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Executive summary

Research into the use of the psychoactive substance known as ‘Monkey Dust’ in Stoke-onTrent

Fiona McCormack, Sarah Page and Sophia Fedorowicz

July 2023

1. Introduction

This summary is based on research commissioned by Stoke-on-Trent City council, to improve understanding of how and why the psychoactive substance known as ‘Monkey Dust’ is used in Stoke-on-Trent.

The council specified that the views and accounts of all stakeholders – particularly those with lived experience of taking drugs known as ‘monkey dust’ and professionals must be considered. As outlined on the brief, the new national drug strategy for England, ‘From Harm to Hope: a 10-year drugs plan to cut crime and save lives’1 places evidence at the heart of the approach to tackling drug-related issues; it describes a focus on interventions that are evidence-led and data-driven, and commitment to building the evidence-base where needed (p 15). More broadly, the strategy sets out a commitment to implementing a whole system approach as recommended by Black’s (2020) extensive review of drugs2; it identifies three priorities to drive this change: cutting off the supply of drugs, preventing and reducing drug use, and world-class treatment and recovery support for those experiencing addiction.1

This research was a collaboration between Staffordshire University’s Centre for Health and Development (CHAD), Centre for Crime, Justice and Security, and Expert Citizens C.I.C. A team of Expert Citizens volunteers were involved as peerresearchers. Alongside a member of staff from Expert Citizens, peer-researchers conducted interviews with people with lived experience of taking the NPS known as ‘monkey dust’. They also provided a ‘sense check’ of the research findings and provided valued feedback on the solutions identified.

1.1. What is the Psychoactive drug known as ‘monkey dust’?

‘Monkey dust’ falls into the broader category of New Psychoactive Substance (NPS) drugs. The term ‘monkey dust’ has been used generically to describe a number of different synthetic substituted cathinone compounds.3 The chemical cathinone is a naturally occurring stimulant drug found in the plant khat. The effects of cathinones are considered to be broadly similar to amphetamines and ecstasy. Many cathinones

1 HM Government (2021) From harm to hope: A 10-year drugs plan to cut crime and save lives https://www.gov.uk/government/publications/from-harm-to-hope-a-10-year-drugs-plan-to-cutcrime-and-save-lives (accessed 27 Feb 2023)

2 Black C (2020) Review of Drugs - evidence relating to drug use, supply and effects, including current trends and future risks. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882953/ Review_of_Drugs_Evidence_Pack.pdf (accessed 27 Feb 2023)

3 Public Health England (2018) cited in Atkinson and Sumnall (2020) ‘Zombies, ‘cannibals’ and ‘super humans’: A quantitative and qualitative analysis of UK news media reporting of cathinone psychostimulants labelled ‘monkey dust’. Drugs: Education, Prevention and Policy. 28(4): 299-315. https://doi.org/10.1080/09687637.2020.1799944

are considered to be new, with less known about them and the risks compared to other drugs. The Government funded ‘Talk to Frank’ website describes the appearance of most cathinones as a fine white, off-white or yellowish powder, and some brown in colour4. The website highlights that it is impossible to know how pure the drug is and what else it might have been mixed with, adding that one cathinone may be mixed with another and/or caffeine.

Nationally, the first reference to ‘monkey dust’ in the news was an article in The Sentinel in early 20135 and it has continued to receive media attention locally. Atkinson and Sumnall (2020) argue that the 2013 Sentinel article set the tone for a prevailing association of NPS known as ‘monkey dust’ with violence 5 They analysed newspaper coverage of ‘monkey dust’ nationally and reviewed 368 news articles; 88% of which were published in local news sources and they noted that the majority were from The Sentinel specifically. The conclusion of that analysis was that UK news coverage was underpinned by a drug scare narrative, which led to stigmatisation, dehumanisation and criminalisation of people who use drugs and did not reflect the complexities of people’s experiences of drug use. The researchers also discussed how the use of photographs, which were often mugshots, contributed to this stigmatising narrative.5

Currently classified as Class B, a local MP has recently called for reclassification of ‘monkey dust’ to Class A, echoing an earlier call for reclassification by Staffordshire Police. At the time of writing, the Government has requested that the Advisory Council on the Misuse of Drugs (ACMD) conduct an updated harms assessment of synthetic cathinones more broadly6 As stated on the letter, the request is for an independent assessment of harm reduction measures, classification and whether specific synthetic cathinone drugs, such as those referred to as ‘monkey dust’, “are significantly more harmful than others and may therefore merit a separate approach.” That review will update the previous assessment of the harms of cathinones completed by the ACMD in 2010.7

1.2. What do we know about the use of NPS known as ‘monkey dust’ in Stokeon-Trent?

Previous research into the use of NPS drugs more generally in Stoke-on-Trent in 2016 reported that ‘monkey dust’ was being used locally8, but not extensively9 .

4 https://www.talktofrank.com/drug/cathinones#addiction

5 Atkinson AM and Sumnall HR (2020) ‘Zombies, ‘cannibals’ and ‘super humans’: A quantitative and qualitative analysis of UK news media reporting of cathinone psychostimulants labelled ‘monkey dust’. Drugs: Education, Prevention and Policy. 28(4): 299-315. https://doi.org/10.1080/09687637.2020.1799944

6 Synthetic cathinones: an updated harms assessment - GOV.UK (www.gov.uk)

7 ACMD report on the consideration of the cathinones - GOV.UK (www.gov.uk)

8 Page S and Temple-Malt E (2018) World Café: a participatory research tool for the criminologist engaged in seeking world views for transformation. IN British Society of Criminology Conference Papers. Vol18, pp5-19. http://www.britsoccrim.org/wp-content/uploads/2018/12/WorldCafe-Page-Temple-Malt.pdf

9 Page S (2018) Monkey Dust mayhem: the English city reportedly at the centre of a drug-fuelled ‘epidemic. The Conversation https://theconversation.com/monkey-dust-mayhem-the-english-city-reportedly-at-thecentre-of-a-drug-fuelled-epidemic-102066

Based on the data collection in 2016, Page (2018) concluded that use of ‘monkey dust’ was more likely contained rather than widespread across the city and acknowledged that reports to Police about ‘monkey dust’ and the effects of the drug were problematic 9 The 2016 research identified negative health and crime impacts of NPS more broadly which led to the recommendation to Public Health to consider the development of outreach drug services into hostel accommodation to better support people experiencing homelessness, a group identified as particularly vulnerable to NPS drugs 8

Unfortunately, in the current study, due to the small numbers involved and the potential for compromising anonymity, we were unable to include data on drug related deaths where ‘monkey dust’ specifically had been confirmed as one or more of the substances that the deceased person had taken. Further research into drug related deaths is needed to explore how the figures compare with other drugs locally. During the course of this research, we also reviewed five case studies provided by Staffordshire Police that related to incidents of fires in dwellings and that were considered to be related to alleged ‘monkey dust’ use. However, from reviewing the information contained in those case studies, a link between ‘monkey dust’ specifically and arson was unsubstantiated; there was also reference to alcohol, tobacco and other drugs at the scenes. There is a need to critically examine the claimed link between arson and ‘monkey dust’ in a more robust and evidence-based way. Furthermore, drug testing is essential to confirm whether the person has actually taken the NPS drug known as ‘monkey dust’.

2. Research Aim

This aim of this primary research was to better understand the use of the psychoactive substance known as ‘monkey dust’, including accounts of the impact on individuals, communities and services

3. Methods

The primary research consisted of three strands of qualitative data collection with a total of 39 participants:

➢ Interviews with 13 people with experience of taking NPS known as ‘monkey dust’

➢ Focus groups with 9 concerned and affected members of two local communities

➢ Online world café with 17 professionals to discuss impact on services of NPS known as ‘monkey dust’ and co-produce solutions As part of each strand, the participants were asked to identify key issues related to the use of ‘monkey dust’, perceived impact and solutions. Thematic analysis of each dataset was conducted and is reported separately.

4. Findings

4.1. Insight from people with experience of taking NPS known as ‘monkey dust’

Participants were recruited through support channels related to multiple disadvantage and substance use. All participants had experience of homelessness in the past, which included rough sleeping, sofa surfing and temporary accommodation in hotels, which is unsurprising with this recruitment strategy More research is needed with wider cohorts to get a fuller understanding of how prevalent ‘monkey dust’ is with other groups of people. Timescales and resources meant that this was not possible within this study.

Experiences of taking ‘monkey dust’

Patterns of taking NPS known as ‘monkey dust’ varied within participants. For some, it was something they tried and had taken for a short period of time (e.g., 3 days to 2 weeks), others had experience of taking the drug over a much longer time period (e.g., over a number of years) and/or more regularly. There was also variation in how much people would take at one time and how often, as well as whether this would take place alone or with other people, and whether ‘monkey dust’ would be taken by itself, instead of other drugs, or at the same time as other drugs; whether their preference was to take ‘monkey dust’ specifically, or whether it was almost coincidental based on the people around them at the time and what was available/presented to them also differed. Participants talked about the different types of ‘monkey dust’, including different colours (white, yellow, orange/brown and grey) and strengths, which further adds to this complexity. Some participants with experience of taking ‘monkey dust’ when it was first on the scene, described what is now available as “not pure dust anymore”. Participants also talked about being able to purchase ‘monkey dust’ on the internet as well as from local drug dealers. The majority of participants described smoking ‘monkey dust’. All of this adds to a very complex picture that needs further unpicking to develop more in-depth understanding of the effects of different patterns of use, different amounts taken in one sitting, and of the different types of NPS referred to as ‘monkey dust’.

Accounts of impacts and effects of taking

‘monkey dust’

Given the complexity above, participants emphasised that the effects of the different types of ‘monkey dust’ differed and how long they last for can also vary depending on, for example, “how much you are smoking, what grade it is, how much you sleep you’ve had and how much food you’ve eaten”. Some participants talked about first experiences of taking ‘monkey dust’ and experiencing a powerful high that outweighed any other effects at the time.

The majority of participants framed ‘monkey dust’ as having a detrimental effect on mental health and/or exacerbating mental health experiences. Most participants described ‘monkey dust’ as “mentally addictive” or an “obsession” rather than a

physical addiction or experiencing withdrawal symptoms from the drug. However, expanding on this, one participant continued, “but you’re not looking after yourself”. This was linked to: not sleeping enough or eating properly and difficulties keeping track of time; this was also linked to forgetting to take medications, e.g., for mental health conditions, or not picking up methadone scripts. In addition, ‘monkey dust’ was described as “moorish” and having the potential to take hold of people if they were unable to control it.

In some accounts, experiences of paranoia, and heightened paranoia, and feeling unable to trust anyone was described as common. Taking ‘monkey dust’ was framed as exacerbating experiences of psychosis and paranoia. Participants described how taking ‘monkey dust’ “messes with the brain”, “hard to know what’s real” and talked about examples of when they had seen it “change people”. In response to this, some participants talked about how some people “run and hide in trees all night” whilst others may lock themselves in their rooms/their accommodation.

There was also an alternative account to this; one person described taking ‘monkey dust’ as part of their ‘self-medicating’ and trying to strike a balance with their mental health (“it numbs the pain”) and controlling their pattern of use in line with their responsibilities Other participants commented on the general assumption that people who take ‘monkey dust’ behave in an erratic way and contrasted that with their experiences and that of their peers where this does not seem to happen. Some participants reported that through experience, they have learnt to minimise negative effects whilst taking ‘monkey dust’

Some participants talked about experiencing physical effects from taking ‘monkey dust’; some severe examples were discussed including people whose internal organs had been affected, as well as impacts on skin, teeth, hair, personal hygiene and weight loss. However, it was often hard to separate out what the impact was of the ‘monkey dust’ specifically due to a wider set of experiences people had around taking other drugs and their living conditions, most notably, homelessness.

Taking NPS known as ‘monkey dust’ was also linked to feelings of sexual confidence and feeling “horny”. Some participants, both females and males, framed this as having some positive elements. However, there was also concern that there is “a dark side not talked about” related to sexual violence against females. This should be explored further for treatment, victim support, safeguarding and criminal justice purposes.

The lack of knowledge and awareness about NPS known as ‘monkey dust’ was a thread running through the interviews: that “People don’t know enough about it” was associated with “fear” that appears to result in stigmatisation. Participants identified a clear need to build knowledge and the evidence base about NPS known as ‘monkey dust’:

“I think they should have found out more about it. Especially about how it's made and stuff like that.”

Related to this, some participants highlighted a need for a test to confirm whether or not someone has taken ‘monkey dust’. For some, this was framed as essential so that they could prove to services, including social services, that they had not taken ‘monkey dust’ There was also a suggestion that in the past, other people may have said they had taken ‘monkey dust’ in an effort to minimise consequences or access particular support: “people are getting away with stuff saying it was monkey dust”. As such, some behaviour may have been attributed to ‘monkey dust’ when in fact, the person had not actually taken it

Solutions from the participants identified included:

➢ More investigation to improve knowledge:

o Including forensic investigation about what is actually in it and the effects on the body. The need for a test to objectively confirm whether someone has taken ‘monkey dust’ was also considered important.

➢ Training for professionals to address a lack of knowledge and “fear” connected to ‘monkey dust’:

o Specific training on understanding and working with people who are experiencing psychosis was proposed. Advice on how to approach people who are perceived to have taken ‘monkey’ also needed, to try and minimise the risk of exacerbating the situation.

➢ Address the lack of help and wider options available:

o There was a general feeling there is not much help available for someone looking for support with their use of ‘monkey dust’. There was a belief that drug and alcohol services are limited in what they can do because there is no substitute drug available.

o It was highlighted people may need a different type of support and approach at different points in their experiences of taking ‘monkey dust’, e.g., in a crisis situation, compared to when they are able to “think properly”.

o More opportunities for “circuit breaks” to disrupt cycles, e.g., rehab and respite, but with more help after people leave those environments.

o More one-to-one support and addressing waiting lists to enable a swifter response when someone asks for help.

➢ A campaign by people with lived experiences, drawing on their own lived experiences and stories to promote services and recovery:

o To raise awareness with people with experience of taking drugs, including ‘monkey dust’, or who may be in environments where it may be likely to be offered.

o Including messages on billboards, in phone boxes, and toilets, as well as in hostels, refuges, drug and alcohol services, local churches and other community venues.

➢ Investment in opportunities for young people as a preventative approach for drug use more generally.

4.2. Insight from concerned and affected members of communities

Nine concerned other participants took part across two focus groups in communities identified as having experience/issues connected to drug use generally and ‘monkey dust’ specifically. It should be acknowledged there were some important differences in how the issue was framed, and in the solutions identified to address the issues experienced in their community specifically. Therefore, we would urge further consultation with different communities to better understand how they frame this issue and what they think would help to address the concerns in their communities specifically. It should be noted here that one of the focus groups took place after the world café with professionals, and so the findings from that data collection event did not form part of the debate on solutions at the world cafe. This is important to acknowledge because for that area, the buying, selling and use of drugs (including those assumed to be NPS referred to as ‘monkey dust’) was framed as having a vastly negative impact on residents and the area.

Participants awareness of ‘monkey dust’ stemmed from a range of experiences including: the death of a family member where ‘monkey dust’ had been confirmed as a factor, assault of a friend, concern for children and safety of people within communities, noise levels, antisocial, ‘erratic’ and ‘strange behaviour’ of people perceived to have taken ‘monkey dust’; and criminal activities associated with its perceived use, e.g., theft, shoplifting, vandalism and aggressive begging. For one group, this had also led to community resources being removed or unusable for the wider community; here, the problem was believed to stem from transient people coming into the local area to use, buy and sell drugs including ‘monkey dust’. This included people perceived to be homeless breaking into empty properties, and people moving into privately rented properties in the area which then become a “beehive” for activity related to drug taking and dealing. Participants were clear that this activity, described as happening day and night, was having a detrimental impact on residents in this community and their quality of life. Police had told them that a range of drugs had been found when ‘monkey dust’ drugs had been seized.

The discussions framed ‘monkey dust’ as perceived to be more negative than other drugs, including heroin; there was a clear sense members of the wider communities perceived the risks to them as greater from people who take ‘monkey dust’ because of the erratic and unpredictable behaviour perceived to be associated with it. One group specifically were concerned about media and social media reporting that stigmatised people and felt more health promotion messages were needed with clearer factual information on harm reduction. Those participants talked about how people who take ‘monkey dust’ may be vulnerable and experiences may also be related to challenges with mental health; there was concern about a perceived lack of support. Dual diagnosis and support for mental health generally were framed as crucial here, and it was highlighted that people may have experience of trauma, e.g., related to “hard, hard lives” including adverse childhood experiences, that can contribute to ongoing vulnerability:

“It's like you’ve got to build that resilience, if you've got no-one to help you build that resilience, how do you learn how to build resilience? You don't, you stay vulnerable”

This group felt that more support needed to be accessible from within the community, (e.g., for mental health) to allow for “accessible conversations in places that aren’t statutory” .

Both groups talked about the presence of Spice and Black Mamba (which are synthetic cannabinoids10) prior to the focus shifting to ‘monkey dust’, which was described as cheaper. Both groups of community members highlighted that much of what they were talking about was assumed to be related to ‘monkey dust’ but that they did not know for sure. Some participants highlighted that this representation of ‘monkey dust’ with ‘erratic’ behaviour contrasted to the behaviour of other people they knew to have taken ‘monkey dust’ who were ‘never erratic’ or caused a disturbance. They emphasised that people can react differently to substances and that it also depends on how ‘monkey dust’ reacts with any other drugs in their system.

What would help?

➢ Longer term planning and investment in communities to tackle underlying issues related to drug use generally and ‘monkey dust’ specifically:

o Invest in communities to develop positive social networks to help people learn and build resilience for recovery.

o Mental health support in communities, with resource attached to that

o Reinvestment in community policing to provide reassurance, sense of safety and ease the burden on residents to report and gather evidence about criminal activity.

➢ The solution should co-exist based on looking at people individually and holistically, including consideration of dual diagnosis:

o Housing First was identified as an exemplar for more holistic way of working with people, and with small caseloads of around eight people, so they can invest time in working with and understanding people, their experiences and needs.

o Address the perceived lack of treatment and support options.

➢ Address the stigma and judgement that exists with ‘monkey dust use’, which was identified as part of the news media and social media coverage and public perception, so people are more likely to come forward for help.

➢ More fact-based public health information to improve knowledge and awareness of what it looks like, what’s in it, how to keep safe, and what to do in an emergency. 10 Synthetic cannabinoids | Effects and Risks | FRANK (talktofrank.com)

➢ Address the buying and selling of drugs and associated criminal activity from privately rented properties by holding private landlords to account.

4.3. World café findings: insight from professionals

The 17 professionals participating in the online world café included representation from the city council, drug and alcohol services, Changing Futures, public health commissioning, criminal justice system, housing providers and services for people experiencing homeless.

Key issues for services/where impact is being felt

Overall, from professionals working in the community, there was a perception that the situation was worsening. Staff working in frontline roles with people with experience of homelessness and multiple disadvantage, estimated that large portions of the people they work with take ‘monkey dust’, which was in contrast to the views of professionals who worked in mainstream drug and alcohol services where monkey dust use remained a smaller part of the work they undertook with people on their case load. It was highlighted that there is a perception in professionals and clients that because there is no drug substitute, there is nothing drug and alcohol services can do to support someone who takes ‘monkey dust’. This perception was felt to feed into reports of very low numbers of people accessing drug and alcohol services for support related to their use of ‘monkey dust’. Professionals from drug and alcohol services were keen to clarify that support is available in the form of psychosocial interventions, and there was agreement that this message needs to reach other professionals and the wider community, including people who take NPS known as ‘monkey dust’ and concerned and affected others.

Issues were raised around labelling people who take ‘monkey dust’ and them being excluded from services, including GPs, mental health and accommodation. This in turn had a negative impact on their opportunities for recovery. It was framed as very challenging to find people accommodation who have the label of ‘using monkey dust’; this was linked to some issues around accommodation related to: paranoia, behaviour, damage, impact on other people if accommodation is shared. It was acknowledged that some housing providers are charities, for whom it is difficult to cover the cost of any damage. However, this meant that people labelled as using ‘monkey dust’ faced further exclusion which had other repercussions on their life, experiences and use of services.

There was discussion about the impact of taking ‘monkey dust’ on people’s health and mental health. The paranoia associated with ‘monkey dust’ was felt to make it harder to build trust and a relationship with people which fed into a lack of engagement/willingness to access or accept treatment sooner (e.g., for wound care).

This disengagement and exclusion meant that issues were becoming exacerbated and leading to acute problems and demands on the time and resources of emergency services, including at hospitals, Ambulances and Police. The lack of

support when people present in a crisis situation, and need for dual diagnosis workers were framed as crucial; if someone is already known to services as a ‘monkey dust user’, or known to take other drugs, it was very hard to get support from other services. Frontline staff talked about how they and their work/time are also then affected by this lack of wider support from other services. It was felt that an instant referral pathway is needed when someone is experiencing mental health crisis. In the absence of that, staff are contacting emergency services that they appreciate are already stretched, but highlighted due to their duty of care for people they cannot simply do nothing.

Some professionals were very uneasy with how the ‘monkey dust’ label was used to exclude people from services and accommodation. They made an important distinction between someone being excluded “when they are under the influence”, as a singular event, when it might not be safe or possible to work with them, compared to a blanket exclusion; it was highlighted that the following day, the situation can be different. However, the stigma of having the ‘monkey dust’ label in case notes etc., was felt to automatically close opportunities; this was considered to have a similar effect on reducing people’s opportunities as ‘the arson’ label does for accommodation. Another reason for professionals’ unease with the ‘monkey dust’ label was that it could be applied to certain behaviours without any evidence to corroborate that or to further understand the wider picture of what might be happening with someone.

It was also emphasised that not everyone who takes ‘monkey dust’ reacts or behaves in the ‘extreme’ ways and professionals called for further investigation to understand what was driving this and whether it was related to different batches of ‘monkey dust’, polydrug use, or a particular mental health issue that is exacerbated by taking ‘monkey dust’.

It was felt that improvements are happening with more resource and funding for drug and alcohol services, particularly linked to the rough sleepers’ outreach team, outreach in communities and dual diagnosis workers. The flexibility of this approach was valued and felt it would be useful for drug and alcohol services to replicate more broadly There was an agreed need to “really shout about what can be done, what support can be on offer” from drug and alcohol services to support someone who uses ‘monkey dust’ specifically (i.e., psychosocial interventions were mentioned) The need to challenge the perception that there is no support available for people around their experiences of taking ‘monkey dust’ was emphasised. There were calls for a specific support programme for people who take ‘monkey dust’ and it was acknowledged this may not be particularly different to psychosocial interventions for other drugs. Having a focus on ‘monkey dust’ might help to make it clearer that support is available despite there being no substitute drug.

It was also reported that providing people with an alternative, meaningful use of time, e.g., trips away/residentials, had helped: “well, there’s three days that they haven’t been taking monkey dust because we’ve taken them away somewhere.”

Co-created solutions

Professionals identified the following:

➢ The importance of multi-agency working and communication.

➢ The importance of dual diagnosis and mental health and drug and alcohol services working together.

➢ The need to focus on root causes for people, e.g., blocking out early trauma.

➢ The need for trauma informed training for staff, including gatekeepers e.g., reception staff.

➢ The need for education, training and prevention for young people more generally:

o Talking to people when they’re young, building resilient and strong children.

o Broader education through peer-to-peer system.

➢ Consideration of community hubs and having all services in one place, also where Police could refer people to for help.

The need to reduce stigma associated with taking ‘monkey dust’ was also highlighted, particularly because it was associated with people being excluded from services and support. A need for a holistic approach was highlighted, with some professionals emphasising the primary need for housing to be addressed first, and then building support around people for other experiences.

5. Implications and Recommendations

This research provides new insight into the use of NPS referred to as ‘monkey dust’ in Stoke-on-Trent. Throughout, there has been a focus on identifying what the issues are and possible solutions and service delivery improvements that could be made to address the issues associated with the use of NPS drugs known locally as ‘monkey dust’

Throughout, NPS known as ‘monkey dust’ was framed as cheap and available There was concern about further stigmatising people who may already be stigmatised, who may take drugs to self-medicate in the context of other experiences around mental health and ‘hard lives’, including trauma and adverse childhood experiences. There were calls for investment in opportunities for young people, to build resilience, and as a preventative approach for drug use more generally, along with better drugs education. Having a more trauma informed approach to understanding NPS known as ‘monkey dust’ usage and co-occurring mental health challenges could assist with empathy building as modelled in one of the community groups.

Given the stigma attached to the ‘monkey dust’ label and a lack of clear knowledge about what it actually is, going forward, we hope to see the term ‘monkey dust’

replaced with a more official name that focuses on evidence about the composition of the drugs (e.g., MDPHP if that is borne out in local drugs testing/evidence). This evidence would help improve understanding about the drugs and effects, which may help to distinguish it from the association with ‘erratic’ behaviour that has dominated discussions about ‘monkey dust’ thus far.

It was reported that NPS known as ‘monkey dust’ is available through the internet as well as local drug dealers and there are challenges for policing practice regarding identifying and dismantling supply chains when internet purchasing is being used.

Some professionals in the world café contrasted some of the lived experience findings (e.g., the high it was associated with, learning to minimise negative effects over time with experience, and reports of a lack of withdrawal) with what they have heard from people they work with who are currently street homeless. There is a need to understand experiences of NPS referred to as ‘monkey dust’, including patterns of use and the associated effects, in the context of people’s wider lives and living conditions, e.g., of being homelessness, and the people around them. This echoes the recommendation from the previous local NPS research, for drugs workers to be situated at hostels for people experiencing homelessness 9 Building on this, it is also worth noting Dame Carol Black’s (2020: 93)11 national review of evidence relating to drugs also highlights specific issues for people who are experiencing homelessness and NPS use more broadly, including that: hostel providers have reported a lack of dual diagnosis services for homeless people; evidence from case studies in the third sector highlight that funding cuts for drug and alcohol services has diminished elements such as: outreach services, flexible working hours and drop in sessions, which are highlighted as crucial for people rough sleeping and who may have ‘chaotic lifestyles’. We hope that investment in the current ‘From Harm to Hope’ drugs strategy1 will help to grow these elements locally.

5.1. Recommendations

The recommendations from this research, focusing on ‘monkey dust’ specifically, are set out below:

Further research and investigation

➢ There is a clear and urgent need for more robust evidence and forensic testing of NPS known as ‘monkey dust’; this includes of the different batches and different colours to understand what the ingredients are, how those ingredients would interact with other drugs or medications, how long the effects last, and what the effects are on the body.

11 Black C (2020) Review of Drugs - evidence relating to drug use, supply and effects, including current trends and future riskshttps://uploadsssl.webflow.com/6051b0c9f9390745cc0f3537/61b8c4368dc4f215ce4273e9_Review_of_Drugs_Evidence_Pack %202.pdf

➢ Further in-depth investigation is also needed about the different patterns of ‘monkey dust’ use, and the effects and impact they can have.

➢ In the meantime, given the stigma associated with the ‘monkey dust’ label, we would urge against labelling people as ‘monkey dust users’:

o Especially if the role of ‘monkey dust’ in a particular incident or situation has not been corroborated by evidence.

o And in any case, given the judgment and stigma that can follow people labelled in this way, and the implications that has for their access to services and accommodation options, caution is urged.

More evidence-based information to improve knowledge and awareness

➢ Raise awareness of the research to challenge the existing narrative and stigma that surrounds ‘monkey dust use’.

➢ There is a need for more fact-based public health information about what is in drugs referred to as ‘monkey dust’, as well as raising awareness about what they look like, and how to help someone, including what to do in an emergency:

o For professionals, wider communities, including young people and concerned and affected others.

o Including lived experiences and sharing stories, including harm reduction advice for people, professionals and community members.

More awareness of the support available

➢ There needs to be more awareness of the support that is available through drug and alcohol services, despite there being no substitute drug:

o This needs to happen with other professionals, wider communities including concerned and affected others, with people with experience of taking NPS ‘monkey dust’ and in community venues such as hostels, churches, and refuges; this is important given that people may not disclose their experiences of taking ‘monkey dust’ because of the implications that might have with other services and opportunities.

Training for professionals, based on evidence and lived experience

➢ To improve knowledge and address the fear and stigma associated with the ‘monkey dust’ label.

➢ To improve understanding about how the label of ‘monkey dust use’ can impact and hinder the opportunities available to people to support their recoveries, based on evidence and lived experiences.

➢ Trauma informed training for frontline staff including reception staff and gatekeepers, and on how to work with people experiencing psychosis. This would improve professionals, including Police, knowledge of how to approach someone in a way that reduces the risk of exacerbating the situation; this is

important given the links for some people between taking ‘monkey dust’ and experiencing heightened psychosis and paranoia.

Implications for services

In addition to the need for more awareness of the support available mentioned above, implications for service provision are:

➢ Develop and publicise a bespoke support programme for people with experience of taking ‘monkey dust’. This may help people realise there is support available despite there being no substitute drug:

o Further consideration of what this would look like is needed; given the stigma of taking ‘monkey dust’, hierarchy of drugs and experiences of polydrug use, a general support group may not be appropriate.

➢ Experiences of taking ‘monkey dust’ needs to be understood in the context of people’s wider lives, living conditions (including homelessness), experiences and needs:

o Multi-agency partnerships that enable a holistic response is needed to address this. Dual diagnosis workers and mental health services working alongside drug and alcohol services is essential.

o Small caseloads and investment to achieve that is needed to address underlying factors and the interplay of these factors.

o Further consideration of accommodation options is needed to reflect that without accommodation, it is harder for services to engage with people who are experiencing homelessness, and people could be more vulnerable, with knock on effects to emergency services.

➢ More consideration is needed about what pathway of support is available at different points in people’s experience of taking ‘monkey dust’:

o E.g., when people are presenting in a mental health crisis situation, there needs to be a safe place for them to go to whilst the effects wear off. When possible, this should be followed up with discussion about their experiences and underlying factors, to explore what type of support would be beneficial. This may include broader opportunities for ‘circuit breaks’, and more help to maintain that afterwards.

More investment in opportunities for supportive communities

➢ More investment to grow supportive communities, to help with prevention and as a source of ongoing protective support:

o Invest in communities to develop positive social networks and opportunities for meaningful activities to help grow a sense of community, build resilience and support recovery.

o Consider community hubs where support from a range of services, including mental health, can be accessed.