Critical evaluation of the UK public health policy with regards legal highs | Example Health Essay

Introduction

This essay takes into account the issue of legal highs in UK. Legal highs represent a problem that is gaining increasing visibility only in the last years, thanks to a blanket ban implemented by the government (Home Office, 2016). The aim of this original piece is to explore the nature of legal highs, where they come from, and what are their features. Secondly, UN regulations and national priorities in terms of drug regulations will be outlined. Third, data on legal high consumption in UK and the awareness related to their risks will be mentioned. Fourth, this essay will give an overview of the problem in terms of public health, what are the challenges and the obstacles. Fifth, will be listed the actors involved and affected by the blanket ban, as well as the costs and benefits of the policy. Lastly, the author will draw an alternative framework of action in order to regulate the misuse of legal highs.

Legal Highs in EU and UK

Legal highs or Novel Psychoactive Substances (NPS) are psychoactive drugs containing a variety of chemical ingredients that produce a very similar effect to illegal drugs, such as cocaine, ecstasy, or heroin (Dignam and Bigham, 2017). Given the presence of some illegal ingredients, legal highs are labelled as not for human consumption and are often sold as plant food or bath salts (Travis, 2017).

NPS represent a high risk for public health because of the unknown outcome that some agents in the drugs can have on human beings; at present most of the chemicals have not been tested for safety (Home Office, 2016; Dignam and Bigham, 2017).

The term legal highs derives by a legislative loophole in the 1961 Single Convention on Narcotic Drugs which does not control any of the NPS, be in a pure form or not (UNODC, 2017). Despite NPS have been available in the market for years, the issue recently gained public visibility due to the decision of the Commission on Narcotic Drugs to monitor the emerging trend in production and distribution of legal highs. UNODC reported that 348 NPS have been detected so far, most of which fall outside the regulatory net of the Single Convention on Narcotic Drugs, which takes into account 234 substances (UNODC, 2017; Home Office, 2016). Giving the increasing issues each UN Member State has been advised to control and regulate the spreading of legal highs at the national level. In 2014 101 new substances were identified in the EU, 11 of which made their way to the UK (UNODC, 2017). 

Issues to tackle

In 2015 UK’s Government commissioned an impact assessment in order to draw an effective policy to tackle the spreading of legal highs. The commissioned policy aim is to reduce the harms associated by NPS. The objectives taken into account were to reduce the availability of legal highs on street retailers and online shops, as well as reduce its general availability (Home Office, 2016).

It is important to understand NPS are located in a grey area between licit and illicit: chemical structures can be changed to make the compound fall outside any drug control, therefore, these substances are labelled as legal only because they have not yet been made illegal and controlled (Aires et al., 2012).

Currently speaking, little is known of NPS from the clinical perspective; legal highs that enter the market often pose a threat to users’ health comparable to that caused by known traditional illicit drugs (Measham et al., 2011); consequently, policy options to decrease the public health risk are still being explored and analysed in terms of costs and benefits. In England and Wales the death toll related to NPS consumption has risen from 26 in 2009 to 60 in 2013 (Home Office, 2016). However, of these 60 deaths only 24 involve the sole consumption of NPS. In all the other cases, in fact, a combination of legal highs and other legal or illegal substances (alcohol, cannabis etc.) was the main cause of death (Brandt et al., 2010).

From a public health perspective England NHS has issued a tool-kit to support local areas in terms of information and prevention of NPS use. A new series of awareness campaigns have been promoted and an analysis of policy options was carried (Home Office, 2016).

In terms of policy implementations to regulate the spreading of NPS and decrease the burden on the NHS, the government outlined two different options: the first one is a do nothing approach, which comprised the option of leaving the sale of legal highs to be regulated by the Misuse of Drugs Act of 1971, and allow authorities to take action against NPS retailers in head shops for unlawful behaviour (UNODC, 2017).

The second policy option was to create a new criminal offence through which criminalise the spreading of NPS at any point of its supply chain. With this policy the definition of psychoactive substance would be kept purposely broad (Home Office, 2016). 

Effects on public health

A blanket ban (option 2) was enforced as it was expected to benefit both individuals and significantly reduce the financial burden on the National Health Service (NHS). The policy brief outlined that a total ban on NPS would not only prevent the substances to be sold in high-street shops and online, but would also have a repellent effect on the public and discourage the consumption of legal highs on the basis of their new illegal status that signals the potential harm associated with NPS (Home Office, 2016). Recent experiences (Wilkins, 2014) give evidence that after the implementation of a blanket ban on legal highs, sellers would eventually self-regulate and comply with the ban. However, illicit networks selling NPS would still exist, as the manufacturing of the substances is carried outside the UK in countries like China and India.

The financial benefits on public health are very difficult to calculate for various reasons: first, there is information asymmetry on how the consumers will obtain the substances. Second, there is a lack of information on the exact harm that substances cause to human beings, mostly due to the novelty of the substances (Loeffler et al., 2013).

A ban on legal highs results in 190 fewer admissions to A&E each year. Given the nature of the hospital admissions, the expenditure to treat people legal highs is approximately £790 with further £200 on top for paramedic services (Home Office, 2017). Consequently a blanket ban on legal highs can be translated in a benefit for the NHS of roughly £190 000 per year.

In terms of deaths and patients with overdoses health costs broaden. As said before, 173 deaths in the UK are associated with an intake of NPS; in 29 cases there wasn’t any other substance involved (Home Office, 2017). The reduction of availability, hence, will constitute a reasonable reduction in fatalities with a consistent decrease in the future: if a drug were not available, less people would try it and fall into an addiction problem. When drafting the policy, were taken into account only the 29 deaths directly associated with the sole use of NPS: by banning the substances, roughly 80% of deaths would be prevented. When making the calculation, it is estimated that at least 23 deaths per years would be prevented (80% of the actual deaths correlated to the exclusive use of legal highs). When translating this into annual financial savings, we can refer to the Quality-Adjusted Life Year (henceforth QALY), the index to estimate the disease burden in the healthcare economic evaluation (Hansen, 2012). Assuming that each year of life gained has an average estimated value of 1.7 million Pounds per prevented fatality, a reduction of 23 fatalities would save the NHS roughly 40 million Pounds per year. The number of prevented fatalities would obviously increase if were to be taken into account also the deaths related to legal highs mixed with other substances. 

Several actors are affected by the blanket ban on legal highs: first, high street head shops who generate taxable revenue from their legal highs sales. A median estimation drawn from the police database and local authorities’ database takes into account 335 street shops, which – once kept out of business – generate a 13% fall in the business-based public revenue (Loeffler et al., 2013). Second, online sellers that according to Schmidt et al. (2011) are roughly 115 in UK would cost to business a 3% fall.

It is necessary, however, to make a distinction between shops that sell exclusively NPS, and shops with another primary business (e.g. tattoo shops, piercing shops). Third, Criminal Justice Department would be strongly affected by the new blanket ban in terms of services’ expenditure. It is likely, in fact, that in order to enforce the new ban, new resources are needed in terms of staff and facilities (Home Office, 2016; Loeffler et al., 2013).  

Blanket Ban

The policy approving a blanket ban on legal highs came into force on May 2016; however, it is possible to draw some pros and cons regarding the chosen way to prevent harm from NPS:

First, the ban directly hits sellers that legally trade NPS not for human use (e.g. plant food sellers, bath salts) in a way that may compromise not only their revenues but also the width of VAT levied from this kind of sellers (Schmidt et. Al., 2011). Secondly, the majority of deaths associated to legal highs consumption are correlated to the use of other harmful substances, namely alcohol, cocaine, ecstasy, cannabis. Therefore, it is very hard to tell what is the main cause of death in the reported victims (Wilkins, 2014).

Again, the campaigns against legal highs are not a priority for the British public health: in this way consumers are usually not aware of the real risk coming with the use of such substances. People who have already experienced legal highs are more prone to find a dealer in the black market able to provide new drugs (Loeffler et al., 2013), therefore, the public is a main actor involved in the blanket ban.

An alternative set of choices

In the author’s opinion, a more in-depth analysis of the issue would have proven more beneficial in terms of costs and compliance.

First, the allocation of public finances for Research and Development should be rearranged in order to give the chance to run clinical trials on the new substances present in legal highs. Although this is a solution that will show positive results only in the long run, it is essential to develop new knowledge to tackle the issue of deaths and overdose from NPS. It is equally important to understand to which extent the compounds are harmful to the human being and which other substances increase the level of danger and overdose. The NHS staff should be trained to cope with emergencies related to abuse of legal highs in order to provide the best of care. Also, a license for sellers of products containing NPS would favour the regulation of legal highs: in this way, only sellers dealing with a specific category of products (e.g. plant food) would be able to sell substances containing NPS, decreasing the availability of legal highs to human consumers. Again, potential consumers should be more informed of the risks coming with the use and abuse of legal highs. This could be translated with a preventive campaign in core places where substances are likely to be consumed, such as clubs, bars, and underground events. The government should invest more in campaigning against the issue, perhaps making clear to the public that the risks in taking NPS are similar, if not more drastic to risks in taking heavy artificial drugs such as heroin or crack. A brave step the government should take in order to discourage consumers may be to start a process of de-criminalisation of drugs such as cocaine and crack, and a process of legalisation of light drugs such as cannabis. Legalisation of cannabis, in fact, would produce in the long run a more careful behaviour in terms of recreational use and could decrease the risks associated to products sold illegally with hidden chemicals inside. In the long run, again, consumers would lose their interest in legal highs and purchase cannabis under a regulatory framework that could also generate revenues to be reinvested for public policies (Palali et al., 2016).

Conclusion

In conclusion, we have seen how legal highs have increasingly become a valid alternative to illegal drugs. Most of their success is due to the unknown effects of all the compounds present in the products, which make the classification of the chemicals quite uncertain in terms of level of dangerousness and effect on human beings. In fact, the extent to which NPS are legal is mainly because mostly of the chemicals are newly discovered and lies in a grey area in terms of public health. In order to overcome this problem the government should subsidise and promote clinical trials aimed at understanding the risks and potential benefits of NPS. In May 2016 the government banned legal highs. With the blanket ban in power head shops legally selling NPS were forbidden to deal legal highs to the public. The decision has been taken considering the public health risk associated with the high consumption of legal highs, and of legal highs consumed with other legal or illegal substances (The Lancet, 2016). It has been calculated that the blanket ban would decrease the mortality rate associated to the exclusive use of NPS by 80%. This percentage however, is a very general representation of a small portion of population, as the clinical researches performed until now cannot provide significant results of how much the risk will decrease for people who consume legal highs with other substances. The government should invest more on preventive campaign and to raise awareness in the public regard the adverse effects of NPS. Similarly, the government should regulate sellers who deal with substances for other purposes far from recreational use (e.g. plant food).

Health Essay: How To Analyse a Health Policy

References

Home Office, (2016). Creation of a blanket ban on new psychoactive substances in the UK.

Dignam, G. and Bigham, C. (2017). Novel psychoactive substances: a practical approach to dealing with toxicity from legal highs. BJA Education.

Travis, A. (2017). Blanket ban on legal highs in England and Wales to begin on 26 May. [online] the Guardian. Available at: https://www.theguardian.com/politics/2016/may/05/blanket-ban-on-legal-highs-england-wales-begin-26-may [Accessed 24 Mar. 2017].

UNODC. (2017). Global Synthetic Drugs Assessment. [online] Available at: http://www.unodc.org/documents/scientific/2014_Global_Synthetic_Drugs_Assessment_web.pdf [Accessed 24 Mar. 2017].

Ayres TC, Bond JW A chemical analysis examining the pharmacology of novel psychoactive substances freely available over the internet and their impact on public (ill)health. Legal highs or illegal highs? BMJ Open 2012;2:e000977. doi: 10.1136/bmjopen-2012-000977

Measham, F., Wood, D., Dargan, P. and Moore, K. (2011). The rise in legal highs: prevalence and patterns in the use of illegal drugs and first- and second-generation “legal highs” in South London gay dance clubs. Journal of Substance Use, 16(4), pp.263-272.

Brandt, S., Sumnall, H., Measham, F. and Cole, J. (2010). Analyses of second-generation ‘legal highs’ in the UK: Initial findings. Drug Testing and Analysis, 2(8), pp.377-382.

Wilkins, C. (2014). A critical first assessment of the new pre-market approval regime for new psychoactive substances (NPS) in New Zealand. Addiction, 109(10), pp.1580-1586. 

Loeffler, G. and Craig, C. (2013), The effect of legal bans on poison control center contacts regarding ‘legal highs’. Addiction, 108: 1348–1349. doi: 10.1111/add.12194

Hansen, P. (2012). Health sector decision-making: more than just cost per QALY calculations. Journal of Health Services Research & Policy, 17(3), pp.129-130.

Schmidt, M.M., Sharma, A., Schifano, F. and Feinmann, C. (2011) ‘Legal highs’ on the net – Evaluation of UK-based websites, products and product information Forensic Science International vol. 206 pp 92-97

The Lancet Psychiatry, 2016. Drug policy: getting over the 20th century. The Lancet Psychiatry, 3(3), p.187.

Palali, A. & van Ours J.C. Empir Econ (2016). Cannabis use and support for cannabis legislation doi:10.1007/s00181-016-1172-7

 

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