Overview
An innovative development of guidance aimed at hospital based medical and nursing staff providing useful information that will assist in the management of a patient who has taken a legal high.
Care Setting
In-Patient Setting
Care Group
Adults, Learning Disabilities Services
Evidence Base for Practice
The rationale for the production of the guidance was that several patients had been admitted to the hospital under the influence of legal highs. At the same time a memo emerged from the Chief Medical Officer in connection with Ivory Wave.
(SGHD/CMO(2010)18. These events generated the impetus to generate local guidance.
In Scotland we found no policies in place to cover legal highs. The Policy and Practice Officer of Scottish Drugs Forum was also not aware of any such policies.
The working group responsible for the guidance established contact with the Greater Glasgow and Clyde Legal Highs Monitoring Group.
A search revealed that the North East London NHS Trust had a " Managing Substance Misuse in Psychiatric Inpatient Wards Policy" which incorporated some advice specific to Legal Highs.
The local guidance has been in operation since July 2011. In October , the Advisory Council on the misuse of drugs produced a report on Consideration of the Novel Psychoactive Substances ("legal highs") Local guidance is compatible with the recommendations of that report.
Quality assurance/impact of practice
The guidance was highlighted at the annual NHS Highland Mental Health Conference, and in addition the Dual diagnosis nurse provided in-house awareness training at ward level.
The guidance is still relatively new, and the problem, so far, not widespread.
It is too early to comment on the impact the guidance has made.
Practice Summary
The guidance is aimed at hospital based medical and nursing staff , and its purpose is to provide useful information that will assist in the management of a patient who has taken a legal high.
For example, the guidelines signpost to some recommended websites that contain useful up to date information on legal highs. As this is such a rapidly changing area, this approach avoids the risk of the guidance becoming out of date almost immediately.
Practice Detail
A working group was set up to develop the guidance. As well as healthcare professionals, there was representation from user groups and the police. Contact was established and maintained with the Greater Glasgow and Clyde Legal Highs monitoring group(GG&CLHMG) via the policy and Practice officer of the Scottish Drugs Forum. A draft of the guidance was widely circulated locally and to the GG&CLHMG for consultation. The guidance is planned to be reviewed annually by the working group.
The guidance sits in electronic format in the policies library to enable easy access to the current version.
In summary the guideline provides :
- an explanation of what legal highs are.
-the hospital's position on legal highs.
- suggested websites where reliable information can be found e.g. www.crew2000.org.uk
- course of action to be taken if a patient is supected of being in possession of a legal high.
- information on what tests are available for legal highs.
- information on possible interactions with prescribed psychotropic medications.
- information about how In-patients are informed about this guidance
- an In-patients perspective on the use of legal highs.
Challenges
It can be difficult to know what the patient has taken, and it may not necessarily be what the patient thinks they have taken for a variety of reasons, including that the active ingredient can vary within the same brand of a particular legal high.
The manufactures of legal highs can quickly slightly alter the chemical structure of a compound in an effort to keep one step ahead of legislation. This creates an environment in which what is being misused evolves rapidly. The risk to the user is particularly high at the point where a new substance has emerged and, by defininition, the user has little experience of the substance.
The challenge for the guidance is primarily to keep up with local developments in the use of legal highs. This was thought to be best achieved by signposting to appropriate websites which would provide information on chemistry,routes of administration, dosage, effects both physical and psychological, legal status and harm reduction advice etc.
Gaining access to the relevant websites was complicated by the fact that some of these sites were blocked because of their content. It was necessary to gain an exemption from NHS Highland I.T. policy to access these sites.