New Psychoactive Substances (NPS)

What are New Psychoactive Substances (NPS)?

NPS are drugs that are designed to replicate the effect of other illegal substances. The effect, duration, and appearance of the drug will vary but most NPS are chemicals produced in a lab, and will come in powder, blotter, or herbal form. Liquid versions may also be available for use in e-cigarettes and vapes. Previously, they may have been referred to as ‘legal highs’, but all psychoactive substances are now under the control of the Misuse of Drugs Act 1971 or subject to the Psychoactive Substances Act 2016.

Recently, there has been a growing use of highly potent synthetic opioids reported within the homelessness sector called Nitazenes. Nitazenes are lab made opioids with similar effects for the user as heroin. Their relative strength, however, means it is much more difficult to take them safely and much more likely to result in a fatal overdose. In March 2024, the UK Government classified 15 additional synthetic opioids, including 14 Nitazenes, as Class A drugs under the Misuse of Drugs Act 1971. Many of these substances are highly addictive, incredibly dangerous, and pose a higher risk of accidental overdose.

Another common type of NPS reported in homelessness services are synthetic cannabinoid receptor agonists (SCRAs), or ‘synthetic cannabinoids’. SCRAs are usually smoked and often mixed with tobacco in joints or pipes. They are made to look like herbal cannabis but tend to look artificial and may be dyed a bright colour. These varying compounds are commonly (and now incorrectly) known as ‘legal highs’ or by the street name ‘Spice’.

How can homelessness services support?

First response

Acute symptoms from NPS use include seizures, vomiting, unconsciousness, and psychosis. Where acute symptoms occur, the following will help to minimise harm:

• Maintain direct visual observation at all times
• Treat as a medical emergency rather than a public order offence or mental health episode
• Call an ambulance rather than escorting in a police vehicle or a psychiatric unit

Early identification and admission to A&E will give access to treatment, which may include rapid sedation and cooling followed by emergency anaesthetic.

Where NPS results in aggressive behaviour, there should be a local policy clear to all staff and clients on how this will be dealt with, following any medical intervention.

Assessments and referrals

Client assessments should include questions about drug use, and drug use should be discussed in keywork sessions. Building good rapport will help the client to feel comfortable and share personal information. Staff should be able to talk about the service’s drugs policy and know their responsibilities under the Misuse of Drugs Act 1971. They need sufficient training to have the confidence and knowledge to offer support and signposting if someone discloses their drug use.

Where NPS use is identified, staff should offer information about what specialist support is available from local drug services and help to make a referral. Specialist support might include one-to-one or group work around relapse prevention, harm reduction and coping skills, psychotherapy and counselling, mutual aid groups and peer support. Drug misuse teams running outreach sessions at your service, as well your staff accompanying clients to first appointments, will help to boost engagement.

Cross-sector working

Service Managers should make contact with their counterparts in the police, ambulance and substance misuse services and work to achieve improved information sharing and understanding of client needs, as well as multidisciplinary case working for high use, high risk individuals. Substance misuse services may be willing to come to team meetings and to run training sessions with staff and/or clients with advice on harm reduction.

Recording, monitoring, and alerts

Introducing a system of recording use and incidents amongst your clients will help your team to keep track of levels and trends. This data can be used to report to partner agencies, clients and funders as well as demonstrating the effectiveness of particular interventions or the impact of particular NPS.

Where you have severe incidents and suspect it is related to a particularly harmful strain of NPS, this information should be relayed back to clients and to other services. A local drug information system agreed between public health and local services will help ensure information is rapidly shared and alerts and warnings issued.

Further resources on NPS

• Crew, a harm reduction and outreach charity has information leaflets available on different types of drugs, including NPS.
• Homeless Link has guidance on supporting people who use drugs in homelessness services as well as guidance on how to write a drugs policy. Both can be found here.
• Homeless Link’s ‘Going Beyond’ podcast (Series 4) discusses approaches to supporting people experiencing homelessness who are using drugs and/or alcohol. All episodes can be accessed here.
• KFx, a drug consultancy initiative, has free downloadable resources including drug facts, screening tools and good practice advice.
• Release is the national centre of expertise on drugs and drugs law. They offer free non-judgmental, specialist advice and information to the public and professionals on issues related to drug use and to drug laws.
• Cranstoun have released an app which enables people who are using drugs alone to be connected to a Cranstoun volunteer, with whom they can build a rescue plan in the event of an emergency. Read their blog post here.

This webpage resource has been funded by MHCLG through the VCFS programme.