Intersections in (New) drug research

Background context: new drugs

This article is concerned with the study of ‘new drugs’ applying a broad definition which encompasses both New Psychoactive Substances (NPS), the subject of much recent research attention, and the comparatively under-explored area of Human Enhancement Drugs (HED). The study of new drugs has usually primarily focussed on NPS – a catch all term for chemical compounds that have been modified and developed to mimic the effects of drugs that are already prohibited. The rise in the range and availability of NPS (Winstock & Ramsey, 2010), particularly prevalent between 2009 and 2016, has resulted in a prioritisation of this area among national and international government agencies responsible for responding to the drugs problem (EMCDDA, 2017; UNODC, 2017). In particular, they have struggled to implement legislative responses to effectively control this phenomenon (Reuter & Pardo, 2016, 2017). It is generally agreed that more knowledge is needed in this area, but only a small percentage of the studies conducted to address this issue consider their wider socio-political contexts and consequences (Lauritsen & Rosenberg, 2016; Measham, 2013; O’Brien, Chatwin, Jenkins, & Measham, 2014).

This Special Issue is one of the outcomes of a two-year Economic and Social Research Council (ESRC) funded seminar series (RES-000-23-0384) that brought together academics, practitioners, policy makers, and service users to examine emerging issues in the area of new drugs (https://newdrugseminars.wordpress.com) from a sociological perspective. The seminar series took place between 2014 and 2016, culminating in a conference and postgraduate and early career workshop in September 2016 at the University of Kent (UK). This was a time when NPS were a rising concern within both UK and global drug policy landscapes, creating a climate of rapid drug policy change. The series comprised seven events on various aspects of the field (policy; markets; police and prisons; psychopharmacology; risk; harm reduction and community intervention; and future directions) and was underpinned by two main aims which set it apart from other NPS-related events. The first was to include a wide variety of participants ranging from academics, policy makers, practitioners, law enforcement agencies and the users of new drugs themselves. The second was a desire to study NPS, not in isolation, but in tandem with other new drugs such as HED (e.g. steroids, cognitive enhancers, sexual enhancers, etc.), and alongside more traditional illegal drugs (e.g. heroin, ecstasy/MDMA, cannabis).

Despite the significant research attention that has been given to NPS in recent years, there has been less focus on other new drugs (Chatwin, Measham, O?Brien, & Sumnall, 2017) and little appreciation of the similarities and differences between them. Instead, different kinds of new drugs have traditionally been studied quite separately. Furthermore, NPS and HED have rarely been considered in conjunction with substantial existing bodies of knowledge on more established illegal substances. In our wider seminar series, and within this special issue, the aim has been to address this gap in knowledge by explicitly seeking to understand the intersectional complexity of meaning where traditional drugs crossover with new drugs including NPS and HED, and where new drugs cross over with each other. The successful achievement of the aims of the seminar series is evidenced by the rich and varied research collated here on the intersections in drug research and by the inclusion of an academic and practitioner writing partnership (Blackman, Bradley, Fagg, & Hickmott, 2018).

Intersections: new drugs and traditional drugs

The primary unifying theme of our special issue is thus not NPS, or even new drugs, but the importance and complexity of these intersections. We employ the theoretical idea of intersection in this special edition because it links together a diversity of different impact points in relation to understanding drugs in society and culture. Kimberlé Crenshaw’s (2004) original argument about intersectionality is that it can reveal forms of coercion and discrimination which derive from different aspects of the social structure. For her, intersection reflects multiple forms of oppression at a structural level, and here, we intend to use intersection in a macro sense of the differences between new drug research and the existing body of research on ‘traditional’ illegal drugs and then trace the impact of these intersections at a micro level focussing, primarily, on drug users and drug service providers.

Several of the articles contained within this Special Issue focus on intersections as a way to provide a sense of the impact which NPS, and the responses to them, have had on existing bodies of knowledge about the traditional drugs field. For example, collective evidence from articles concerned with drug-related service delivery, health or law enforcement work more widely, or indeed the ‘psychonaut’ drug user, reveal that practitioners and drug users motivated by a desire to use drugs responsibility have all had to readdress and re-evaluate their strategies in the light of the rise of new drugs, their unpredictability and their propensity to undermine either professional practice or expert knowledge. Several of the articles capture this experience in qualitative data. By forefronting research participant voices, these articles demonstrate how expertise has been recalibrated, and service delivery developed through creative responses, interventions and new styles of work.

In particular, several of the articles have focussed on the area of drug service provision as one that is particularly worthy of study in an intersectional context. Drug service practitioners have to deal with the day to day reality of substance consumption. Collectively, the papers offered here attest to a complex situation catalysed by the rising profile of new drugs. On the one hand, we need to recognise that many users of new drugs will also be users of other substances and thus may already be known to existing service providers, suggesting that interventions would most appropriately address underlying problems rather than specific substances. On the other hand, however, we also need to recognise that with new drugs, new problems will arise and existing services have to innovate and develop in order to effectively address the issue and continue to attract users of all substances to their interventions. This complex and paradoxical situation perfectly illustrate both the deep complexities and the inherent value of exploring these intersectional fields.

A final key area of intersectional interest emerging from this issue concerns drugs and media representations. This issue was critically addressed by Jock Young (1971, p. 179) in his classic study The Drugtakers, where he states the media ‘selects events which are atypical, presents them in a stereotypical fashion, and contrasts them against a backcloth of normality which is overtypical. The atypical is selected because the everyday or humdrum is not interesting to read or watch, it has little news value’. Stan Cohen (1972, p. 9) further contributed to this debate, arguing that his key concept of ‘moral panic’ is related to a ‘group of persons’ who emerge ‘to become defined as a threat to societal values and interests’, a status that has often been conferred on the users of various different illegal substances at different time periods since the 1970s. In this issue, Blackman et al. (2018) and Alexandrescu (2018) pick up and further develop these theoretical concepts by exploring the recent designation by the media of UK users of spice as ‘zombies’. Clearly, Zombies are a major threat to the human race but they are of course fictional creations of the imagination. As Cohen (1972) originally described, the mass media fashion stereotypes and these stylised ‘monsters’ work on the imagination of people through a process of mediation. Rather than use accurate information to describe the drug problem, the visual representations produce a fantasy of fear. We fear zombies, and we should fear NPS as it creates zombies. Anti-drug images have a long history within the media and the movies.

Introducing research on intersections in the wider drugs fields and theorising drug use

The final section of this editorial introduces the individual contributions to our Special Issue in more detail, teasing out their contribution to the theme of intersections in a more detailed manner. By focussing on specific intersections, Ralphs and Gray (2018) address head on the point raised above about the paradox of drug treatment and service provision – do we need specific services to deal with NPS or other new drugs, or should we rather attempt to adapt existing services so they are able to deal with, not only NPS and other new drugs, but also a range of more traditional substances? Ralphs and Gray present research with two groups of vulnerable drug users in Manchester – the homeless population and those active on the MSM (men who have sex with men)/chemsex scene. They argue that both scenes have undergone a significant shift, from the primary use of more traditional illegal drugs to the primary use of NPS. In the homeless population, this has comprised a move from heroin to Synthetic Cannabis Reactor Agents (SCRA), and in the MSM/chemsex scene from the non-intravenous use of ecstasy and cocaine to the injection of methamphetamine and mephedrone. Ralphs and Gray’s research suggests that the number of users of SCRA and methamphetamine/mephedrone in these groups who are accessing treatment services are worryingly low and explores the reasons why this might be the case.

Ultimately, Ralphs and Gray’s discussion teases out the complexities around treatment and service provision in this area. It argues that some users of newer substances do find it off putting that existing services have been designed around people who use heroin and crack cocaine. On the other hand, there are also underlying issues which affect the treatment system in general, regardless of which substance is being used. Examples of these underlying factors include the shame and stigma associated with treatment and drug-related services in general and the practicalities of accessing services that are only open at certain times and only available in certain geographical locations (Blackman & Bradley, 2017). Ralphs and Gray recommend that in order to engage the users of newer substances, we need to adapt existing systems by offering training on up to date substance-specific information and, at the same time, implement new, more innovative, services – for example pop-up services that open out of hours or services attached to specific locations such as homeless centres or fetish clubs. These new services, of course, would have appeal to the users of both new and old drugs, and a final pertinent point raised in this article is that pathways are needed, not only into services, but between different services such as treatment, the criminal justice system and mental health services.

Echoing these sentiments, but in a different context, Addison et al. (2018) have conducted a study within a police custody suite which engages with both the individuals who end up in police detention with NPS in their system, and the police officers who have to deal with them. Focusing on the intersections with other drugs, Addison et al report that NPS users are usually users of other substances as well as NPS, and are often already known to the police prior to their NPS use. As with Ralphs and Gray’s study, this suggests that NPS should not be viewed as a distinct problem in their own right, but rather as part of a pattern of complex polydrug use and other non-drug-related issues. Here again, however, there is a paradox as police themselves report that despite this connection between the use of legal and traditional illegal drugs, they do feel that NPS have placed an added burden on an overstretched service and that more knowledge on new substances is needed if detention is to be used as a time to support people in reducing their reliance on these substances.

Blackman et al. (2018), writing as an academic and service provider partnership, have also conducted research in the service provision setting, this time with professionals working with young people across the county of Kent. They also focus on the inconsistency in strategy between substances and between different service agencies, but the main thrust of their contribution is to explore the impact NPS have had on driving forward and developing existing theories and concepts in the wider drug field. For example, they suggest an increasing sense of ambiguity within drug markets, applying Matza’s (1964) concept of drift to chart young people’s move from illegal drugs, towards NPS, and then back again. They also explore the concept of normalisation in the context of emerging critiques that equate normalisation with the tolerance of illegal and harmful substances, particularly in the context of NPS. Furthermore, they note that providing NPS interventions which aim to reduce the harm associated with use has been difficult and has thus provided a challenge for the application of the concept of harm reduction in this area. Instead they argue for a focus on pragmatic strategies surrounding ‘sensible drug use’ – an approach which would allow service providers to focus on underlying issues such as risk which are not dependent on specific substances.

Blackman et al. (2018) provide one example of the benefits brought from considering NPS in the wider drugs context, explaining how the advent of NPS has helped to challenge and drive forward existing theories and concepts associated with understanding drug use and our responses to it. Their arguments sit at the heart of the drug intersectionalities debate suggesting that NPS have had an important impact, but they are not an entirely separate entity worthy of study, or of service provision, in isolation. Responding to them, either theoretically or practically, does require changes to the existing landscape but, ultimately, they are very much a part of the wider drugs field and cannot be properly understood if they are not seen as such.

Potter and Chatwin (2018) take up this theme by critically engaging with the validity of the construction of the category NPS as distinct in its own right. They suggest that placing NPS in their own distinct category presents three main consequences: the differences within the category (i.e. between different kinds of NPS) are obscured; the similarities between NPS and other categories (e.g. more traditional drugs, HED) are obscured; and a separation of NPS from the wider field of drugs prevents us from understanding the bigger picture in terms of the wider societal, cultural and theoretical underpinnings of drug use. They argue that these consequences are visible across a variety of arenas, for example: public discourse, policy making and academic research.

A practical example of the benefit to studying drugs and drug users in the wider context, rather than as members of a specific group related to type of substance used, is provided by Ruane’s (2018) qualitative research on psychonauts and the provision of harm reduction services at music festivals. Ruane identifies psychonauts as those who are interested in and enjoy experimenting with drugs – whether they are new or old. Her article offers insight into the depth of her respondents’ mistrust of government drug information and of their own struggle to retain autonomy and clarity as a result of the availability of an increasingly diverse range of drugs. In her interviews with those involved in this scene, she critiques the category of NPS in line with Potter and Chatwin’s (2018) arguments. Like Blackman et al. (2018), she also focuses on the challenge NPS have presented for harm reduction services in general and the impact her research population are having on harm reduction efforts in this area. For example, the psychonauts in her study act as sitters/mentors for those undergoing an intense drug experience in an unfamiliar environment, some become ‘responsible’ dealers, or collate and share via the internet their own ‘scientific’ research on the effects of the plethora of new substances now available on the market.

Koenraadt and van de Ven’s paper (2018) explores internet and lifestyle drugs and, in line with Blackman et al. (2018), finds the application of normalisation theory relevant to the understanding of substances (whether for sexual enhancement of weight loss) as integrally related to individual identity and personal pleasures. A further key finding of the study, echoing priorities in wider drug-related research, – is the gender differences inherent in the lifestyle drug market in relation to social and cultural pressures, whereby men buy body-based performance drugs and pain killers, whereas female substance use is dominated by weight-loss drugs. Perhaps most interestingly, from an intersectionality perspective, however, is the implication that focussing explicitly on one particular category of drugs can obscure the similarities experienced across categories, and thus impair our overall understandings. In this context, the authors contend that another area of recent research focus has been the development of internet markets for illegal drugs, and that this area has been disadvantaged by a failure to also consider as part of that development, the semi-legal internet markets that exist for lifestyle drugs, and the blurring of the boundaries between them.

Finally, Alexandrescu’s (2018) article provides a cautionary tale of what will happen if we don’t use NPS as an impetus to drive forward new understandings. His analysis of how the Romanian and British mainstream media have reacted to NPS use depicts a depressingly familiar picture. He outlines the bifurcated practice of conceptualising NPS users as either good, sober, educated young people unfairly corrupted by dangerous new substances available on the market, or as polluted and unsalvageable members of vulnerable populations such as the homeless, the mentally ill or the prison population. In this context, Alexandrescu conceptualises NPS as the latest trend in substance use to be seised upon by the media, with the negative consequences that can bring. Ultimately, he argues that the media and the way they report on matters are an important driver of policy agendas. As such, if we want to shape NPS policy in more sensible directions and if we want to have meaningful debates and pragmatic interventions, rather than knee jerk responses, to this latest chapter in our drug history, then we need to start by reforming the way that drugs and drug users are reported on in the media.

Conclusion

Collectively, these articles attest to the value in focussing on the ways in which different categories of drugs (NPS, HED, traditional illegal drugs) intersect with each other, rather than studying them in isolation from each other. Our special issue evidences the various benefits that can come from such an approach. In the more practical arena, the rise of new drugs has necessitated drug service providers to move forward and innovate in their response to diversifying drug use: for example, by introducing services that are open out of hours and/or attached to specific locations, by encouraging pragmatic strategies that focus on underlying issues such as risk rather than on the specifics of individual substances, and by creating pathways between different agencies of service provision. Importantly, the impact of many of these benefits will also be felt by users of more traditional substances and will help to refocus attention on the underlying causes (e.g. poverty, homelessness, imprisonment) of drug use amongst vulnerable people, whichever substances are involved. At a more theoretical level, not only can many existing drug-related theories and concepts be successfully applied to new drugs, the impact of new drugs on existing bodies of knowledge (for example in areas such as harm reduction, moral panic theory, and normalisation theory) can provide a useful catalyst for the further evolution of our understanding. It is clear that further research is needed, not only on new drugs themselves, but also on the ways in which they intersect with our wider bodies of knowledge in this area.

Caroline Chatwin
SSPSSR, University of Kent, Canterbury, United Kingdom of Great Britain and Northern Ireland
[email protected]
Shane Blackman
Media, Canterbury Christ Church University, Canterbury, United Kingdom of Great Britain and Northern Ireland

Kate Louise O’Brien
SASS, Durham University, Durham, United Kingdom of Great Britain and Northern Ireland

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported by ESRC seminar series (ES/M002330/1).