Years ago when I started doing harm reduction work it was a very different drug landscape, heroin was the main drug used by people coming into services (after alcohol of course) Most injectors I saw used heroin, and possibly the occasional 'treat' of a rock of crack. Of course there where also people injecting steroids and the occasional amphetamine injector but these where far less common. Now though we have the rise of the legal high.
These drugs have been around for quite a while already (as any reader of Pihkal will tell you), they've been there on the verges used by experimental users that are unlikely ever to engage with a drug service for support/treatment. But over the last few years they've gone mainstream, we have mass production of drugs like mephedrone, wide media coverage (great advertising for the dealers) and of course the resulting knee jerk law making from government.
The rise in popularity also coincided with our latest heroin drought which may help to explain how fast some groups have taken to injecting these drugs. I was surprised to see the injecting of mephedrone in some areas come as a shock to some of my colleagues in drug services. For me it was obvious that when you have a number of people who have been using their choice of drugs by a particular route that they would then try a new drug in the same manner.
It's also no real surprise that injecting a new type of drug can be a very risky affair leading to increased abscesses and other related injuries, people get used to injecting a drug using their own ritual, often when a new drug comes up they'll use exactly the same method of preparation (look at how many people still use heat when preparing crack for injection even though 'cold cooking' it is more effective). But every new drug will have its own unique 'personality' some might need heat, some might need an acid, some will even get thick and viscous if heated.
Treat the effect
But the main-streaming of these drugs has a knock on effect on drug services and workers, many are struggling to keep up to date with the new drugs and come up with specific targeted messages for each one, personally I think this is an impossible task. Since 1997 there have been over 150 new 'legal highs' identified, 50 of these in the last year. This gets further complicated when you consider that people give random names to the drugs,and that these names are often interchangeable across drug types. For instance the name 'Bubble' is used for almost any legal high.
In the recent HIT Hot Topics seminar on legal highs Dr. Harry Sumnall suggested that a better way would be for people to work with the 'range of symptoms' a drug delivers. To me this makes prefect sense. At the stage someone is looking for help and support all the worker really needs to know is how the drug is effecting someone, is it a stimulant causing sleep deprivation, a hallucinogen causing them to question reality, or a depressant that's worrying their family because of overdose risks (or a combination of any of these). The worker needs to know is someone's use binging or daily and the route they use to administer. The knowledge that a drug effects a particular neuroreceptor or that it's related to an obscure family of plant stimulants is 'interesting' but not essential for working with someone who needs support. This further research can be left up to the scientists to write dense wordy papers about, or the forum members on places like Drugs-Forum to discuss (their advanced knowledge of chemistry is something I'm often in awe of).
We need to remember that the key to harm reduction is to work with the presenting issue of the person in front of you. Whether this is problems with injecting resulting from using a novel compound, or helping someone deal with the fallout from the effects a drug has had to their social life. These drugs are not going to conveniently disappear, and more will be appearing every month, what we have to do is adapt to respond to their effects without getting bogged down in the tiny details of chemistry.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.