATIONS MESSAGES AND COMMUNICATIONS Messaging regarding ~~Blanket harm reduction messages are only provided to young people aged 16 and over. substance misuse is congruent with the ~~Substance misuse messaging for under 16’s is short, sharp and setting in which it is consistent. delivered; ensuring that children and young people receive clear and consistent health promoting messages at universal level.

Greater governance arrangements are put in place to ensure that broad community safety messaging is sophisticated and appropriate.

~~The three CSP’s strongly consider forming a regional communications group which includes membership from the APB, Police and Crime Commissioner’s Office and communication leads. ~~The potential harm of community safety messages should be carefully appraised especially the harm this may cause for children and young people. ~~Commissioned substance misuse services do not communicate to the media, regarding community level substance misuse, without prior permission and endorsement by the Area Planning Board. Community Safety Partnerships should be a key member in this decision process.

STRATEGIC Area Planning Board Strategic Actions

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~~The APB reviews its primary care substance misuse provision for over 18 -25’s. ~~The Children and Young People’s subgroup of the APB undertake an audit of referrals from universal services. ~~The third sector young person’s substance misuse services should be permitted to receive referrals for young people under the age of 18 that smoke. ~~Children and young people’s substance misuse services focus on secondary prevention services for children and young people. ~~The contribution that the All Wales School Liaison Core Programme provide to primary prevention and information services among the under 16’s is recognised and respected by the Area Planning Board and wider partners. ~~The role and function of the PET group is communicated to other strategy groups outside of the remit of the APB.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

1. Introduction 1.1 BACKGROUND

1.2 ASSUMPTIONS

Prior to the introduction of the Psychoactive Substances Act 2016 (PSA), there had been increasing concern regarding the accessibility of New Psychoactive Substances (NPS) across the Western Bay region. Information across agencies gave a mixed picture but it appeared that young people living in Bridgend, Neath Port Talbot and Swansea were experiencing greater harm from experimenting with NPS than traditional drugs controlled under the Misuse of Drugs Act 1971 (MDA). The prevalence of NPS use among the 11-25 year olds was not fully understood by the Area Planning Board (APB) but there was mounting evidence of increased harm from this type of drug use. Local emergency services maintained that the use of NPS across the region was creating increasing pressures on service delivery. There was also grave concern that the availability of NPS via high street retailers was promoting the perception of safe drug use to young people.

A number of perspectives about NPS use among young people were presumed but two dominating assumptions would be tested as part of the inquiry. The first was that the lack of a regulatory framework around NPS was promoting the safety of NPS use to young people. The assumption that young people use regulatory systems to determine levels of risks; in the absence of regulation, young people perceived NPS use to be free of risk. The second assumption, with some overlap upon the former, was that the explicit availability of NPS was normalising drug taking. The premise that young people who would not ordinarily engage in drug use would now participate in NPS use because of their perceived popularity and ease of access via arguably legitimate outlets. While there were other theories circulating across the Western Bay region, the two above mentioned were the dominating perspectives which had underpinned information and education campaigns until recently.

As the Psychoactive Substances Bill came under increased scrutiny from media, as well as national and local partners. The launch of the Act was delayed in 2016 as definitions were refined and clarifications around certain substances made. At a Western Bay level, this delay was received as an indication that the legislation was at risk of being mothballed, posing a potential risk to community safety. It was therefore necessary to develop an integrated primary prevention strategy to ensure the region was sufficiently resilient to the continued availability of NPS.

The project group comprised of professionals from a range of disciplines and sought to take an account of the wide ranging dynamics of NPS availability. And so while certain assumptions about NPS use among young people would be tested, the project group set a broad exploratory frame to the inquiry.

The Prevention Education and Training (PET) sub-group of the APB, agreed to develop an exploratory inquiry into NPS use among young people living in the Western Bay region. The inquiry aimed to appraise the prevalence of NPS use across the population of 11-25 year olds.

The inquiry also aimed to gather insights from young people to establish an understanding of their perceptions and experiences of NPS. This report sets out the findings of the inquiry and makes recommendations for inclusion in the regional prevention strategy currently being developed by the PET. There are also a number of recommendations that are pertinent to a wider range of planning and delivery boards.

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1.3 METHODOLOGY Young people aged 11-25 make up 19% of the population of the Western Bay region (ONS; June 2016) and it is this age range that primary prevention strategies are generally targeted.

It was an aspiration that 60% of this target population would participate in the inquiry.

Achieving this target would offer assurance that the findings were dependable and sufficient to be generalised. To that end, a web based survey had the greatest utility to reach the population target of this size. Neath Port Talbot Youth Council contributed to the design of the survey.

Following further testing and ‘sense’ checking by critical colleagues13, the survey was launched in September 2016 and ran until the end of January 13 The Communications & Public Engagement Manager of South Wales Police provided specialist support in the development of the survey.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

1. Introduction 2017. Young people also produced the ‘Not so Legal, Not so High’ branding of the survey campaign.

New psychoactive substances were the fundamental element to the inquiry but it is recognised that substance misuse across the population is multifarious. To provide greater stability to the data collecting tool, the survey encompassed several lines of enquiry. These elements included, but were not limited to, knowledge and attitude towards NPS, NPS use, knowledge of the law and the use of drugs controlled under the Misuse of Drugs Act. The web based survey comprised of 37 questions. Thirty three questions generated quantitative data and required an option selection response. There were four free text response areas which required young people to submit qualitative responses to specific key questions. A paper copy of the survey was also developed and disseminated for instances where the internet was inaccessible.

The survey was disseminated across a range of settings that engage with young people within the target age range. The range of settings was diverse and included: comprehensives, colleges, pupil referral units, universities, training providers, youth clubs, substance misuse support services, the youth offending service, police volunteers, and engagement projects with young people not in education or employment.

Social media, press releases and radio campaigns were also used to promote the survey.

At the close of the survey nearly four thousand young people had participated which equates to 4% of the target population living in the region.

Respondents spanned from across the region but there was an under representation from young people over the age of sixteen.

Unfortunately, the ambitious target of sixty percent of the population was not achieved.

The implication is that the findings of the inquiry should not be generalised to all young people living in the Western Bay region.

1.4 LIMITATIONS There are some limitations to this report that must be acknowledged.

First, all responders self-selected to participate in the survey and therefore the results will have suffered from some degree of self-selection bias.

Whole classrooms were encouraged by staff to complete the survey but the young people that participated in the survey might be very different from the young people that chose not to participate.

The profile of responders is not equally distributed across the region and there is an under representation of young people over the age of 16. However, the distribution of responders by age range across local authority area is sufficient to be compared. With the exception of the 20-22 age group, at least two local authority areas achieved the mean regional response rate by age group. So while the age profile of the responders was uneven across the region, there were always two authority areas that were comparable14.

The implementation of the inquiry was modestly hampered through the use of the term ‘new psychoactive substances’. There was an over presumption that standardised education provision had clarified terminology with school age pupils prior to the launch of the survey. Complete coverage of age appropriate information sessions in schools regarding NPS had been achieved. It is clear that young people are not retaining this technical terminology. The greatest proportion of responders initially stated that they were unfamiliar with the term NPS. This had an impact on survey fidelity; it is estimated that around three percent of responders believed that NPS had a legitimate role in medicine. This will be explored further in the report.

Furthermore, it was a goal of the PET group that this inquiry would provide greater intelligence in the development of primary prevention strategies. That approaches would be enhanced, and in time, all young people living in the Western Bay region would refrain engaging in substance misuse. Sadly, what became apparent 14 The age distribution table can be seen on page 13.

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1. Introduction throughout this inquiry was actually young people generally had very limited insight into the reasons why they initially engaged in substance misuse.

For those who had already started to use drugs, they seemed unable to articulate why. And for those who hadn’t engaged in substance misuse there was a prevailing belief that disaffected strangers, unknown to the greatest proportion of society, take drugs and not regular people in their communities.

The survey responder quote, on this page, reveals some of the limitations.

Despite some deviation in the fidelity of the survey, the data that was gathered was rich.

While the project group set questions with a specific answer set in mind, what returned was in fact more valuable. The exploratory technique generated many levels of authentic data that could not have been explicitly elicited by any structured inquiry.

It must be noted however, that when the data has been analysed based on those that have used NPS, the numbers start to become quite small. In addition, it has been presumed throughout this exploratory inquiry that all survey responders responded truthfully. To that end, the authors advocate caution is applied when receiving this report.

The findings however were based on quantitative data and the frequency in which themes across the age groups emerged. Only the strongest themes have been used to inform the recommendations. So while the limitations of the inquiry are acknowledged throughout the report, the conclusions described in the following chapters are based on the most concrete findings of the inquiry. The findings of the data have been validated by the project group and critical key professionals. The subjective conclusions of the authors have been omitted from this report.

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I’m only 13 so talking about NPS is very difficult because I don’t know what it is. All I know that it’s very bad and harmful. If I ever got offered something in a sealed bag and couldn’t see inside the bag and a stranger gave it to me I wouldn’t take it.

SURVEY RESPONDENT

1.5 HOW TO USE THIS DOCUMENT This document should be received as an inquiry report that has been sponsored by the APB to inform primary and secondary prevention strategies. The scale of the inquiry and this subsequent report means that the recommendations are pertinent to a number of planning and delivery boards.

This report has been written as a technical document, which explores the findings of the inquiry under key headings which are described for ease of reference in the contents page.

Within each heading a regional overview of the findings is described. This is then followed by a breakdown against age groups and local authority areas where appropriate. Under each heading, an initial summary of the findings is presented then a more comprehensive analysis is provided. Following this, the authors explore the findings with discussion and set recommendations for improvements in primary and secondary prevention services. n

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2. Response Profile 2.1 POPULATION

2.3 AREA OF RESIDENCE

There are an estimated 98,800 children and young people aged 11-25 living in the Western Bay region. This age group makes up 19% of the total population in the region (ONS, June 2016).

Swansea responders accounted for the greatest proportion of responders at 40.29% of the total response rate. Neath Port Talbot and Bridgend accounted for 35.48% and 21.49% respectively.

Only 2.6% of the responders lived outside the region and have been omitted from this report.

Figure 2 demonstrates the percentage of responders by local authority area.

A total of 3926 young people self selected to participate in the survey. This equates to 4% of the total population of the target cohort residing in the region; a rate of 1 in 24 young people participated in the survey. Those who responded in Welsh made up 3.94% of the total number of respondents.

2.2 AGE The age profile was broken into 5 age groups.

The greatest proportion of responders were aged between 11 and 16. The age profile of the responders is illustrated in figure 1.

Figure 2.

Percentage responders by area of residence

21.49%

2.6%

35.48%

40.29%

Figure 1.

Numbers and percentage by age group Age Group

Total

%

11-13

1,981

50.4

14-16

1,522

38.7

17-19

251

6.39

20-22

64

1.63

23-25

107

2.75

Key Equal to or above the mean regional response rate Below the mean regional response rate

Swansea

Neath Port Talbot

Bridgend

Outside region

2.3.1 AGE BY AREA OF RESIDENCE Summary: Swansea had the highest overall response rate but this is concentrated in the younger age ranges. Neath Port Talbot responders were also primarily represented by the 11-13 age range. Bridgend overall were underrepresented in the total population figures but had better representation of responders in the older age brackets. Swansea had the greatest response rate among the 23-25 age group.

Figure 3 (overleaf) illustrates the age profile of the survey responders by local authority area.

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

2. Response Profile Figure 3.

Survey age profile, percentage by local authority area Age Group

Bridgend Neath Port Swansea Talbot

11-13

8.53

35.9

38.8

14-16

25.6

25.4

42.2

17-19

52.9

13.1

29.4

20-22

48.4

22.41

23.4

I’ve seen my friends being taken to hospital after them and being very ill, also seeing them in the state they get in is embarrassing.

23-25

28.7

17.5

32.4

SURVEY RESPONDENT

Total response

21.49

35.48

40.29

percentage by age group

Key Equal to or above the mean regional response rate

2.4.1 GENDER BY AREA OF RESIDENCE

Below the mean regional response rate

2.4 GENDER Of the total response rate, there was a fairly even division between male and female responders. Female responders marginally accounted for the greatest number of responders. Figure 4 demonstrates the percentage of responders by gender.

Figure 4.

Against the response rate, there was no significant variation in gender profiles across local authority areas. The gender distribution across the age ranges were also generally equal although a slight increase in female responders in the older age ranges was observed and there was a greater representation of responders stating they are transgender in the 14-16 age group.

Number and percentage response rate by gender

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Gender

Total

%

Male

1,877

47.8

Female

1,886

48.0

Transgender

72

1.83

Other

30

0.76

Prefer not to say

61

1.55

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2. Response Profile 2.5 HOUSING STATUS Survey participants were asked to state their housing status. Eight options were provided.

Over 90% of responders were living with parent/s.

The greatest number of homeless responders lived outside the region. Following this, 27.1% of homeless responders were from Swansea local authority area. While the numbers were few, the 23-25 and 11-13 age groups were the groups where homelessness would most likely be declared at 30.9% and 25.9% respectively.

Figure 5 demonstrates the profile of housing status among survey responders.

Figure 5.

2.6 EDUCATION AND EMPLOYMENT STATUS There were ten categories under this heading.

Responders were asked to select the most applicable. The following describes a selection of those headings. As would be expected, 85.4% of the total number of responders stated they were in comprehensive school.

Figure 6 demonstrates the education and employment profile of the responders. n

Figure 6.

Percentage responders by education and employment status 100%

Percentage responders by housing status

85.40%

80%

100% 90.14% 60% 80% 40% 60% 40% 20%

3.20% 2.06% 1.24% 1.24% 1.06% 0.38% 0.30%

0%

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Living with parent/s

Other family members

Homeless

Guardians / carers

Partner

Alone

Support workers

With friends

20%

6.58% 0.87% 1.67% 0.97% 0.69%

0% Comprehensive school

College

University

Employed

Unable to work due to ill health

Parents

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3. ‘Psycho What?’

3.1 NEW PSYCHOACTIVE SUBSTANCES (NPS) Summary: Data from the survey suggests that across the population of young people in the region, around 30% are actually familiar with the term ‘New Psychoactive Substances’ conversely 80% have heard of ‘Legal Highs’.

Neath Port Talbot responders were more familiar with the term ‘NPS’ and ‘Legal Highs’ than its neighbouring authorities.

Analysis: All survey responders were asked whether they had heard the term ‘New Psychoactive Substances’ prior to participating in the survey. Sixty nine percent of respondents had not heard of the term.

with the term ‘Legal Highs’ than responders in neighbouring authorities. While 84% of all responders in Neath Port Talbot had heard of ‘Legal Highs’ in Bridgend and Swansea this figure was 67% and 63% respectively. Figure 7, illustrates the degree of terminology knowledge by local authority area.

Figure 7.

Percentage responders by local authority area

It is estimated that 30% of young people across the Western Bay region are familiar with the term ‘New Psychoactive Substances’.

Among the lower age ranges, 11-13, 14-16 and including the 17-19 age group, less than a third of the responses from each group stated that they were familiar with the term ‘New Psychoactive Substances’.

Conversely 40% of 20-22 year olds and 52% of 23-25 year olds had heard of the term.

However, of the total responders that had heard of the term, 40% of these responders resided in the Neath Port Talbot area despite having fewer older responders from this local authority area. Less than a quarter of responders from Bridgend or Swansea local authority areas overall said that they knew the term ‘New Psychoactive Substances’ or ‘NPS’.

3.2 LEGAL HIGHS Analysis: All survey participants were asked whether they had heard of ‘Legal Highs’ before.

Seventy eight percent of responders had heard of the term ‘Legal Highs’.

Among the 11-13 age group 66% had heard of the term ‘Legal Highs’ and familiarity with the term increased with age with 86% of responders in the 14-16, 88% at 17-19 and so forth.

This follows a similar pattern to NPS knowledge when we mapped the responses against local authority area. Responders from Neath Port Talbot area again, were more familiar 15

22% 67% nd ge ir d B

39% 84% h at t Ne lbo Ta rt o P

22% 69% a se an Sw

Had heard of NPS Had heard of legal highs

Discussion: The All Wales School Liaison Core Programme (AWSLCP) delivers substance misuse lessons as part of a spiral curriculum across all primary, comprehensive schools, special schools and pupil referral units in the region. This universal service administers lessons regarding NPS at key stage 2 (age 7-11) and key stage 3 (age 11-14). It is a quality assured, minimum provision for all pupils. The Western Bay region achieves maximum coverage across all schools, year upon year, and these education sessions consistently refer to these substances as NPS. Despite this, fewer young people in these key stages said they were aware of the term. This strongly suggests that the term NPS is not being

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

3. ‘Psycho What?’ retained by the younger age groups. It is an indication that ‘New Psychoactive Substances’ or ‘NPS’ is not an age appropriate term; it does not resonate with younger comprehensive school pupils and has little applicability.

Following the introduction of the Psychoactive Substances Act, it must be assessed if it is now still necessary to continue to differentiate between traditional illegal drugs and NPS in education services. That is, NPS is a broad term used to describe drugs not controlled under the Misuse of Drugs Act. This is a legal policy paradigm. It does nothing to equip young people to make decisions day to day in everyday life. All drugs are controlled under a legislative framework and differentiating between these legal frameworks does not help young people make a more informed choice out in the community. Complex messaging is compromising meaningful learning outcomes and reducing the potential efficacy of education.

It is strongly advocated that information and education provision for the 16 and younger age groups is reviewed. Knowledge based learning in substance misuse education, in isolation, is not helping young people to negotiate exposure to substance misuse. Every effort must be made to help young people develop the skills to manage the social dynamics of substance misuse at adolescence. There must be less emphasis on the legal frameworks that surrounds controlled drugs that are prevalent in the community.

This suggestion is also supported when we consider the variation in knowledge across the region. In addition to the AWSLCP, Neath Port Talbot has a specific substance misuse education service that is delivered by Welsh Centre for Action on Dependency and Addiction (WCADA) which is commissioned by the APB. The Safer Neath Port Talbot Partnership also implemented a community safety campaign around NPS in 2016 which actively sought to inform pupils about the risks of NPS and support parents to identify NPS use. Evidence strongly indicates that including parents in their children’s learning improves the efficacy of education and attainment15. More young people in Neath Port 15 Department of Education; 2010 https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/182508/DFE-RR156.pdf

16

I don’t like the idea of drugs, legal or not. They’re dangerous. They do not carry an appeal apart from the fact that they are easy to get hold of and they are legal.

SURVEY RESPONDENT

Talbot knew, and retained, the term NPS because this local authority had much greater depth to its substance misuse education and information services in 2016 than its neighbouring authorities.

RECOMMENDATIONS 1. Following endorsement by the APB, the PET group undertake a comprehensive evidence review regarding substance misuse education.

2. In partnership with the All Wales School Liaison Core Programme, the Area Planning Board review the continued relevance and applicability of the term NPS in the context of substance misuse education and information.

3. Substance misuse education services are standardised, equitable and consistent across the region. This provision should complement the All Wales Schools Liaison Core Programme, the PSE curricula and the Healthy School Scheme, to ensure that education provision is unified across the region.

4. Parental engagement should be a key consideration in the development of universal prevention and education services that target young people below the age of 16.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

3. ‘Psycho What?’

‘Schools and Police on top!’

3.3 SOURCES OF INFORMATION Summary: Responders gained their information about NPS or legal highs from an average of 3 sources per individual. Very few responders actively sought information regarding NPS and sources of information changed as age increased.

Analysis: All responders that had heard of either NPS or legal highs were asked where they got their information from. Responders were asked to select all their information sources from a selection of seventeen options. This question was designed to establish how young people had heard about NPS and not where they would go if they needed more information.

Eighty two percent of all responders answered this question. Data from the survey indicated an average of 3 information sources per individual.

The below describes the top 6 sources of information against our survey response profile.

The school setting was the most frequently indicated source of information regarding these substances with 46% of all responders stating that they had received their information in school.

This was followed by the Police Service with 37% of all responders; presumably via the All Wales School Liaison Core Programme.

Television generated a 34% response rate followed by 33% stating friends were the source of information.

Young people only marginally indicated social media channels over parents with 31.8% and 31.7% respectively. However 19% of responders also stated that they had received information from the wider family which suggests, that among our survey responder profile, a family member is a significant source of information.

Very few young people received their information from a health service with only 7% receiving information from their doctor and 2% from a sexual health clinic.

In addition, the data suggests that very few responders actually actively sought out information regarding these substances with 17

only 11.6% indicating that they had undertaken a specific internet search and 11% stating that they had accessed some form of literature.

Figure 8 demonstrates the range of sources that responders gained their knowledge of NPS or legal highs.

Figure 8.

Sources of information by percentage 46% 37% 34% 33% 32% 40% 32% 50%

30% 20%

19% 12% 11% 11%

10% 0% School setting

Police

TV

Friends

Social media

Parents

Family members

Internet

Drug & alcohol worker

Leaflets

3.3.1 SOURCE BY AGE GROUP When sources of information were cross referenced with the age of the responder, there was a clear pattern of variation among the age groups.

Age 11-13 Over half of responders aged 11-13 indicated that they received their information in a school setting at 53%, followed by police at 43% and then parents at 40%. This age group had a rate of 2.8 sources per individual. Fewer young people received their information from friends, social media or the television which accounted for 24% for each source. In comparison to the other age groups, 11-13 year olds are generally

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

3. ‘Psycho What?’

Age 17-19

Because I’m not allowed, my parents don’t allow me!!!

Also I don’t want to be addicted to a drug I’m a child.

SURVEY RESPONDENT

passive recipients to universal information that is administered. There is no evidence that this age group actively seeks information regarding substance misuse.

Age 14-16 This pattern starts to change among our 14 -16 age group. In this age group responders are subject to a greater range of sources at a rate of 3.2 sources per individual. The school setting is still the dominant source of information at 48% however, responders in this age group begin to receive slightly less information from their parents about substance misuse and glean more information from friends and/or social media. In this age group, 32% received their information from parents, 41% from friends and 40% from social media. The television becomes more of a feature in how young people receive information with a 37% response rate. This is closely followed with 36% stating that the police were the source of their information. Again, there is little evidence that this age group actively seeks information regarding substance misuse.

18

This pattern is more strongly observed among our 17-19 age group. This age group has a rate of 3.8 sources per individual however the police and parents are a less likely source of that information at 20% and 21% respectively. Friends become the dominant source of information in this age group, yielding 63% of responses.

This is closely followed by social media at 58%.

In this age group active internet searches for information begin to increase and television also becomes an increasing source of information with a 48% response rate.

Age 20-22 Following this, respondents in the 20-22 age group received their information from slightly fewer sources than their younger counterparts at 3.5 sources per individual. There is less information received from friends at 22.8% but a greater absorption of information from social media at 63%. TV was a source of information for 54% of responders in this age group. Only 21% of responders stated that their parents were a source of information regarding NPS.

Age 23-25 The 23-25 year old responders received information from 3.4 sources per individual.

Friends and social media are both the primary source of information both yielding a 48% response rate. This is closely followed by television at 44%. The greatest rate of deliberate internet searches regarding NPS is seen among this age group. Parents were indicated as a source by 12% of responders.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

3. ‘Psycho What?’

Discussion: As the analysis highlights, sources of information for young people incrementally change as they age. At early comprehensive school age, information sources are generally secure, and age appropriate. There is no evidence that 11-13 year olds actively seek out information regarding substance misuse.

Young people in this age group appear to be passive recipients to information provision and do not necessarily retain the knowledge.

This is in part because of its applicability to their lives at that age. It is also suggestive that current substance misuse education provision and teaching strategies are not sophisticated enough in preparing pupils for the challenges in adolescence regarding substance misuse.

Primary prevention strategies are critical for this age group. We must do more to engage this age group in skill based and affective learning provision. Meaningful learning that develops young people’s understanding and resilience when exposed to substance misuse by their peers and acquaintances.

The same is true for the 14-16 age group although parents and services have less control over the quality of information that young people are exposed to. While 14-16 year olds still receive secured information, young people in this age group participate in a more dynamic knowledge acquisition. They become more at risk of gaining poorer knowledge from friends and social media.

Primary prevention strategies still remain critical for this age group.

Someone told me it was a fag I tried it, passed out, stopped breathing and ended up in hospital.

I woke up with my mother standing next to me still tripping my box off.

My mother didn’t look too happy.

SURVEY RESPONDENT

As young people mature into adulthood, there are limited quality assured information sources that are controlled locally. However, actual demand for information appears to develop from 17-19 and more active knowledge acquisition develops. Media sources of varying quality now become the primary source of information.

RECOMMENDATIONS 5. Substance misuse education provision for 11-16 year olds is reviewed and service specification developed by the APB. 6. A quality assured, and relevant, substance misuse information resource is sought and promoted among the 17-25 age group. n

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

4. ‘I forgot what it means...’

4. SAFETY Summary: Nearly half of responders were not sure about the safety of NPS use although there is variation across the age groups. There is a clear indication that young people are confused by the term NPS; with some thinking that NPS have a legitimate medical application. Only 1% of the total survey responders made explicit reference to the legal status of NPS as a measure of safety.

All young people recognised that any drug use carries some risk. Those who had experience of NPS chose not to acknowledge the risks.

Young people in Neath Port Talbot were much surer of the harms posed by NPS use than their counterparts in neighbouring authorities. Young people in Bridgend demonstrated the riskiest pattern of knowledge about NPS. Analysis: All survey responders were asked whether they thought NPS were safe to use.

The quantitative data indicated that 45% of responders were ‘not sure’ if NPS were safe to use. However, 37% of responders did recognise that NPS were ‘not safe at all’. Only 2% stated they felt that NPS were ‘very safe to use’. Figure 9 demonstrates perceptions of safety among the survey responders by percentage.

Figure 9.

Do you think NPS are safe to use?

2.31% 3.43% 9.0% 37.4% 44.8%

Very safe to use

A bit safe to use

A little bit unsafe

Not safe at all

The qualitative responses around perceptions of safety will be discussed under heading 4.1.

Across the age ranges the 11-13 and 14-16 age groups were most likely to answer ‘not sure’ at 46% closely followed by ‘not safe at all’ at 38%.

Conversely responders aged 17-19, 20-22 and 23-25 were more likely to state that NPS were ‘not safe at all’ at 53% followed by ‘not sure’ at 30%.

A compelling 13% of responders in the 23-25 age range stated that NPS were ‘very safe to use’.

This is much higher than the mean response rate. Across all other age ranges, this perception does not exceed more than a 3.5% response rate despite substantially greater representation in other age brackets. However, from the qualitative data to follow, it is clear that those who felt that NPS were safe to use had some experience of NPS use.

Substantially more responders in Neath Port Talbot stated that NPS were ‘not safe at all’ at 52%. In addition, much fewer Neath Port Talbot responders stated that NPS were ‘very safe to use’ at 1.7%. As mentioned earlier in the discussion heading 3.2, it is surmised that this is due in part to the depth of NPS prevention strategies in the Neath Port Talbot local authority area in 2016. That is, there was less confusion in Neath Port Talbot regarding the term NPS and therefore responders knew how to attribute risk. Following this however, Neath Port Talbot responders were also disproportionately more likely to state that NPS are a ‘bit safe to use’ at 4%. While the overall numbers were small, this is greater than Swansea and Bridgend with both just below 3%. In part, this is due to younger responders confusing NPS with medication and this will be discussed further in the report.

Conversely, Bridgend only had 32% of responders who stated that NPS ‘were not safe at all’. Bridgend had the highest number of responders stating that they were ‘not sure’ about the safety of NPS and that NPS were ‘very safe to use’ at 54% and 3% respectively. This is likely to be symptomatic of the limitations in prevention services provided for young people in Bridgend.

Not sure

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

4. ‘I forgot what it means...’

The quantitative data for Swansea showed a fairly even picture, however responders stating that NPS use was a ‘little bit unsafe’ was 1% above the regional mean rate at 10%. In addition, Swansea responders were also less sure about risks posed

by NPS. Just over half of Swansea responders stated they were ‘not sure’ about the safety of NPS use at 51%. Two percent stated they felt that NPS were ‘very safe to use’ which was just below the regional average.

4.1 WHY SAFETY All responders were asked to describe their reason behind their perception of safety about NPS. This was a free text response. Ninety four percent of survey participants responded to this question.

...because I heard that if you consume legal highs it can kill but I think it’s used for plants, that’s what I was told.

SURVEY RESPONDENT

‘A bit safe’ Among the survey responders 4% stated they felt NPS were a little bit safe. Two main themes emerged when the qualitative data was analysed.

The first theme was that the greatest number of responders under this heading believed that NPS was a type of medication or that an NPS had a legitimate medical application. Statements ranged from ‘some NPS are used in hospitals’ ‘they can help your health’ and ‘if people use them the right way they will do the things they’re meant to’. Nearly a quarter of responders under this heading made reference to a medical purpose and NPS, and that they were a bit safe if used for the correct purpose. Following this 14% under this response heading stated that they felt NPS were a bit safe to use because of their perceived legal status. Statements ranged from ‘they wouldn’t be allowed to sell them if they weren’t safe’ ‘because it says legal’ and ‘they would be illegal if they were completely unsafe’.

‘A bit unsafe’ Almost ten percent of survey responders stated that they felt NPS use was a bit unsafe.

The strongest response theme again was that NPS may have a medical use. Nearly a third of responders under this heading referred to the potential risks that NPS pose to the body if not used for its intended purpose. That NPS had the

21

potential to be directly toxic to the body or that their use would result in an accident. This was closely followed with a quarter of responders stating that NPS mimic illegal drugs; that NPS were still drugs and all drug use posed some risk. Following this, the perceived legal status of NPS was referred to among 6% of responders under this heading ‘cos they’re legal for a reason’.

Among these responders while it was recognised that all drug use poses some risk, the responders felt it was not as risky as using drugs controlled under the Misuse of Drugs Act.

‘Not safe at all’ Forty percent of responders selected ‘not safe at all’. The primary reason given among responders was that NPS use was a drug and all drugs are hazardous to the individual and others around them. Some responders made reference to NPS mimicking the effects of traditional illegal drugs and therefore it must be dangerous. Two percent made specific reference to the introduction of the Psychoactive Substances Act; that the new legislation was an indication that NPS are not safe at all.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

4. ‘I forgot what it means...’ drugs in medicine and that is why they were unsure about the safety of NPS.

Overview analysis

...because there are some that can have the same effect as illegal drugs but there are things like pain killers that can’t kill you.

SURVEY RESPONDENT

‘Very safe’ Only 2% of responders stated that they felt NPS were very safe to use. Under this heading, responses were from survey participants that had some experience of using NPS. Generally responders described the pleasure of their drug taking rather than their perceptions of NPS safety.

A small amount of responders elaborated and stated that they’d had no adverse experience from their NPS use and that is why they felt that NPS were very safe to use.

‘Not sure’ The highest proportion of survey responders stated they were unsure about the safety of NPS. Forty five percent of responders were not sure about the safety of NPS. Analysis of the qualitative data demonstrated that this was actually because the responders were ‘not sure’ what the term NPS meant. Survey responders were not sure about the safety of NPS because they didn’t know what they were. Eighty two percent of responders in this heading felt they had insufficient information to make a decision.

Following this, despite not knowing what NPS stood for, a proportion of responders made reference to the general risk of drug taking and

22

An analysis of the themes that emerged from the qualitative data under each safety category was undertaken to establish if there were any dominating influencers on perceptions of safety. Across all the safety categories 41% of responders either stated they ‘don’t know’ why they perceived the safety the way that they did or had insufficient information to make a decision. Nearly 10% made reference to ‘it’s a drug’ recognising that any drug use carries some risk. This also links with the 2% medicine theme where responders thought that NPS may have their legitimate uses and risky if used inappropriately. Only 2% of responses mentioned the legal status of NPS explicitly; either ‘they must be dangerous they’ve been made illegal’ or ‘they are legal so they can’t be as bad as illegal drugs’.

Discussion: Neath Port Talbot responders are more informed of the risks posed by NPS which suggests that this local authority area was more resilient in 2016 to NPS harm than its neighbouring authorities. Despite having greater representation from older groups of young people, Bridgend responders were much less informed than Swansea and Neath Port Talbot young people and demonstrate a riskier pattern of knowledge.

Overall young people maintained that they were not familiar with the term NPS and felt they didn’t know enough about them to make a decision.

However while this holds true, it was clear that if young people suspected that it was a drug, then they recognised that all drug use was not without its risks irrespective of the regulatory framework around them.

Generally all young people recognised that drug use poses some risk even if they didn’t know what NPS meant. Those who had experience of using NPS chose not to acknowledge these risks.

4.2 SAFER THAN ILLEGAL DRUGS Summary: Almost a quarter of responders felt that NPS were safer than illegal drugs. Neath Port Talbot appeared to have the most accurate

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

4. ‘I forgot what it means...’ knowledge about NPS overall. Bridgend responders demonstrated a riskier pattern of knowledge. There is some evidence of a tiered system approach, to appraise the risk posed by drugs, which is underpinned by legal status.

Analysis: All survey responders were asked whether they thought NPS were safer than drugs controlled under the Misuse of Drugs Act. Responders were asked to select one of five risk categories. The quantitative data indicated that 55% of responders were ‘not sure’. Twenty percent of responders recognised that NPS were ‘not safe at all’ but 18% of the responders stated that they felt NPS were ‘much or a bit safer’ than illegal drugs. In total, data from the survey indicated that 24% of responders thought that NPS were safer than traditional illegal drugs in some way. Just fewer than 7% stated that they thought that traditional illegal drugs were safer than NPS. Figure 10, demonstrates the perceptions of NPS safety when compared to drugs controlled under the Misuse of Drugs Act.

Figure 10.

Perceptions of NPS safety when compared to drugs controlled under the Misuse of Drugs Act by percentage

55.50%

4.50%

20.10% 6.50%

Responders in the younger age groups (11-16) were most likely to indicate that they were unsure whether NPS were safer than illegal drugs; averaging at 50% per age bracket. This is in part due to young people not knowing the term NPS and how to appraise their associated risks. While nearly half of all the older responders 17-25, would clearly state that NPS were ‘not safe at all’. Significantly more responders in the 23-25 age group would state that NPS were ‘much safer’ than illegal drugs at 11%.

Responders residing in Neath Port Talbot were most likely to identify that NPS were ‘not safe at all’ at 24%. However, while Neath Port Talbot had below the mean response rate for an uncertain response of ‘not sure’ at 49%, Neath Port Talbot were 1% above the mean response rate with responders stating that NPS were ‘a bit safer than illegal drugs’ at 14%. Swansea had the highest number of responders stating they weren’t sure if NPS were safer than illegal drugs; 60%. This was closely followed by Bridgend with 58%. Despite an under representation from the Bridgend local authority area, Bridgend had slightly above the mean response rate for stating that NPS were ‘much safer’ than illegal drugs with 5%. Neath Port Talbot and Swansea were around the mean response rate at 4%.

Discussion: The data under this question is somewhat skewed because young people are not familiar with the term NPS and are not sure how to attribute a level of risk when compared to traditional illegal drugs. Among the remaining responders however, where there is no knowledge of NPS, there is some evidence of a tiered system approach to appraise the risk posed by drugs which is underpinned by legal status. This would support the premise that explicit legislation does help orientate young people to levels of risk. n

13.40%

Much safer

A bit safer

Not as safe

Not safe at all

Not sure

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

5. ‘Knowledge = Power’ 5. MORE INFORMATION?

5.1 WHAT KIND OF INFORMATION

Summary: Nearly half of young people wanted more information regarding NPS. Almost 60% of all responders indicated that they would like more information regarding NPS and the law. Very few responders requested information regarding help and support but there is slight variation across age groups. Neath Port Talbot demonstrated the greatest demand for further information despite having more intensive provision. Younger responders are requesting a duplicate of the information they have already received.

Analysis: Survey responders that wanted more information were asked what information they would like. There were six category options and responders were asked to select all that would be helpful.

Analysis: All the survey responders were asked if they would like more information regarding NPS. There was a 95% response rate to this question.

Overall, 40% of responders in each age group would like further information but there is slight variation among age groups.

Nearly 60% of all responders across the region indicated that they would like more information regarding NPS and the law. Very few responders requested information regarding help and support. This may be in part due to the overall age profile of responders. Figure 11 demonstrates the variation in information needs across the age groups by percentage.

Figure 11.

Information requirements 35%

Over 50% of the 11-13 age group would like further information and 44% of the 14-16 age group also requested further information regarding NPS. Responders 17 years and above had a 40% response rate across each age group.

What is also interesting is how this pattern is distributed across local authority areas. Across the region, data from the survey suggests that around 48% of young people in our target population would like more information regarding NPS. However, despite Neath Port Talbot having more equitable substance misuse information services across its area, than its neighbouring authorities, young people in Neath Port Talbot expressed the greatest demand for further information at 52%. Conversely, while Bridgend has far fewer information services, only 43% of responders from this local authority area requested further information. This is in part due to Bridgend responders being more representative of the older young people that clearly actively seek the information they require. Swansea does have better information services in schools than Bridgend. This service is provided by Drug Aid Cymru but access is inequitable. Half of all responders in Swansea wanted more information regarding NPS which is just slightly above the population mean response rate.

24

33%

27% 63%

67%

74%

49%

58%

67%

71%

55%

56%

52%

55%

45%

49%

47% 57% s yr 13 11

61%

6 -1 14

s yr

9 -1 17

s yr

2 -2 20

s yr

s yr 25 23

Info regarding law around NPS Info regarding associated NPS health risks Info regarding effects of different NPS Info regarding different chemicals in NPS Info regarding help and advice

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

5. ‘Knowledge = Power’ There are slight differences in information requirements as age increases. The 11-13 age group stated that they wanted more information about the law around NPS at 57% and then information regarding the health risks associated with NPS at 47%. Almost 45% stated they would also like information regarding the effects of different NPS. While among the 14-16 age group we see a similar pattern with 55% requesting information regarding the law and 49% requesting information regarding the associated health risks; 49% also requested further information regarding the effects of different NPS. Among the 17-19 year old responders, information about the law around NPS starts to become slightly less helpful at 56% and this group of responders are requesting more information regarding the effects of different NPS; 63%. This is followed by the health risks associated with NPS at 58%. There is also a slight upturn in the number of requests for information on further help and advice.

This pattern is also observed among the 2022 age group. Over 67% requested further information on the effects of different NPS and

I would never try NPS because I know the consequences behind them which would potentially ruin my mental state. I would not break the law either since I am not willing to do something stupid to lose everything.

SURVEY RESPONDENT

25

67% also requested information on the health risks associated with NPS use. Fewer request information regarding the law at 52%. In this age range a third of responders request more information regarding further help and advice.

The 23-25 age group primarily want more information on the effects of NPS with 74% requesting this information. This is closely followed by 71% requesting information on the associated health risks and 61% regarding the different chemicals that are in NPS. In this group, 55% requested information regarding the law. Just over a third of responders requested information on further help and advice.

Overview analysis Across the survey responders information requests change as age increases. It appears that the 11-13 age group have a general interest in knowing more about NPS. In this age group young people want to know what they are, what risks they pose and what the penalties are. At age 14-16, things start to change. This age group begin to enquire what the direct effects are to the individual. This infers that young people are either becoming aware of peers that are using substances, or are starting to appraise what effects NPS might have on them as individuals.

The risks of NPS are becoming more relevant.

From age 17 a small but clear incremental increase in interest regarding the effects and risks of NPS is observed. This further supports the inference that information is becoming more applicable in their lives. As age increases there are greater enquiries about sources of advice and help. This is suggestive that once experimental use has now become more problematic use for them or someone around them.

Discussion: Young people in the Western Bay region continue to express a need for further information regarding NPS. What is interesting is that despite Neath Port Talbot possibly having the most equitable service in the region, the demand for more information in that authority area is greater. To some extent this can be explained by the age distribution among survey responders. That is, older age groups actively seek information they require. Their younger counterparts on the other hand are more passive

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

5. ‘Knowledge = Power’ recipients to universal provision but also the groups that express the greatest demand for more general information. However, the younger responders are also requesting a duplicate of the information they have already received. While this might hold up when we compare Bridgend with Neath Port Talbot age group data, it doesn’t explain the comparison between Swansea and Neath Port Talbot. This further supports the assertion that young people do not need more information services they need better, age appropriate and more sophisticated, learning opportunities. Complex messages are weakening learning outcomes. Current knowledge only based learning has little applicability. This is particularly important pre age 16. It is proposed that the use of technical terms, and references to regulatory frameworks are rationalised. That ‘real life’ and affective based learning is the integral part of substance misuse education.

Substance misuse knowledge only based provisions cease and young people are provided with opportunities to explore drug use and reality which does not create anxiety or cause harm.

They sound like bad company.

SURVEY RESPONDENT

RECOMMENDATIONS

7. A comprehensive review of substance misuse information and education services is undertaken across the region with particular regard to content, learning outcomes and intended audience.

8. In partnership with the AWSLCP, primary prevention substance misuse interventions are agreed and endorsed by the PET group prior to implementation.

9. All primary prevention information resources, regarding substance misuse, are subject to endorsement by the Area Planning Board and the AWSLCP prior to their use with young people.

10. The PET develops an internal check list to ensure that all primary prevention interventions do not cause harm and contribute to the Western Bay’s APB prevention strategy.

11. The role and function of the PET group is communicated to other strategy groups outside of the remit of the APB. n

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THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

6. Who you going to call?

6. WHERE WOULD YOU GO?

Age 11-13

Summary: Responders would seek information from an average of 2.7 sources. These sources change with age.

Analysis: All survey responders were asked where they would go if they wanted information on NPS. There were sixteen categories to choose from and responders were asked to select all that apply. Preference was analysed based on the frequency that each category was selected.

Broadly, young people aged 11-25 will approach 2.7 sources per individual, with slight variation across the age groups. Across all age groups however, responders would be less likely to actively seek information regarding NPS from their friends; generally preferring more official information sources. Telephone helpline was the least attractive source of information for all age groups. Figure 12 demonstrates preference of information sources across the age groups by percentage.

Figure 12.

Information sources regarding NPS 3.0

30%

2.4

2.5

2.5

30%

2.5

22% 30%

25%

47% 28%

37% 29% 52% rs 3y 1 11

36% 39%

23%

17%

39%

24%

20%

s yr

s yr

6 -1 14

9 -1 17

2 -2 20

s yr

28% 35% 15% 15% s yr 5 -2 23

Parent/s

Doctor

Police

Substance misuse worker Access of sources average per individual

School staff Internet 27

36%

26%

Young people in this age group would access an average of 2.5 sources per individual. Over half of the youngest responders definitively indicated that their parents would be the first place they would turn to if they needed more information regarding NPS at 52%. The police was the second most credible source of information with 37% of this age group selecting this category. Following this, 25% would directly approach school staff.

The same percentage would also approach their doctor. However it is questionable whether this age group would access a doctor without being accompanied by a parent and perhaps also symptomatic that this age group thinks that a medical professional is a source of NPS.

Age 14-16 Young people in this age group use an average of 2.4 sources per individual. For 39% of responders in the 14-16 age group, parents are still the preferred source of information.

Secondary to this, 30% would look for information on the internet. The internet however is only marginally more popular than the police, with 29% stating that they would access advice from this source. Fewer 14-16 year olds would access information from their doctor but 28% would prefer to turn to a member of school staff.

Age 17-19 The 17-19 age group access slightly more sources than other age groups with an average of 3 sources per individual. The internet was the primary source of information for this age group with 47% stating they would turn to the internet in the first instance. Following that, 36% stated they would approach a member of school staff.

In this age group, 30% stated that they would approach their doctor and a further 30% stated they would access advice from a substance misuse worker. Only 24% stated that they would approach their parents and 23% would approach the police for information.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

6. Who you going to call?

RECOMMENDATIONS

Age 20 -22 The 20-22 age group would turn to an average of 2.5 sources per individual and for 39% the internet was the preferred source of information.

Just over 36% stated that a doctor would be their second source of information and 22% stated they would approach a substance misuse worker. This is closely followed by 20% stating they would approach their parents and 17% stating they would approach the police.

Age 23 -25 There is little variation between 23-25 year olds and their slightly younger counterparts. This age group would turn to 2.5 sources per individual.

Again, over 35% would access information from the internet. Twenty eight percent would approach their doctor and 26% would approach a substance misuse worker. Only 15% would approach the police or their parents.

Discussion: As suggested earlier, the sources of information that a young person will access changes with age. For the younger age groups, parents and the police were perceived as the most credible sources of information regarding NPS and other drugs. Although at age 14, the internet begins to become a more valuable tool to young people for knowledge acquisition. At 16, the influence of parents and police begins to wane and the internet is the primary source of information followed by school and college staff.

A greater reliance is observed post 18 on primary care services and is marginally a preferred source of advice above substance misuse support services.

28

12. School and college staff have sustained support to identify young people that are at risk of substance misuse.

13. Measures are put in place to ensure that school and college staff are competent to respond to the needs of young people regarding substance misuse advice.

14. The contribution that the All Wales School Liaison Core Programme provide to primary prevention and information services among the under 16’s is recognised and respected by the Area Planning Board and wider partners.

15. The APB reviews its primary care substance misuse provision for the 18-25 age group.

16. The Children and Young People’s sub group of the APB undertake an audit of referrals from universal services. n

Because of the dangers that come with it, or I might get addicted like other family members and I don’t want that to happen.

SURVEY RESPONDENT

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

7. Who’s doing it?

7. WHO USES AROUND YOU Summary: Data suggests that an estimated 1 in 5 young people living in the Western Bay region knew someone that had used an NPS in the last 12 months. A friend was the most common person implicated by over half the responders.

However, over a third of responders implicated a family member. Experience or knowledge of others substance use increased with age. There is a 15% increase in exposure to substance use observed between the ages of 14 and 19.

Analysis: All survey participants were asked if they knew of anybody reasonably close to them that had used NPS. The question was specifically designed to eliminate hearsay; only people that the responder came into contact with could be included in the response. This question did not enquire about young people’s perception of NPS use within the community. Figure 13 demonstrates the route of exposure to NPS use by percentage.

Figure 13.

Ninety six percent of survey participants responded to this question. Just over 22% knew of somebody that had used NPS in the last 12 months. It is cautiously suggested that across our population 1 in 5 young people would have known someone that had used an NPS in the last 12 months. Of those that knew someone, 57% stated ‘a friend’. Following this, there is a strong link towards family members. To illustrate: ‘other family members’ accounted for 12% of known NPS users, closely followed by ‘parents’ at 11%. ‘Brother or sister’ was indicated by 11%.

Combined, a family member response equated to almost 34% of all positive responses to this question. This means that 8% of the overall survey response rate had a family member that was known to have used an NPS within the last 12 months. This is a rate of 1 in 13 across the population of young people in the region.

However some caution must be used when using this data; it is clear that some 11-13 year olds are confusing NPS with medical steroids and anti-depressants.

Source of NPS exposure through others by percentage

57% 9%

Friends had a legal high which they got from a market and you would smoke it like cannabis.

I tried it because everyone else was.

11%

SURVEY RESPONDENT

11%

12% A friend

Other family members

Parents

Brother or sister

Work colleague

29

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

7. Who’s doing it?

The younger age groups, 11-13 and 14-16 were most likely to state that they did not know of anyone that had used NPS in the last 12 months at 86% and 75% respectively. As age increased, more responders stated that they knew of someone that had used NPS. Following an ‘I don’t know anyone’ response, 6% of 11-13 year olds indicated that they knew of ‘a friend’ that had used an NPS in the last 12 months but this was substantially below the mean response rate against all age ranges.

Alternative categories did not achieve above a 2% response rate. The 14-16 age range followed a similar pattern with 16% responding that they knew of ‘a friend’ that had used an NPS in the last 12 months. This was below the mean response rate by 5%. Again, alternative selections did not generate above a 2% response rate.

Data from the 17 and above age range demonstrates a different picture. As mentioned previously, as age increases more responders knew someone who had tried NPS in the last 12 months. Over 40% of young people in the 17-19 age group knew of someone who had tried an NPS; this is a 15% increase on the 14-16 age group. This rate increases further again by 20% among the 23 -25 age group.

Across all the age brackets ‘a friend’ was the most commonly identified person that was known to the responder to have used in the last 12 months but we see a substantial increase at 17 years of age and above. Across the three age brackets the mean response rate is 28% stating friend with the greatest response in the 20-22 age bracket with just over 29%.

Following ‘friend’, the 17-19 year old responders state that a sibling or a work colleague was the person they knew that had tried NPS in the last 12 months, both scoring a 4% response rate for each category. The 20-22 age group also knew of NPS use among work colleagues at 5% followed by 3% stating ‘parents’.

Despite having low representation from the 23-25 age group, all category responses were substantially above the mean rate. Over 6% stated that they knew their parents had used a

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Because I have been brought up to stay away from drugs, legal or not.

SURVEY RESPONDENT

NPS in the last 12 months. Ten percent stated that their sibling had used an NPS. Nearly 8% in this age bracket had ‘other family member’ that had used and 11% knew of a work colleague that had used an NPS. There was little variation across the local authority areas against the responses to this question. However, Neath Port Talbot responders were less likely to have known of any family member that had tried NPS in the last 12 months.

Each local authority area was within the mean response rate of 13% that knew of ‘a friend’ that had taken a NPS. Bridgend responders were slightly above the mean response rate for ‘parents’, ‘sibling’ and ‘other family member’.

Discussion: Younger responders had less knowledge or experience of people using NPS. As age progresses, exposure to the use of NPS increases and this pattern is also reflected in the change of information needs previously mentioned under heading 5.1. At age 17, young people are becoming more exposed to substance misuse and young people want more information on the effects this has on themselves and people around them. n

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

8. To use or not to use...

8. HAVE YOU EVER USED NPS? Summary: It is estimated that 1 in 14 young people living in the region has used an NPS at least once. Well over half had previous experience of using drugs controlled under the Misuse of Drugs Act. There is an incremental increase as age progresses with older young people demonstrating an increased incidence of NPS use than their younger counterparts. Neath Port Talbot had the fewest number of responders stating they had used an NPS; however this statement must be considered against the survey responder profile data.

Analysis: When responders were asked whether they had ‘ever used’ NPS, 7% stated that they had used an NPS at least once. Data from this survey suggests that 1 in 14 young people living in the Western Bay region has used an NPS at least once. Quantitative data from the survey indicates that 44% of responders to this question had no previous history of substance misuse prior to their use of NPS. Following further analysis however, 44% is an overestimated figure due to some young people confusing NPS with medication. In addition, around 5% of responders’ state their use of NPS was unintended as will be explored in the following paragraphs. However despite this, it is accurate

It’s dangerous.

I would not like to do anything as stupid as that, it can affect your health, plus it is very immature and irresponsible.

SURVEY RESPONDENT

that the remaining 56% of responders that had used NPS, had experience of using drugs controlled under the Misuse of Drugs Act. While recognising there was low representation of 23-25 year old responders, this age group had the greatest positive response rate with 28% stating that they had ‘ever used’ an NPS. As would be expected, fewer 11-13 year olds stated that they had ‘ever used’ an NPS at 3% but a steady incremental increase across the age brackets is observed. Among the 14-16 group, 7% have ‘ever used’ an NPS but there is then a sharp rise to 20% among the 17-19 group. There is a modest dip among the 20-22 age group at 16% but this is still above the mean response rate.

Males made up 46% of the gender distribution for ‘had used NPS’ response. This was followed by 36% for females. Twelve percent of responders identified as transgender. ‘Other’ and ‘prefer not to say’ at 2% and 3% respectively.

Proceeding with caution, the following data infers that 1 in 17 males within the survey age range would have ‘ever used’ an NPS. We see a rate of 1 in 21 for females. However, we see a rate of 1 in 3 in individuals that identify as transgender.

‘Other’ generated a 1 in 8 rate of ‘ever used’ NPS. Bridgend had the highest number of responders stating that they had ever used an NPS at 8%.

This is a rate of 1 in 15 of survey responders.

Despite Swansea having a higher number of older responders, fewer responders in Swansea stated they had used an NPS at just under 7%; the mean response rate. This is a rate of 1 in 17 survey responders. Neath Port Talbot had below the mean response rate at 5%. This is rate of 1 in 26 survey responders. Self selection bias must be considered against these figures. These figures describe NPS use among survey responders. It is not indicative of NPS use prevalence at local authority area level.

8.1 NEVER USED NPS ‘I know what it does to you. Nothing but harm.’

Analysis: Responders that stated that they had not used a NPS were asked to describe the factors that prevented them from using an NPS. This was a free text response and 82% of all

31

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

8. To use or not to use... survey responders answered. The qualitative data was analysed and coded into key themes. Thirty two themes were identified in the data overall, however the data generated by this question is limited. Upon analysis the quality of the data was compromised due misinterpretation of the question. In hindsight, this question could have been framed better to increase the efficacy of the line of questioning. The top 7 themes are described below. The remaining 15 themes did not generate above 1.5% response rate.

Just under 22% of the qualitative data had to be discounted because of the inadequacy of the response and a further 9% had to be discounted because the responder had misunderstood the question.

‘Don’t know what they are’ Eighteen percent of responders stated that they didn’t know what NPS were. That nothing actually prevented them from using NPS. They either hadn’t heard of these substances at all, or despite knowing about ‘legal highs’, had not heard of NPS specifically. Some also stated that while they didn’t know what NPS were, they suspected it was a drug and would not try any drugs.

‘Kills’ Just fewer than 5% of responders state that the risk of death is sufficient information to prevent any substance misuse on their part.

That the knowledge they have regarding deaths implicated to drug use is enough to prevent them from ever using drugs, including NPS. There was no evidence that these responders had ever been in contact with substance misuse.

Among a large proportion of responders, under this heading, there is the perception that drug use guarantees premature death.

‘Lack of opportunity’

Ten percent of responders stated that NPS use would be dangerous or bad. In this group, the responses were either about the dangers to the individual directly or that NPS use is ‘bad’ for health or ‘bad’ behaviour. There was no evidence that any responder in this group had been in contact with NPS. Their responses were based on their attitude towards, and knowledge of, the risk of drug use.

Over 2% stated that they had not had the opportunity to use an NPS. There were a few sub groups under this response heading. The first was that the responder had never been offered but wouldn’t have been interested anyway. The second was that the responder leads a type of lifestyle where the offer of drugs would be unlikely. The third is, that despite the responder actively looking for NPS or promoting their openness to use NPS, they were hampered by a lack of money or an identified source.

Responders in the third group were the minority but still a firm feature under this heading.

‘It’s a drug’

‘Stupid’

‘Dangerous / bad’

Following this 8% of responders made reference to NPS and drugs. There was no evidence among these responses that they had ever been offered an NPS. All the responders in this group would not use NPS because of what they know about drugs. E.g. ‘I hate all types of drugs’ ‘its drugs and I don’t want to get messed up’.

‘Not interested’ Seven percent stated that they have no interest in drug use of any kind. There are inferences 32

made from some responders in this group that they had actively distanced themselves away from drug using peers. In this group, drug use is pointless and very unappealing. Some responders go further to say that the risk of a lack of control over oneself is not something that interests them. Furthermore, responders in this group do not understand the need to use drugs or why drug users felt compelled to use drugs in the first place.

Just fewer than 2% of responders stated that they wouldn’t engage in drug use because they are not stupid. Similarly with ‘not interested’ group, this group do not understand drug use or why people use drugs. While the responder doesn’t assert that they are cleverer, they do state that people who use drugs are less intelligent than the general population. The perspective of these responders is: ‘drug use is bad and dangerous and kills, why would I take them? That’s stupid.

People that use drugs are stupid’. n

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking?

9. RECENT USE The following 15 pages, explores the quantitative and qualitative responses from the survey responders that had used an NPS. This is a small sample size and describes the results from only 7% of survey responders.

‘They get me off my bin’ Summary: Among the survey responders the recentness and frequency of NPS use changed as age progressed. Generally younger responders were more likely to have used an NPS recently but to have used only once. With the exception of the 23-25 year olds, older responders were more likely to have used an NPS much more frequently but less likely to have used recently. Figure 14 illustrates the recentness of NPS by age group.

Figure 14.

Recentness of NPS use; percentage by age group

18%

22% 31%

14%

12% 41%

44%

23% 6%

27%

20%

12%

12%

14%

23% 5%

14% 29% rs 3y 1 11

27% 6 -1 14

s yr

11% 9 -1 17

s yr

2 -2 20

In the last 7 days Within the last month In the last 6 months Within the last year More than a year ago

33

56% s yr

40% rs 5y 2 23

Insights from NPS users

Analysis: Survey participants that stated they had ‘ever used’ an NPS were asked when they last used. The greatest proportion of responders stated they had used an NPS ‘more than a year ago’ at 28%. Following that however, 25% stated that they had used an NPS ‘within the last 7 days’. Just under 11% of responders stated they had used an ‘NPS within the last month’. ‘In the last year’ and ‘within the last 6 months’ both generated an 18% response rate.

The recentness of NPS use across age groups is mixed. The 11-13 age group were more likely to state that they had used ‘in the last seven days’ or ‘more than a year ago’ at 29% and 31% respectively. However, this may be symptomatic of some confusion between NPS and legitimate medication. Among the 14-16 age group the recentness of NPS use is fairly evenly distributed.

Twenty seven percent stated that they had used ‘in the last seven days’ but 27% also stated ‘in the last 6 months’. Just over 22% in this age group stated they had used NPS ‘more than a year ago’.

While a greater ‘ever used’ response rate among our older young people was observed, they were less likely to have used an NPS recently.

Over 40% of 17-19 age group had used an NPS ‘more than a year ago’ and 20% ‘within the last year’. Only 11% stated that they had used ’in the last seven days’. This pattern is more strongly observed among the 20-22 age group, with no responders stating they had used in the last six months. Fifty six percent stated that they had used ‘within the last year’ and 44% stated that they used ‘more than a year ago’.

Conversely, there were more ‘ever used’ and more recent use of NPS among the 23-25 age group. Forty percent stated they had used ‘in the last 7 days’ and 23% stated they had used an NPS ‘in the last six months’. Much fewer of the 23-25 age group stated that they had used ‘more than a year ago’ at 18%.

Responders from Swansea were most likely to have used NPS more recently with 29% stating that they had used in the last seven days and 16% within the last month. Conversely, responders in Neath Port Talbot reported less recent use with 36% stating they had not used an NPS in the last year. Bridgend had more responders stating that

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking? their last use of NPS was more than 12 months ago at 32% but also had the mean response rate for use within seven days at 23%.

9.1 FREQUENCY OF USE Analysis: Survey participants were asked about the frequency of their NPS use. The greatest proportion of responders stated they had used ‘only once’ at 28%. ‘A couple of times’ generated a 25% response rate. Combined 53% of survey responders did not frequently use NPS. However, this is closely followed by a 25% response rate for ‘daily’ use. A ‘once a month’, ‘fortnightly’ and ‘weekly’ response did not generate more than a 10% response rate for each category which suggests that substance use among young people is not particularly planned or organised.

Figure 15 demonstrates the frequency of NPS use by age group.

Figure 15.

Frequency of NPS use; percentage by age group 9%

15% 4% 4%

13%

23%

22%

s yr 13 11

34

34%

13%

7%

6 -1 14

s yr

11% 11%

20% 7%

46%

22%

25%

25%

11% 55%

2%

2% 5% 2%

32% 9 -1 17

s yr

5% 5% 9% 18%

44% 2 -2 20

s yr

rs 5y 2 23

Couple of times

Weekly

Once a month

Daily

Fortnightly

Only once

Insights from NPS users

Forty six percent of the 11-13 age group that stated they had used an NPS had used them ‘only once’. Conversely, fewer of the 23-25 age group had used an NPS ‘only once’ at 9%, with 55% stating that they used an NPS ‘daily’. The 1416 age group were marginally more likely to have used an NPS ‘only once’ at 25% however this was closely followed by ‘a couple of times’ response at 22%. The 17-19 age group stated that they would either use NPS ‘daily’ at 34% or a ‘couple of times’ at 32%. Similarly to the 23-25 age group, they were also less likely to have used an NPS ‘only once’.

Responders from Bridgend were most likely to state that they used an NPS ‘daily’ at 26%. This suggests that 1 in 4 of NPS users in Bridgend would use them daily. This was closely followed

by Swansea at 20% which infers that for every young person that used an NPS in Swansea, 1 in 5 would use them daily. Fewer responders from Neath Port Talbot would use NPS ‘daily’ at 18% making this a rate of 1 in 6. Fewer responders residing in Bridgend would have used an NPS ‘only once’ at 23%. Bridgend responders would generally use NPS a ‘couple of times’, at 32%.

Most responders residing in Swansea and Neath Port Talbot would use NPS ‘only once’ with both generating a 30% response rate.

Discussion: This data suggests that experimental use of NPS begins early and peaks between age 14 and 16. Following this, there is less experimentation among the proceeding age groups and use becomes more frequent. It also appears that frequent NPS use has a limited lifespan for most of its users, with recent NPS use declining perhaps to cessation. However, due to the risks associated with NPS use, it must be a priority that substance misuse is prevented among children and young people.

RECOMMENDATIONS

17. The PET to undertake evidence review to establish how to enhance primary prevention strategies targeting the 11-13 and 14-16 age groups.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking?

9.2 WHAT MADE YOU TRY NPS? Summary: Generally among survey responders, friends were the source of NPS and the primary influencing factor behind a person’s choice to use an NPS for the first time. Some individuals demonstrated internal factors that led them to try NPS. There were very few levers that services could have utilised to prevent NPS use. Among these responders, over 55% had also used drugs controlled under the Misuse of Drugs Act at some time.

Analysis: Following the inquiry regarding the frequency of use, the survey asked responders about the factors that led them to try an NPS for the first time. This was a free text response and 95% of responders that had stated they had ‘ever used’ an NPS responded. The qualitative data was analysed and coded into key themes.

Twenty one themes were identified in the data overall. In a number of responses, some themes are combined but these are discussed in each heading.

Thirty two percent of the qualitative data had to be discounted because it did not provide any insight into why individuals begun using NPS. As the report will discuss further, it is evident that a proportion of young people have little insight as to why they begun using drugs.

‘Friends’ Eighteen percent of the qualitative responses indicated that friends had a role in their first use of NPS. There are two main themes within this.

The first is that a friend unexpectedly had an NPS and the responder in that moment decided to try it. That is, the responder had previously no intention of using an NPS until the friend made it available. Throughout these responses there is no indication of pressure per se, just that a friend provided unexpected access to an NPS. The second theme among the friend response was that they felt everyone they knew was doing it. The responders felt that all their friends were doing it and had witnessed no adverse experiences from NPS use. The responders wanted to be part of the group’s experience and felt the risks were minimal. Again, there is no indication of pressure from friends but there is an indication that NPS use among the group was 35

Insights from NPS users

planned. When cross referenced with who was using NPS around them 65% of responders that had used an NPS identified that a friend/s were using NPS and 19% had a sibling that was using.

Just fewer than 23% of responders that used an NPS themselves did not know of anyone that had used an NPS. There were a small number of responses that did not fit perfectly into these two sub categories under ‘friends’. In a few responses, while friends were the source of the NPS, the responders believed that an NPS was safe to use because it was legal. In a small number of responses, while friends were the source of an NPS, the responders used because they were a new drug they hadn’t tried before. In some responses, the responders used an NPS for the first time because a person they were interested in was using them.

‘Unintended’ Some further friend responses which straddles another key theme, is that a friend administered NPS to the responders to enable them to feel better. There is some ambiguity as to whether these cases are in fact NPS administration or confusion with medication. However, the theme was sufficiently strong to suggest that some young people are accepting drugs from friends based on poor advice. This also links to the ‘unintended’ theme that was clearly identified among the data. Nearly 5% of the responses to this question indicate that they hadn’t intended to use an NPS and they were either misled by a friend, spiked or administered an NPS under duress. ‘Unintended use’ ranked as the fifth highest reason for NPS use among our responders to this question. In the highest proportion of these cases the young person thought, or were told, they were being offered a cigarette.

‘Curiosity’ Following a friend response, which incorporated unintended, ‘curiosity’ was the second leading answer given by responders at 8%. Responses ranged from ‘I wanted to try it once’ or ‘I wanted to see what it was like’. Within some of the ‘curiosity’ responses there is some reference that a proportion of responders were

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking? accustomed substance users and an NPS was a new substance to try e.g. ‘I wanted to see what the high was like’. From the data it is difficult to determine the proportion of responders that were naive to substance misuse previously but curious about trying an NPS.

‘Effect’ ‘Effect’ was another theme that emerged. Seven percent of responders were looking for a form of intoxication and actively pursued an NPS for their psychoactive effect. Through the qualitative responses under this heading it is evident that the responders participated in substance misuse more generally and NPS was another range of substances to experience. In addition, all responses under this theme describe why the responders continued to use NPS as opposed to why they begun using NPS e.g. ‘the intoxication was stronger’.

‘Fun’ ‘Fun’ was the fourth leading answer given as to why responders had tried an NPS. Almost 6% of responders gave this response when asked why they had tried an NPS. Within the ‘fun’ heading there are two key elements. A proportion of responders presented with the opportunity to use an NPS thought it would be fun to try it. That is, this proportion of responders had a pursuit for fun and it was perceived by the responder that use of an NPS would serve that function e.g.

‘I thought it would be a right laugh’. From the qualitative data it is difficult to determine whether these individuals planned their NPS use in pursuit of fun. It was also difficult to establish what proportion of these individuals were previously naive to experimental drug use.

Following that, the remaining responders captured in the ‘fun’ heading gave a response as to why they continued to use NPS rather than why they initially tried an NPS e.g. ‘because it makes life fun’ ‘because its fun and I like it’.

‘Substitute’ There is a clear theme among 3% of responders that NPS was used as a ‘substitute’ for illegal drugs. Either a traditional illegal drug was too expensive, or not available, or they used an NPS in an attempt to temper other drug use.

36

Insights from NPS users

No access to cannabis was one of the leading factors under this theme. It was also mentioned that a legal cannabis substitute was attractive to some responders because they were curious about experimenting with cannabis. Synthetic cannabinoids (SCRA) were purported as cheaper than cannabis which made SCRA’s appealing to cannabis users. In addition, some responders initially believed that NPS were similar and more accessible than cannabis and this is the reason why they tried them.

A small proportion of responders under this theme reported NPS use to manage their withdrawals from other drugs particularly heroin and diazepam. Following a mapping of these responders it is concluded that this group of responders were in the upper age ranges of the target cohort.

Coping Sadly, just over 3% reported NPS use as a means of coping with an enduring mental health issue or sustained stress. It is clear that among these responders, reactive depression to a serious adverse event or a situation at home made them vulnerable to the use of NPS. From the data it is impossible to determine whether these responders used a variety of substances to cope with their circumstances or whether they turned to NPS because of their relative availability in comparison to drugs controlled under the Misuse of Drugs Act.

Access The route of purchase and sustained supply of NPS was explicitly stated in 3% of responses.

While ‘access’ was the strongest feature in this response it was sometimes interwoven with another influencing factor. As an example: ‘all my friends were using them and they were easy to get hold of and cheap’. ‘They were cheap and easy to get hold of and I had no fear of being arrested’. Responders in this group used NPS because of ease of access, convenience and relative price to other drugs. That is, NPS were the preferred substance because negotiating the illegal drug market was perceived as burdensome.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking?

Only three responders made explicit reference to the legal status of NPS prior to the Psychoactive Substances Act coming into force. However, throughout the qualitative responses for NPS users overall, there is a distinct suggestion that NPS were either more accessible than illegal drugs, due to their limited regulation, and/or that accessing illegal drugs was viewed to pose more risk and sources were inconsistent.

Health While the 3% of responses under this heading were definitive in their explanation as to why they took an NPS, it became clear that there is a misunderstanding among young people about the term NPS. Every single responder under this key theme stated they had been legitimately administered an NPS either for a physical ailment or made reference to the administrator i.e. ‘a doctor gave it to me’. This was verified when the responses of these individuals were mapped through the system. Using the data collected it is suggested that 1 in 32 young people believe that either NPS have a legitimate use in medicine, or that medicines are an NPS or perhaps less surprisingly, young people are confused about the variation in drugs and the regulatory frameworks around them.

Minority responses The numbers of the following responses fall below a 2% response rate but are still interesting insights into some of the factors that led some responders to use an NPS. A small proportion definitively expressed that boredom was the factor that led them to experiment with NPS. The same proportion of responders stated that either NPS looked ‘cool’ or it looked like a ‘cool’ thing to do. A proportion of these responders felt that NPS use would enhance their image.

The novelty of NPS was also a draw to a small percentage of responders. Although it is tentatively concluded, from the limited evidence available, that these responders were experienced substance misusers e.g. ‘it was a new drug out’ ‘to try something different’.

As mentioned under access, a small minority of responders explicitly made reference to the

37

Insights from NPS users

legal status of NPS prior to May 2016. Similarly to ‘access’ these statements were interwoven with other factors. In only one response was it stated that the responder felt that NPS were safe because of their legal status. One responder preferred to access NPS purely because there were fewer legal ramifications than illegal drugs.

And similarly to the insights captured under ‘substitute’ some responders had always been curious about the effects of specific controlled drugs but accessed an NPS because of their perceived similarity and limited regulation prior to May 2016.

A small minority of responses stated that their relationship with their partner led them to using NPS. In these cases the partner was always male and the source of the NPS. In a few number of responses, the setting was viewed as the primary influencing factor e.g.

‘I was at a party’ ‘the sesh’. Within this small number of responses there is reference that use of an NPS was planned and that the responders were open to substance use.

A small number of responders definitively stated that a key family member was the factor that led them to use an NPS. There are two elements within this small number of ‘family member’ responses.

The first element is as previously discussed under the ‘health’ theme of responses. In some of the ‘family member’ responses, it is conceivable that a family member administered a legitimate medicine to treat an ailment and that the young responders have misunderstood what is meant

by NPS. The second element however, has a more sinister theme that runs through these responses.

While the numbers are few, some responders clearly suffered abuse at the hands of a family member and NPS was a feature of that abuse.

In a small number of cases the family member term has been used to describe the abusers. It is concluded that among the survey responders, NPS supply by a family member was very rare.

Following the above, there were only a very small number of cases where perceptions of safety were actually explicitly mentioned. These individuals used ‘because it is safe’.

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9. What were you thinking?

Some responders stated that they had used NPS for the first time based on the advice of a drug dealer.

Discussion: The qualitative data suggest that there are limited levers that services could have harnessed to reduce NPS use among this group of young people. Over half of the responders to this question were already engaged in substance misuse and either NPS were new substances to try, a credible alternative to drugs controlled under the Misuse of Drugs Act, or generally just more accessible. The greatest proportion of those that appeared naive to any substance misuse was influenced in some way by friends.

In these cases it was either that NPS use was perceived as the social norm or ‘hot thinking’ led them to their use when faced by unexpected NPS provision. What is demonstrated among these responders is that despite knowing the risks associated with substance use they still felt compelled to use them. In these cases, the actual drug in itself is irrelevant. It was social circumstances that weakened the efficacy of prior learning about substance misuse and risk.

Preventing substance misuse more broadly among young people is the key strategy to preventing initial NPS use. And a component part of this must be, that substance misuse education gives greater emphasis on negotiating the social dynamics of substance misuse among adolescents. Following that, reducing access of NPS was the only additional lever that would impact on NPS use among this group.

9.3 WHO HAVE YOU USED WITH? Summary: Responders were asked who they used NPS with. An interesting picture emerges.

With the exception of the 11-13 age group and the 23-25 age group, all responses in the other age groups indicate that 50% and above will use NPS with friends. It is also clear that there is a misunderstanding among younger responders around NPS and medication.

Analysis: In the case of 11-13 age group, ‘friends’ account for greatest percentage of responses at 32%, although there is less incidence of NPS use among this age group overall. However, what is interesting is that a significant 20% stated that they use an NPS with their parents 38

Insights from NPS users

and 13% state with another family member. The mean response rate for use with ‘parents’ was 9.3% and ‘other family member’ at 7%. While it is conceivable that some responses might be genuine based on some of the qualitative data already discussed, it is probable that this is further evidence of young people’s confusion between NPS and legitimate medication.

Over half of the 14-16 age group stated they used with ‘friends’. However, 16% also stated that they used ‘alone’ and 15% stated that they used NPS with ‘people they met’. Seven percent claimed that they used with ‘parents’.

The 17-19 age group were also above the mean response rate for using NPS with ‘people they met’ at 15% and below the mean response rate for ‘alone’.

While 67% of 20-22 year olds stated they used an NPS with ‘friends’, 22% also stated that they used NPS ‘alone’. Nobody from this age group used with ‘parents’.

Fewer 23-25 year olds stated that they used NPS with ‘friends’ with a response rate of only 24%.

When compared to the mean response rate this group of responders were much more inclined to use an NPS with ‘people they met’ 22% or on their own 21%. A sharp rise in NPS use with parents is also observed in this age group at 13%.

There was no significant difference in the number of responders that stated that they used an NPS with friends across local authority areas. However we saw that responders in the Neath Port Talbot area were above the mean response rate for stating that they used with ‘parents’. Again, Neath Port Talbot responders were disproportionately represented by the younger age groups in the selected cohort so it is suggested that this is due, in part, to a misunderstanding around NPS. Responders from Swansea were marginally more likely to use NPS with ‘other family members’ when compared to the other local authority areas with a response rate of 8%; mean rate 6.1%.

Responders in Bridgend were above the mean rate of NPS use with ‘people they met’ at 16%.

Both Neath Port Talbot and Swansea were just below the 14.6% mean rate.

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Insights from NPS users

9. What were you thinking?

Discussion: Excluding the 11-13 age group, the indication is from this cohort, is that early age NPS use generally with friends and is used socially. As age and frequency of use progresses, while NPS use is still a social activity, the individual gradually reduces this activity with trusted friends and by implication becomes more risky.

RECOMMENDATIONS

Figure 16.

Describe your experience of using NPS; percentage by age group

18% 32%

18. Substance misuse messaging for under 16’s is short, sharp and consistent.

19. Substance misuse education is reviewed to ensure that key messages do not cause unintended harm to children and young people.

20. Substance misuse education provision rationalises knowledge based sessions in favour of affective based learning for all young people 16 and under.

21. Broad education services are not an effective or adequate intervention for young people already identified as misusing substances.

22. Young people that are identified as misusing substances require tailored secondary prevention services for their substance misuse, this should also include use of nicotine products.

23. Blanket harm reduction messages are only provided to young people aged 16 and over.

9.4 NPS EXPERIENCE Summary: Younger experimental NPS users report a more positive experience than their older counterparts. Greater negative effects emerge from prolonged use. Figure 16 illustrates the experiences of NPS use by age group.

39

33%

35% 12%

44% 41%

32%

42% 36% s yr 13 11

50% 6 -1 14

s yr

14% 9 -1 17

s yr

67% 2 -2 20

s yr

41% s yr 25 23

Good experience of NPS Bad experience of NPS OK experience of NPS

Analysis: Survey responders that stated they had used an NPS were asked to describe their experience. Eighty eight percent of those who had ever used NPS survey answered this question. Responders were asked to select between ‘good’, ‘ok’ and ‘bad’.

Thirty seven percent of responders stated they had a good experience when they used an NPS. However data from the 11-13 age group would skew this data to a degree due to some confusion among this age group between NPS and medicine. Fewer stated they had a bad experience at 28% and 36% stated their experience was ‘ok’.

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9. What were you thinking?

The 11-13 age group were slightly more likely than not, to describe their NPS experience as ‘good’ at 38%; this was 9% above the mean rate across the age groups. However, data must be considered with caution among this age group.

Thirty three percent of young people in this age group had both a ‘bad’ and ‘ok’ experience.

Combined this means that 64% in this age group did not find the experience particularly rewarding.

There is a slightly different picture among the 14-16 age group. More responders in this age group found their NPS use rewarding. Half of the responders, 50%, stated that they had a ‘good’ experience of using NPS. This was 21% above the mean response rate across all age groups. Much fewer responders stated that they had had a ‘bad’ experience at 12%. Nearly 40% stated that their experience was ‘ok’.

A different picture is observed for the 17-19 year olds. Fewer responders in this age bracket describe their use of NPS as ‘good’ at 14%. The 17-19 age group were more inclined to state that experience was either ‘ok’ at 44% or ‘bad’ at 42%.

firmly stated that they would use an NPS again at 34%, and 18% were unsure.

The 11-13 age group made up 22% of the responders to this question. Nearly 60% in this age group stated they would consider using an NPS, although perceptions of a medical application cannot be discounted from this data.

The 14-16 age group accounted for the greatest response rate to this question at 44%. Sixty four percent in this age group stated that they would use an NPS again.

While the older age groups have fewer response numbers to this question at 25% combined, both the 17-19 and 20-22 age groups clearly indicate they had no intention to use an NPS again with 74% and 89% respectively.

The 23-25 age group made up 10% of the responses to this question and 59% stated they would use an NPS again.

Among the 23-25 age group, 41% described their NPS experience as ‘good’. However, 41% also described their experience as ‘bad’ and 18% described their experience as ‘ok’.

Discussion: Younger users were most likely to express that their use of NPS was a good experience. It has also been identified that experimental use begins at this age and initiation into drug use is usually socially driven. This suggests that experimental substance misuse with friends is rewarding for individuals previously naive to substance use. As recreational NPS use progresses, and frequency of use increases, it is suggested that positive experiences of NPS use begins to decline. An increased frequency of NPS use is also suggestive that NPS use cannot always be a social activity. This may be a contributory factor as to why greater negative effects emerge as age progresses.

9.5 INTENTION TO USE AGAIN

9.6 EMERGENCY ASSISTANCE

Summary: Nearly half of the ‘ever used’ NPS cohort stated they would not use them again.

However, the greatest intention to use again is observed among the 14-16 age group.

Analysis: Survey responders that had used an NPS, were asked whether they would use an NPS again. Nearly ninety percent of responders that had ‘ever used’ an NPS responded.

Summary: Over half of the NPS users stated that they had received any emergency intervention following their use of NPS at 53%. Individuals that needed emergency assistance accessed an average of 1.5 services per respondent.

Responders in Neath Port Talbot were more likely to require an emergency service than responders in its neighbouring authorities.

Despite 72% of responders stating they had a ‘good’ or an ‘ok’ experience, 47% stated they would not use an NPS again. Just over a third

Analysis: Responders that had used an NPS were asked whether they needed any emergency assistance due to their use of NPS. In this

A similar pattern is observed for the 20-22 age group. Almost 67% of responders in this age group described their experience of NPS use as ‘bad’. The remaining responders described their experience as ‘ok’. No responders in this age group described their experience as ‘good’.

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Insights from NPS users

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking? question responders were asked to indicate all the services that they had used.

Fifty three percent stated that they had received any emergency intervention from their use of NPS. Individuals that needed emergency assistance accessed an average of 1.5 services per respondent.

A doctor was the most common source of help stated among our responders at 10%. This was followed by a paramedic at 9%. Presentation to A&E and treatment by a nurse, each had a response rate of 7%. Assistance from a police officer also accounted for 7% and 6% received treatment from a first aider.

Responders from Neath Port Talbot that had used an NPS were much more likely to access emergency services following their use of an NPS. Each responder in Neath Port Talbot required 1.8 services each; particularly paramedics at 11% and the police service at 10%.

Responders in Swansea had the lowest use of services following NPS use, at an average of 1.3 service per responder. Very few had accessed A&E or paramedic following an adverse event from NPS use. A doctor was the preferred source of help by responders in Swansea at 9% but this was below the mean response rate.

Bridgend responders were also below the mean rate for service use at a rate of 1.4 services per responder. However, responders in Bridgend were more likely to present at A&E or receive services from a paramedic with both responses generating a 9% response rate. Following this, Bridgend were also above the mean rate for accessing a doctor for assistance following NPS use.

Discussion: Among the NPS users in this survey, over half required immediate assistance from a service following their NPS use. It is tentatively concluded that this is a much higher incident rate when compared to other drugs commonly misused by young people. The data from the survey suggests that while only a few young people have used NPS, the greatest proportion have needed assistance from a service.

Controlling access to NPS has meant that fewer young people will need emergency assistance for experimental substance misuse.

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Insights from NPS users

9.7 WHAT WOULD HAVE STOPPED YOU? Summary: It appears that NPS users generally had little personal insight into the factors behind their initial NPS use. The greatest proportion of responders believed that nothing would have stopped them from experimenting with NPS. Following that, only paradoxical hindsight learning would have prevented first time use.

Better knowledge was stated among nearly 20% of responders. Far fewer responders implicated the role of friends, in their substance misuse, in this part of the inquiry.

Analysis: All responders that indicated that they had ‘ever used’ an NPS were asked if there was anything that would have stopped them from trying an NPS for the first time. This was the second free text response that NPS users were asked to complete and 90% responded. The qualitative data was coded into key themes.

Twenty themes were identified within the data.

Just over 22% of the data was unusable due to the inadequacy of the response. A further 12% gave a ‘don’t know’ response and when included with the below suggests that a large proportion of young people have little insight into why they used an NPS. The system did not allow for qualitative responses to be cross referenced against age groups.

‘Nothing’ The strongest theme that emerged from the qualitative responses is ‘nothing’. Nineteen percent of responders stated that ‘nothing’ would have stopped them from trying an NPS for the first time. While in the main, responders only replied ‘nothing’ a few responders did provide additional information. In some cases the responders stated that they actively pursue psychoactive substances of any sort and that part of their identity was drug use generally.

That is, they used drugs and NPS was another drug; why would they not use an NPS? One responder goes slightly further to say that they liked experimenting with drugs and viewed NPS as another drug to take but discontinued due to declining mental health. A few responders stated in various forms ‘live life while you can’. Finally, a number of responders also added why they continued to use an NPS e.g. ‘nothing would

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

9. What were you thinking? have stopped me, I wanted to try them and liked them’. A ‘nothing’ response could also infer that some responders do not know what would have stopped them from using NPS for the first time.

‘Experience’ The next identifiable theme was ‘experience’.

In essence, 13% of responders would not have used an NPS after their experience of using them for the first time. All of the qualitative responses in this category indicate that the responder had a bad experience from using an NPS, with some stating they had been hospitalised or had experienced feelings like they were ‘dying’. In this theme all the responders developed their viewpoint about NPS following experimentation with them. The responders experience will prevent them from using NPS again.

‘Knowledge’ The third theme with an 8% response rate was ‘knowledge’. There are a range of sub themes within this data and there is a degree of overlap with ‘experience’. In the greatest number of responses under this section, the responder had used an NPS and had no prior knowledge of NPS but wished they’d known more beforehand. It is asserted by the responders that had they known more about the effects and risks, they would not have engaged in this type of substance use. While this may seem similar to responses identified under ‘experience’, in these cases, the responder states that explicit information on NPS would have prevented them from using an NPS for the first time.

Among a smaller number of responses, it is difficult to decipher the meaning behind the qualitative data provided. A proportion of responders state that they would not have used an NPS if they knew what it was. E.g. ‘more info’ and ‘if I knew what it was’. This could be viewed in two ways. The first is that the responder did not have sufficient prior knowledge to make an informed decision about whether or not to use an NPS. That is, the responders were unaware of the health advice and potential risks of using an NPS. The second perspective which links into the previously discussed ‘unintended use’ was that the responders didn’t know that it was

42

Insights from NPS users

an NPS they were being offered. It is concluded that both of these statements exist under this ‘knowledge’ theme.

Also under knowledge, a number of responses state that if they had known of the number of fatalities associated with NPS use, they would have never have used an NPS. In some responses, responders state that knowledge of people dying through media channels prevented them from further NPS use.

A little less of a feature but also important, responders felt they would have benefitted from knowing the risks associated with the chemicals; knowing the impact NPS had on physiology and how addictive the substances were.

‘Risks’ Five percent of responders explicitly mentioned ‘risks’. What is felt acutely in this heading is that the responders had used an NPS but then since learnt that they had consumed a potentially lethal substance e.g. ‘I’m scared of dying’ and ‘everything about dying’. This theme has links with ‘knowledge’.The responders maintain that had they known the real risks of using an NPS they would not have tried them.

In a few number of responses under risks, responders make reference to knowing the risks that NPS would have on mental health and the risks around overdosing.

‘Peers’ The role of peers was the next theme identified and yielded a smaller response rate than in the previous free text response (9.2) and accounted for only 4% of the qualitative responses. Similar to the pattern we see under heading 9.2; we see the two main themes repeated. The first theme, as highlighted previously, had the peer not provided opportunistic access, the responder felt it was unlikely that they would have tried an NPS. While the numbers were few, this was felt to be sole reason why the responder engaged in NPS use.

Again, the second theme was that the responder felt that all their peers were engaging in NPS use and felt compelled to use because the activity was common place e.g. ‘if no one else done it’.

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9. What were you thinking?

Under ‘peers’ also, while few, some responders stated that more supportive friends and/or credible advisors around them would have prevented their experimentation with NPS.

‘Observation’ Just under four percent of responders stated that had they observed the adverse side effects of NPS prior to their own personal use, they would have not begun using NPS. A number of responders stated they had seen their peers experiencing seizures and losing bladder control and that this was enough for them to discontinue using NPS. In all these responses, the individual directly witnessed an adverse event from NPS use and allude that had they had this prior knowledge they would not have experimented with them.

‘Family’ The role of the family was stated in 3% of responses. While some of the information given under this heading is difficult to decipher e.g. ‘my mother’ the greatest proportion of the data under this heading suggests that some responders have key individuals in their family that they either don’t want to disappoint and/ or are viewed as a credible source of support. In other cases, responders state ‘family’ as means of conveying a more fulfilling use of time than using NPS. It is also feasible that some of the data is alluding that it was family that exacerbated the source of stress that led to NPS use e.g. ‘parents’. However, while it is important to recognise this is a feature under this theme, it is concluded that this view point is a very small fraction of the responses under this heading.

Minority Responses The numbers of the following responses fall below a 2.5% response rate but are still interesting insights into some of the levers that may prevent initiation into NPS use.

A small number of responders stated that more positive activities such as work, time with family, or access to sport activities would have prevented them from using NPS. A proportion definitively stated that they

43

Insights from NPS users

would have not used NPS had they had more information regarding the chemicals that were in NPS and their associated strength.

A similar proportion stated that the lack of access to cannabis prompted them to purchase NPS as an alternative.

A small but important few stated that the new legislation has changed their use; that the risk of sanctions now prevents them from using NPS. A few state that ‘the cost’ would have stopped them from using an NPS. It is unclear if these statements refer to monetary cost or a wider sense of loss.

Finally, in some cases, responders make specific reference to particular individuals that were instrumental in their NPS use. In these cases, the responder was controlled by an individual and they attribute their NPS use solely to these individuals.

9.8 SOURCES OF NPS Summary: Survey responders used 1.7 sources per individual. A friend was marginally the preferred source of NPS but the original source of the NPS, via the friend route, could not be determined. The 14-16 age group were the group most likely to come into contact with a dealer. There was variation in the primary source of NPS across the local authority areas.

Analysis: Responders that stated that they had ‘ever used’ an NPS were asked where they sourced their NPS from. Responders were able to select multiple options from the following list of sources: a friend, a dealer, a shop, the internet, parents, family, and sibling. Of those that were directed to this question there was a 79% response rate. The mean rate was 1.7 sources per individual.

Across the total response rate, the primary source of NPS for 48% of the responders was a friend. This was followed by 45% of responders stating that they sourced their NPS from a dealer.

A local shop was indicated by 40% of responders.

Just under a quarter of responders used the internet to purchase NPS. Parents and family members had a 9% response rate each, however 21% of responders in the 11-13 age group stated their source of NPS were from their parents.

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Insights from NPS users

9. What were you thinking?

This data is inaccurate and access to NPS from parents among this age group is rare. Sibling was the least common source for NPS and yielded a 5% response rate in this question.

Due to the confusion among 11-13 age group with medication, analysis of family sources of NPS has been omitted. As a result, it is difficult to determine the average number of sources per individual within each age group. However there is some indication that the 23-25 year olds relied on a broader range of sources than their younger counterparts.

For 43% of the 11-13 age group the primary source of NPS was through a friend. Among this age group it is also claimed that 40% purchased NPS from a local shop and 35% were supplied an NPS by a dealer.

The 14-16 age group had a preference for accessing NPS through a dealer with 51% indicating this as the primary source. Forty eight percent had their NPS from a friend and 24% purchased their NPS from a shop.

Sixty eight percent of the 17-19 age group indicated that a local shop was their preferred source of NPS. Friend was indicated by 40% of responders in this age group and 38% indicated that they accessed their NPS from a dealer. A quarter of responders among this age range also indicated they used the internet to purchase NPS. While the numbers of responders are few, the 20-22 age group primarily accessed their NPS via a friend at 56%. A third accessed NPS from a local shop and a third from a dealer. The internet was used by 11% of responders.

Finally, as mentioned previously the 23-25 age group appeared to use more sources per individual. Sixty five percent implicated a friend as the primary source of NPS. Half of responders purchased NPS from a local shop. The internet was used by 45% of responders and 45% also used a dealer.

The source of NPS was cross referenced with the local authority of the responders. Similarly to the above, family member responses were omitted from this analysis. This also meant that an average source rate per local authority area could not be calculated.

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The primary source of NPS for 35% of responders residing in Bridgend was a local shop. This was much higher than Swansea and Neath Port Talbot with 22% and 21% respectively. Neath Port Talbot just slightly had the highest rate of NPS access from a friend at 32% of responders.

This was closely followed by Swansea with just under 32%; Bridgend had 30%. In Swansea, the primary source of NPS was through a dealer, accounting for 33% of responses from this area.

Thirty percent of responders in Neath Port Talbot accessed NPS via a dealer; this figure was 22% in Bridgend.

Neath Port Talbot had the highest response rate for sourcing NPS via the internet at 17%.

Swansea and Bridgend were below the average rate in this field with 13% and 14% respectively.

Figure 17 illustrates the primary source of NPS by local authority area.

Figure 17.

Primary source of NPS; percentage by local authority area 14%

13%

17%

22% 33%

30%

32%

32%

22%

21%

30%

35% nd ge ir d B

a se an Sw

h at t Ne lbo Ta rt o P

Local shop

From a friend

Dealer

Internet

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Insights from NPS users

9. What were you thinking?

Discussion: While the above provides a breakdown of the preferred sources by age range and local authority, it cannot accurately determine the original source of the NPS. That is, while younger responders primarily accessed an NPS from a friend or a dealer, the original source of that NPS could have been from a local shop or the internet. It is acknowledged among services across the region that the previous availability of NPS via certain high street outlets did promote some enterprising young people to become street level dealers. Controlling shop access of NPS would have reduced the number of NPS dealers. The introduction of the Psychoactive Substances Act has had an impact on the harm posed by NPS for all young people and reduced a number of routes of NPS availability.

Despite the regulatory framework surrounding alcohol and tobacco, 20% of NPS users, aged 11-13, stated that they used tobacco/nicotine alongside NPS, and 18% stated alcohol. Sixteen percent also stated they used cannabis.

9.9 NPS AND OTHER DRUG USE

Sixty five percent of the NPS users, aged 23-25, combine their use with tobacco / nicotine. Forty three percent used alcohol and / or cannabis.

Figure 18 demonstrates the percentage of other substances use alongside NPS use by age group.

Summary: Two thirds of NPS users smoked tobacco either with or alongside NPS. Younger responders appeared to have easy access to tobacco and alcohol despite the regulations around these substances.

Analysis: This question asked NPS users if they used any other substances with NPS. The options were ‘Tobacco/Nicotine’, ‘Cannabis’, ‘Alcohol’, ‘Ecstasy’ and ‘Other’. Respondents were asked to select a ‘yes’ ‘no’ or ‘sometimes’.

Nearly sixty percent of NPS users stated that tobacco/nicotine was the substance most commonly used alongside an NPS. A further 7% stated that they used tobacco/nicotine sometimes. Just over 47% of responders stated they regularly used cannabis alongside an NPS with a further 10% stating ‘sometimes’.

Less than a quarter of responders indicated that they used other drugs with an NPS. Alcohol was used alongside NPS regularly by 37% of responders; however older NPS users were less likely to combine NPS use with alcohol.

This data was cross referenced with the age ranges; the numbers start to become very small. Tobacco / nicotine were the primary accompanying drug of choice across all age ranges. This could mean that NPS use was routinely combined with tobacco and smoked and/or over half of NPS users are smokers.

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Nearly 50% of NPS users, aged 14-16, indicated tobacco as the accompanying drug. Fewer young people used alcohol in this age group at 36% but 46% stated that they regularly used cannabis with NPS. The same pattern is observed among the NPS users, aged 17-19, with 63% indicating they use tobacco and 43% using cannabis. Just over a quarter stated they consumed alcohol with NPS. Among the NPS users, aged 20-22, 55% indicate tobacco and 44% cannabis. Eleven percent stated they use alcohol with NPS.

Figure 18.

Use of other substances with NPS

43% 43%

46%

44%

25%

43%

11%

36% 16% 18% 20% rs 3y 1 11

50% 6 -1 14

s yr

63% 9 -1 17

s yr

55% 2 -2 20

Tobacco / nicotine Alcohol Cannabis

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

s yr

65% rs 5y 2 23

9. What were you thinking?

Insights from NPS users

RECOMMENDATIONS 24. Smoking among young people is as a strong indicator of further substance misuse and an indication that secondary prevention services are required16.

25. The third sector young person’s substance misuse services should be permitted to receive referrals for young people under the age of 18 that smoke.

26. School staff initiate brief interventions for substance misuse when smoking or alcohol use among pupils is detected.

9.10 AGE OF FIRST NPS USE Summary: Among some young people substance misuse does begin early and incrementally increases across the population as age progresses. Males begin experimenting with substances sooner than females.

Experimentation with NPS among survey responders, was concentrated among the 14-16 age group. This pattern is also consistent among those naive to the use of drugs controlled under the Misuse of Drugs Act. Analysis: Responders that had indicated that they had ‘ever used’ an NPS were asked how old they were when they first tried an NPS. Just fewer than 80% responded to this question.

Across the total response rate, the peak age for first time use of an NPS was between the ages of 14-16 at a total of 42% of all responders.

Following this, 28% of responders were aged between 11-13 when they first used an NPS. Sixteen percent state that they were 10 or younger, however caution must be used with this quantitative figure; some responders may have based their response on medication and not first time NPS use.

What is observed across the total response rate is that experimentation with NPS did begin early among a proportion of young people, and as age increases, the number of young people that have tried an NPS increases until it peaks at the age of 16. This pattern is also observed among responders that were naive to the use

Wanted something strong to express and block feelings out also my mates done it and when we stopped the friendship group separated so I’d say didn’t want to lose mates.

SURVEY RESPONDENT

of drugs controlled under the Misuse of Drugs Act. Following age 16, as age increases, a steady decline in the incidence of first time NPS use is observed. Only 8% of young people begun using an NPS between the ages of 17-19. Two percent tried an NPS for the first time between the ages of 20-22 and 4% between the ages of 23-25.

This pattern is also consistent across each local authority areas, although Swansea responders appear to have a higher rate for early NPS use with just over 3% above the mean rate for 10 or younger. While across all local authority areas, experimentation is concentrated among the 1416 age group, Neath Port Talbot were 10% above the mean rate in this age group. Bridgend, while marginally below the mean rate for early use is above the mean rate in the 17-19 age group.

However, this data must be considered against the overall profile of survey responders.

16 http://www.nta.nhs.uk/uploads/jsna-support-pack-promptsyoung-people-2017-final.pdf

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Insights from NPS users

9. What were you thinking?

Figure 19 demonstrates the percentage of first time NPS use by local authority area. It is to note that the data in the figure represents only 7% of the total survey responders.

Analysis: Responders that had ‘ever used’ an NPS were asked how their use of NPS had changed over the last 12 months. This question was designed to appraise the life span of NPS use for individuals and also appraise the immediate impact of the Psychoactive Substances Act 2016.

Just fewer than 80% responded to this question.

The gender distribution was also analysed with first time NPS use. Nearly half of the survey responders that had used an NPS were male.

Females accounted for 36% for ‘ever used’ an NPS. A greater density of NPS use among males is observed at 11-13 than in females, with initial NPS use being more evenly distributed across the 11-16 age range for males. For both genders however, first NPS use was concentrated among 14-16; this is particularly true for females.

Across the total response rate, 47% had stated that their use of NPS had stopped and 16% stated that their use had decreased. However, 21% stated that their NPS use had increased over the last 12 months and 16% stated that it had stayed the same.

Across all the age groups, the highest proportion of responders stated that their use of NPS had stopped. This is observed particularly among the older age groups, from 17-25. Among the 11-16 age groups, while stopped is the leading response, more responders state their use of NPS had increased than other age groups. This is seen particularly among the 11-13 age group with 30% stating that their use of NPS has increased. While confusion with legitimate medication among some 11-13 year olds cannot be discounted, this data does support the premise that early experimental use of NPS is rewarding, and for some young people, there is a strong inclination to use again.

RECOMMENDATION

27. Primary prevention substance misuse initiatives are maintained until the age of 16.

9.11 NPS USE CHANGED IN LAST 12 MONTHS? Summary: Across all the age groups, the highest proportion of responders stated that their use of NPS had stopped. Twenty one percent of responders stated their use of NPS had increased in the last 12 months. Some tenuous inferences can be made regarding the early impact of the Psychoactive Substance Act 2016 at local authority level.

Figure 19.

Percentage first time NPS use by age and local authority area Age Group

Bridgend

Neath Port Talbot

Swansea

Regional response rate

% by age group 10 or younger

9.8

8.5*

13.7*

15.7

11-13

27.4

28.5

28.7

28.4

14-16

41.1

57.1

42.5

41.5

17-19

19.6

0

6.3

7.8

20-22

0

0

3.7

2.1

23-25

1.9

0

6.3

4.2

Key

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Above regional mean response rate by age group

Peak age group

* Potential over estimation

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9. What were you thinking?

Responders in Bridgend were most likely to state that their NPS use had stopped at 63% and less likely to state their NPS use had increased at 10%.

As discussed under heading 9.8, the local shop was the primary source of NPS for Bridgend responders which may have had an impact on this. However, Bridgend responders were also represented by older responders that were more likely to indicate that their regular use of NPS had ceased.

Nearly 46% of responders living in Neath Port Talbot stated their NPS use had stopped but 20% stated their use had increased. Generally responders in Neath Port Talbot acquired NPS from a friend or a dealer which suggests that the impact Psychoactive Substances Act on NPS was moderately delayed possibly due to dealer stockpiling or continued NPS access via internet based sources. This premise may also hold true because Swansea had the greatest number of responders that stated their use of NPS had increased in the last 12 months at 23% and the fewest responders stating that their use had stopped at 43%. Swansea was the local authority where a dealer was the primary source of NPS purchase. n

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Insights from NPS users

Its not that I knew it was a drug it was common sense that a chemical is poisonous anyway.

SURVEY RESPONDENT

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

10. Crossing the thin blue line The following and remaining pages, reverts back to the data gathered from the total number of survey responders.

Summary: Older responders were surer about the legal status of NPS possession. Young people do not retain knowledge about substance misuse if it cannot be applied.

Analysis: All survey responders were asked if they thought they could get into trouble with the police for having an NPS in their possession. Just over 85% of responders answered this question.

Over 58% of responders thought they would get into trouble with police and 32% were unsure.

Ten percent firmly stated that they wouldn’t face any criminal charges for having an NPS in their possession.

Each age group, had above a 50% response rate for thinking that possession of an NPS was illegal. The 11-13 and 14-16 age groups were slightly below the mean response rate but to almost insignificant levels. This may be in part due to the current NPS education provision that is being delivered at key stage 2 and key stage 3.

However what is clear, that while the 11-14 age groups have had quality controlled information, it is not being retained.

Already previously identified as the age groups that will seek out information, 17 year old responders and above were much surer of the legal status of NPS than their younger counterparts. The 23-25 age group were significantly above the mean response rate for asserting that possession of an NPS was not illegal.

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Because people are dying and getting high and its dangerous to the public.

SURVEY RESPONDENT

This may be suggestive that those who engage in substance misuse do familiarise themselves with the legal framework that surrounds the substances. For those where substance misuse information is inapplicable, recently gained knowledge is not retained. n

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

11. Drug use & the bigger picture than drugs controlled under the Misuse of Drugs Act. As previously mentioned, over 55% of individuals that had used an NPS had also used a drug controlled under the MDA.

I was addicted to heroin and was homeless. I swapped heroin for NPS. Worst thing I ever did. Knew nothing about them and they damaged my insides SURVEY RESPONDENT

Summary: Among survey responders there was a greater use of drugs controlled under the Misuse of Drugs Act (MDA) than NPS. Survey data suggests that the rate of drug use, controlled under the MDA, has a population rate of 1 in 9, while NPS use had an estimated rate of 1 in 14.

Analysis: All survey responders were asked whether they had used an MDA drug in the past.

This was to establish if NPS users more broadly were also traditional illegal drug users and generally used a range of substances. Just over 85% of the total response rate responded to this question.

The data identified that across the total number of survey responders, MDA drug use was more prevalent than NPS use. Seven percent of survey responders indicated that they had used an NPS, 11% stated that they had ‘ever used’ a drug controlled under the MDA. Using the survey data this suggests that the rate of drug use, controlled under the Misuse of Drugs Act, across the population has a rate of 1 in 9, while NPS use had an estimated rate of 1 in 14. Furthermore, there is no evidence of confusion with medication among these responses. It is suggested that the rate of NPS use was much less across the population

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11.1 AGE OF ANY DRUG USE Summary: Among survey responders, the pattern of first time drug use across the age groups was identical to first time NPS use. Males were slightly more likely to experiment with substances and begin at an earlier age than females.

Experimental use by females was concentrated in the 14-16 age group.

Analysis: Responders that indicated that they had ‘ever used’ a drug controlled under the MDA were asked to state their age of first use. When compared to first time NPS use, the response profile of first time MDA drug use across the age groups was a mirror image. As age increased, first time drug use increased until it peaks at 16.

However, this data must be considered against the profile of the survey responders.

As mentioned previously, under age of first time NPS use, a very small proportion of responders would have tried an NPS or a drug controlled under the MDA at 10 or younger. However, for either substance, 15% of responders stated they had first tried these drugs at the age of 10 or younger. While it is suspected that some young people may have confused NPS with medication, 16% of responders stated they had used a drug controlled under the MDA at this early age. Therefore while NPS use was not as prevalent as MDA drug use in this age group, a small proportion of young people begin using substances much earlier than is comfortable to acknowledge.

The pattern of NPS use across the age groups holds true for MDA drug use; as age increases the prevalence of first time drug use increases until it peaks between the age 14-16. While 27% of responders stated that they had tried an NPS for the first time between the ages 11-13, 32% of responders had tried drug controlled under the MDA at this age. Similarly, 40% of responders had first tried an NPS between the ages of 14-16, while 40% of responders in this age group had tried a drug controlled under the

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

11. Drug use & the bigger picture MDA. This suggests that while the incidence of MDA drugs use is more prevalent than NPS use, experimenting with any substance for the first time in the Western Bay region is concentrated in the 11-13 and 14-16 age groups.

Following the same pattern as NPS use, across the age groups, first time use of drugs controlled under the MDA significantly declines when the 17-19 age is reached. In this age group, 7.1% of responders stated they had used a controlled drug for the first time and 7.5% had first used an NPS. Likewise, 1.9% of responders had first used an MDA drug between the age at 20-22, while 2% had tried an NPS. In the 23-25 group, 3.5% had tried an MDA drug and 4% an NPS.

If I knew how I was going to feel, I wouldn’t have taken them.

SURVEY RESPONDENT

11.2 FIRST TIME ANY DRUG USE AND LOCAL AUTHORITY AREA Summary: Neath Port Talbot had fewer responders stating they had used any substance overall but appeared to have earlier initiation into substance misuse than it’s neighbouring authorities.

Analysis: When the response profile was cross referenced by local authority area, it indicated that Neath Port Talbot had the highest response rate for early initiation of use of drugs controlled under the Misuse of Drugs Act both for 10 or younger and in the 11-13 age group. However, Neath Port Talbot was under represented in the survey by older age groups and had fewer responders overall stating that they had used these controlled drugs.

As mentioned previously, the incidence of first time drug use begins to incrementally develop at 11-13 but it is concentrated in the 14-16 age range. This pattern holds true when mapped across local authority areas. This is particularly observed in the Swansea local authority area, where there was the greatest representation of

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the 14-16 age group in the total survey response rate. Forty four percent of responders, that had tried a drug controlled under the Misuse of Drugs Act and lived in Swansea, first tried them between the ages of 14 and 16. Bridgend also have their highest concentration in this age category at 41% but had a high representation from the age 17 and above. Neath Port Talbot only marginally exceed their 11-13 age group figure with 41%.

Among the older age categories, first time drug use declines sharply and this is also observed when mapped against local authority areas.

However, 16% of responders from Swansea and 11% from Bridgend stated they had first tried an MDA drug between the age of 17 and 19. Neath Port Talbot only have a 3% response rate for this age group but this is in part due to the age profile of responders from the area.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

11. Drug use & the bigger picture Figure 20, illustrates the pattern of first time drug use among the survey responders. This data is drawn from the 11% that stated they had used drugs controlled under the Misuse of Drugs Act and 7% that stated they had used an NPS.

11.3 FIRST TIME DRUG USE & GENDER

RECOMMENDATIONS 28. We acknowledge that a small proportion of young people begin to misuse substances early. Strategies in universal services should be in place to identify and respond to the needs of these young people. n

The age of first MDA drug use was also cross referenced with gender to establish if there was any variation in pattern between males and females. Across the age groups the number of males slightly outweighed the number of females. Males accounted for 54% of responses under this question while 46% were females.

While the total numbers are small, the data suggests that first time MDA drug use among females is concentrated in the 14-16 age group at 23%. The pattern for first time MDA drug use among young males is more evenly distributed across 11-13 and 14-16 with 19.3% and 19.6% respectively.

Figure 20.

Percentage first time any drug use by local authority area Age Group

Bridgend

Neath Port Talbot

Swansea

Regional mean rate

percentage by age group Legislation

MDA

PSA

MDA

PSA

MDA

PSA

MDA

PSA

10 or younger

13.7

9.8

14.7

8.5*

12.8

13.7*

13.7

10.8

11-13

28.4

27.4

39.3

28.5

31.9

28.7

33.2

28.2

14-16

41.2

41.1

40.9

57.1

44.1

42.5

42.0

46.9

17-19

11

19.6

3.3

0

15.8

6.3

10

8.6

20-22

2.7

0

1.6

0

2

3.7

2.1

1.2

23-25

2.7

1.9

1.6

0

3.7

6.3

2.6

2.7

Total response percentage

13

6.6

4.3

3.9

10.2

5.7

9.1

5.4

Key

Above regional mean response rate by age group

Equal to regional mean response rate

Below the regional mean response rate

Peak age group

* Potential over estimation MDA: Misuse of Drugs Act

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PSA: Psychoactive Substances Act

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

12. The ‘lawful’ truth All survey responders were asked if they knew that NPS were made illegal in May 2016. Nearly 85% responded to this question and 19% were aware of the recent changes in legislation.

Cross referencing this with age, it is clear that the change in the law was acknowledged more among the older age groups. Only 10% of 11-13 year old responders knew that the Psychoactive Substances Act had come into force and 20% of 14-16 year old responders. Following this, for each other age category, knowledge of the legislation exceeds a 30% response rate with the 23-25 age group being the most aware at 34%.

Young people in Swansea were less likely to be familiar with the new laws around NPS. Only 16% of responders from this local authority area indicated that they knew about the Psychoactive Substances Act; 4% below the mean response rate. Bridgend demonstrated the greatest level of awareness at 22%. Despite having fewer young people from the older age groups represented in the survey, Neath Port Talbot was above the mean response rate at 21%. n

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They are dangerous they might kill me, I would stop them.

SURVEY RESPONDENT

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

13. ‘Drugs literally scare me’ knowledge or perceptions of drug use in the community causes anxiety for young people.

Because it could really hurt someone and they are extremely unsafe, they also can trick children into getting them, therefore I think they are not safe at all.

SURVEY RESPONDENT

All responders were asked if they thought that making the sale of NPS illegal was a good thing to do. Responders were requested to provide a definitive ‘yes’ or ‘no’ answer. Eighty five percent of all participants answered this question. Fifty five percent of responders stated that they thought the introduction of the law was a good thing.

Among the 11-13 age group there is a fairly even divide with 49% of responders stating that making NPS illegal was a good thing and 49% stating it was not. However, as mentioned previously, it is clear that a proportion of responders in this age group believe NPS have their legitimate use in medicine.

As age increases, opinion among the age groups becomes stronger with an average of 66% stating they felt that making the sale of NPS illegal was a good thing across each age group.

‘I want to live a happy life and not die from legal highs. I want them to not exist because they could ruin families’ There is a particularly important message to note here for all services. While not captured directly under this survey question, throughout the qualitative data it is an indisputable fact that 54

Young people are informed that drug use changes behaviour and has the potential to harm others. That drug use makes people’s behaviour unpredictable and do bad things; drugs kill people and ruin families. This belief prevails across a high proportion of the qualitative data combined. What is also expressed acutely is that the knowledge about the ease of access to NPS actually did more to magnify young people’s anxiety.

‘Because you can buy them and they will change you’ There is no evidence that the marketing and availability of NPS made these substances more attractive to young people. There is strong evidence that it actually did more to heighten their feelings of being unsafe in their communities.

Young people believed that the lack of regulation around NPS meant that more people would take them; that more people in the community would become unpredictable and do bad things.

That more people would have the ability to trick young people in to consuming them and strangers had easy access to a tool to that could hurt them. The wide spread availability of NPS did not promote the safety of these substances it did much more to compromise young people’s feelings of security.

‘If someone bad got their hands on NPS they could use it for bad things’ The Psychoactive Substances Act served a number of functions. Firstly the introduction of the legislation confirmed to young people what they already knew. That NPS were a type of drug and all drugs are dangerous. Secondly, there was now a reassuring mechanism in place to manage the availability of these dangerous substances and all the potential risks they posed in the community. Thirdly, the closure of high street retailers meant that fewer enterprising young people had the opportunity to become street level dealers. This was a recognised tier of distribution across the region and possibly contributing to normative perceptions of drug

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

13. ‘Drugs literally scare me’

The things I heard about what it can do scares me.

SURVEY RESPONDENT

aspects of community safety. We take a logical perspective when developing our messaging. In some cases however, we are undermining our own efforts to ensure the public feel safe in their communities. Some of our communications are having a countering effect. We must re-evaluate the aims and methods of our communication strategies. We need to take a more balanced approach in how we convey risk to the public.

We must have much greater regard for the burden that our messaging has on different groups of the general public, especially children and young people.

RECOMMENDATIONS

29. The three CSP’s strongly consider forming a regional communications group which includes membership from the APB, the Police and Crime Commissioner’s Office and communication leads.

use. In addition, the survey has also identified that ‘spiking’ or drug administration under duress, while still infrequent, is in fact a reasonable concern for young people to have.

The introduction of the Psychoactive Substances Act was a significant community safety reassurance tool among young people. It firmly stopped the observable promotion of drug availability in the community. As a result, anxiety about uncontrolled drug use in the community has been substantially reduced; young people feel reassured and safer.

However, this does raise a significant practice issue for partnerships. We currently use information campaigns to raise awareness about

55

30. The potential harm of community safety messages should be carefully appraised, especially the harm this may cause for children and young people.

31. Any emergent information, disseminated via the via the All Wales School Liaison Core Programme is quality assured by the programme co-ordinator prior to dissemination across schools.

32. Commissioned substance misuse services do not communicate to the media, regarding community level substance misuse, without prior permission and endorsement by the Area Planning Board.

Community Safety Partnerships must be a key member in this decision process. n

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

14. Help!

The concluding question of the survey asked all responders if they would know where to go for help if they, or anyone they knew, had a problem with NPS. Eighty four percent of survey responders answered this question. Over 60% of survey responders did know where to access help and support. This pattern is consistent across the age groups with each age group scoring above 62%. While this pattern is also seen across the local authority areas, Swansea 63% and Neath Port Talbot 66%, by comparison only 56% of responders in Bridgend knew where to access help if they needed it.

Linking to heading 6, when young people were asked where they would go for further information, it is clear that different age groups have different preferences. Younger responders prefer to seek help first from parents and then either from the police or school staff.

Substance misuse services are not attractive to young people until they are at least age 17.

It is generally universal, front line, staff that will be the workforce that will suspect, or receive admissions, of substance misuse by young people. This is in part because substance misuse services do not appeal to young people, in the belief that these services generally work with hazardous and dependent adult drug users.

The data from the survey also suggests that early experimental use of drugs is rewarding for young people. Young people that are using substances do not feel they have a problem; they are just enjoying their experience of using substances.

This suggests that any marketing of substance misuse support services to young people, in isolation, is ineffective because they do not view their experimental substance use as problematic, or a behaviour that warrants support.

Recognition of the need for substance misuse support services becomes more of a feature for young people post age 17. However even then, primary care is marginally the preferred source of help initially.

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In a strategy to identify young people that are misusing, alcohol, tobacco and drugs early on, there must be greater recognition across all universal services that they will be the services that will come into contact with these young people.Incidence of substance misuse among young people is not a reflection on the quality of their services; it is a feature of the population that they work with. It is not acceptable to continue to ignore this fact, and it is not acceptable for us to have insufficient strategies in place to respond to substance misuse among young people.

Schools in particular must be brave and accept that a small proportion of their pupils will be experimenting with alcohol, tobacco and other substances.

It is advocated that substance misuse support services take a more strategic approach and work closer with universal service staff. With support from the APB and the Directors of Education, children and young people’s substance misuse services provide a stronger and equitable, liaison service to universal staff.

RECOMMENDATIONS

33. Children and young people’s substance misuse services provide sustained support to school and college staff and primary care services.

34. An explicit intervention criteria is developed to support universal service staff to intervene when alcohol, tobacco or substance use is suspected among young people.

35. Children and young people’s substance misuse services focus on secondary prevention services for children and young people.

36. Substance misuse support services support universal school staff to deliver education around substance misuse, ensuring that primary prevention strategies are of high quality and access to secondary prevention services are integrated and explicit.

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES SURVEY REPORT 2017

This report has been produced by the Western Bay Area Planning Board.

For more information, please contact the team at: wbapb@npt.gov.uk Report design and diagrams by ©Scarlet Design Int. Ltd 2017 www.FranOHara.com This report is the property of the Western Bay Area Planning Board.

Reproduction of individual quotes and pages from this report must be authorised by the Area Planning Board Commissioning Team.

Please feel free to reproduce individual pages from this report with the following credit “Extract from the ‘Not so Legal, Not so High’ New Psychoactive Substances Report ©Western Bay Area Planning Board, 2017"

THE WESTERN BAY NEW PSYCHOACTIVE SUBSTANCES (NPS) SURVEY REPORT 2017