Research and analysis

Response from the devolved administrations to the ACMD nitrous oxide review

Updated 22 June 2023

The Northern Ireland Department of Health response to the ACMD report on the use of nitrous oxide.

The Northern Ireland Department of Health notes the ACMD report on the nitrous oxide updated harms assessment.

The UK government has decided not to accept recommendation 1 from the ACMD report that the drug not be reclassified and has instead made the decision to make nitrous oxide subject to control as a Class C drug under the Misuse of Drugs Act 1971.

This decision may well have impacts on the other recommendations put forward by ACMD (such as recommendation 2 and recommendation 4) which they made based on nitrous oxide remaining under the Psychoactive Substances Act 2016.

Responses to most of the recommendations are being led directly by UK government departments and agencies as outlined in each recommendation. The Northern Ireland Department of Health will continue to work with the Home Office and all the other relevant Whitehall departments to ensure relevant Northern Ireland considerations are fed into the UK consideration of all developments around nitrous oxide.

The Northern Ireland response to recommendation 3 will be led by the Public Health Agency who are content to raise awareness of the related harms of nitrous oxide.

However, given the ongoing challenging budgetary situation, this recommendation needs to be considered against the requirement to raise awareness of the harms of other substances that may be causing more impact locally.

The Home Office consultation on the legitimate uses for nitrous oxide launched on 2 May 2023 and the Northern Ireland Department of Health has already forwarded this consultation to a wide range of stakeholders to ensure that comments in respect of making equivalent changes in Northern Ireland are considered and taken on board.

Welsh government response to the ACMD report on the use of nitrous oxide

Welsh government notes the ACMD report on the nitrous oxide updated harms assessment.

We recognise that responses to most of the recommendations are being led directly by UK government departments and agencies as outlined in each recommendation. Welsh government will continue to work with the Home Office and all the other relevant Whitehall departments and will feed into the UK consideration of all developments around nitrous oxide.

Recommendation 1

Nitrous oxide should remain under the Psychoactive Substances Act 2016. Enforcement under the Psychoactive Substances Act 2016 should be supported by interventions in the following recommendations on tackling non- legitimate supply, monitoring and reducing health and social harms associated with nitrous oxide.

Police forces should share examples of good practice in enforcement using the Psychoactive Substances Act 2016.

Lead

Home Office, police forces.

The legal classification of drugs is not a devolved matter and remains a responsibility at UK government level. The Advisory Council on the Misuse of Drugs (ACMD) has responsibility for advising the UK government on drugs which appear to have harmful effects sufficient to constitute a social problem. It is important that we focus on the wide causes of substance misuse, including trauma, which cannot be tackled through criminalisation alone, our focus needs to be on how we respond and diverting people from custodial sentences into treatment where that is more appropriate.

Recommendation 3

a.  Universal prevention activity focused on nitrous oxide. This should include education and harm reduction interventions aimed at the public, including young people and schools, around the immediate and long-term health effects associated with repeated and heavy nitrous oxide use. For example, there could be a national campaign which could utilise appropriate platforms such as social media.

b.  Information and advice should be made available to the public and in places where nitrous oxide use is more common (for example festivals). Organisations that already provide advice to the public should review this information to ensure it takes into account the most recently published information.

c.  Local authority public health teams should ensure they are connected to local policing, community safety and wider community concerns about the availability, prevalence and use of nitrous oxide in their areas, and ensure commissioned treatment services have the necessary information and resources to support individuals to reduce the risks and harms of nitrous oxide use.

d.  Dissemination of information and guidance to healthcare staff to increase awareness of harmful nitrous oxide use, its clinical consequences and appropriate treatment protocols. Organisations that already provide advice to health professionals should review this information to ensure it takes into account the most recently published information.

Lead

Department for Education, Office for Health Improvement and Disparities, Local Government Association, Association of Directors of Public Health, Chief Medical Officers in England, Wales, Scotland and Northern Ireland, National Poisons Information Service, FRANK.

Whilst Wales does not have the powers on many aspects of drug legislation, we continue to work with partners (particularly our Area Planning Boards (APBs), who commission substance misuse services, and the substance misuse third sector) to ensure we maximise all the powers we have at our disposal to continue to develop our unique Welsh response to substance misuse. As part of our harm reduction approach, It is important that people understand that the “quality”, content and strength of substances bought on the street cannot be certain. We have seen many tragic cases where people, including the very young, have died as a result of taking often small amounts of unknown substances.

Tackling substance misuse continues to be a priority for the Welsh government and we are investing over £67m in our substance misuse agenda this financial year.

Reducing health harms

The information below covers other recommendations within the document.

Our Substance Misuse Delivery Plan is rooted in a harm reduction approach which recognises substance misuse as a public health issue as opposed to one that is solely related to criminal justice. The overall aim of the plan continues to be to ensure that people in Wales are aware of the dangers and the impact of substance misuse and to know where they can seek information, help and support. The Welsh government works with a range of partners, including Public Health Wales, Area Planning Boards and Substance Misuse Services on this. Our DAN 24/7 website is also a key source of information.

We invest £1.98m each year to the Wales Police Schools Programme (WPSP) with match funding also provided by the four police forces. Over the years, the Programme has evolved by broadening its scope to cover wider community and personal safety issues at all key stages of the curriculum. The core programme includes substance misuse, anti-social behaviour, domestic abuse, bullying, online safety, sexting, child sexual exploitation and consent, delivering a balanced programme within primary and secondary schools.

The WPSP delivers a Year 10 lesson within its core curriculum titled ‘Class Act’ which includes important information about a range of New Psychoactive Substances (NPS) including nitrous oxide. This interactive workshop increases students’ knowledge of the consequences and laws governing substance misuse, whilst also educating on the short and longer term health consequences of using legal and illicit substances.

Information on nitrous oxide is widely available via a range of resources to ensure people in Wales are aware of the risks and harms of this substance – this includes DAN 24/7, our national drug and alcohol helpline, substance misuse services across Wales and the Wales Police Schools Programme.

Tackling drug litter is an action within our Substance Misuse Delivery Plan specifically for Area Planning Boards and Welsh government to learn and share good practice on reducing drug related litter and work with relevant stakeholders to tackle localised hot spots - this includes the nitrous oxide gas canisters that are sometimes discarded after use.

Scottish government’s response to the ACMD report on the use of nitrous oxide

The Home Office has asked the Scottish government to respond to the recommendations the ACMD made in their report on nitrous oxide.

The Scottish government agrees with the ACMD’s first recommendation that nitrous oxide should remain under the Psychoactive Substances Act 2016 and should not be scheduled under the Misuse of Drugs Act 1971.

In response to recommendation three, the majority of people who consume nitrous oxide do so at a low or infrequent level and do not encounter the harms associated with exceptional high-level use. It is important to note that use can be relatively safe by following harm reduction advice such as:

• using balloons for inhalation
• taking a breath between each balloon
• taking supplements of vitamin B12
• taking regular breaks between nitrous oxide uses

Most people will not use nitrous oxide long-term to a high enough level to cause the health concerns which have been highlighted in the media and academic journals.

The Scottish government has and will continue to promote a public health approach, rather than continuing the failed war on drugs. It is our view that banning nitrous oxide will further criminalise people for their drug use, serving only to heap additional harms on vulnerable individuals, our young people and communities while doing little to improve the health of these individuals.

The most recent survey of young people regarding substance use shows the vast majority of teenagers do not take drugs. Nonetheless, we are taking forward substance use education work in our schools through Curriculum for Excellence. Children and young people learn about a variety of substances including alcohol, medicines, drugs, tobacco and solvents. They explore the impact risk taking behaviour has on life choices and health. We hope by educating children and young people about substance use and the impact it can have on their life and health, this will prevent them making unhealthy choices.

In relation to the ACMD’s fourth recommendation, Police Scotland will work with colleagues in UK policing to make sure the law is applied in the same way across the UK.

The Scottish government would also be supportive of further investigation and study of the harms associated with nitrous oxide.