P ROBLEMS WITH N EW P SYCHOACTIVE S UBSTANCES AND HOW TO DEAL WITH IT Roman Gabrhelík Serbia, 2013

NSPs - terminology New psychoactive substance (NPS) that is not controlled by intnt’l UN treaties dating 1961 a 1971, may have equal impact on public health as already controlled substances (Council Decision 2005/387/JHA) = ‘designer drugs’, ‘ethno botanicals’, ‘research chemicals’… = „legal highs“ X but not so „legal“ = Synthetic substances („new synthetic drugs“ - NSD) Cannabinoids of herbal origin May come in different forms: herbal mixtures, powders, crystals, tablets, solutions…

Actual Trend Prohibition creates incentives for the production of other substances Every year there are more new substances than in the previous year Every new substance we know less than the previous one (=risk unknown) Made illegal in EU NSs Total NPSs

What are the NSPs?

Dependence A dependence on these substances is highly questionable, given the the two following reasons: We don’t have enough scientifically reliable data The sporadic use does not allow us to monitor development of addiction. However, given the experience with similar substances, particularly MDMA and some hallucinogens, we assume that some of these substances may have the potential to cause psychological dependence. The physical addiction is no information available (Palenicek).

‘Don’t knows’ related with NPS 1. How many NPS users there are? 2. How to ask correctly for prevalence? different products, materials different understanding difficult to describe 3. What are the main sources of NPS supply the drug market? Online shops vs. under-the-counter New methods of selling – via a mediator 4. What new substances are actually used? What is being sold Is what is being sold actually used 5. What are the risks of NPS? EWS x new undetectable substances Discussion forum

1. Prevalence - Who to ask? What is the prevalence of use of NPS (comp. to ‘traditional’ drugs)? General population Population studies Online surveys School populations (e-)shops have no age limits Night life venues / Music events Experimentators Party goers Recreational drug users / Experimentators Availability / price

2. Prevalence - How to ask? Questions asking about use in the lifetime, the past 12 months, past 30 days separately for each type of substance Synthetic cannabinoids New synthetic drugs Herbal drugs What substance Do you know the structural formula of the substance used? (MDPV, MCPP..) If not, do you know the chemical group? (piperazines, tryptamines) How the drug was called? Funky / Plan B / Euphoria (and others) If not, what was the effect of the drug? (stimulant, hallucinogen, downer)

2. So what is the prevalence Relatively low compared with ‘traditional’ illicit substances for the general and school student populations. General population; LifetimePrev (EMQ): Highest: Ireland (2011) (15-64 years) 3.5%; (15-34 years) 6.7% School population; (EMQ): Croatia (2011) 7.5% any NSP; Latvia (2011) (15-16 years) 11% Spice NPS using popul.; Czech (N=151; aged 15-34) (Mravčík, 2012): 80% used in the past year, 7% in the past month 1/3 used mephedron or other catinone 10-15% used synthetic cannabinoids Past year Regular use 2%, Repeated use 51%, Once 47% Obtaining from Friends 74%, the rest from shops and online shops

3. What main sources of NPS supply the drug market? Until around 10 years ago, most NPS appearing on the European drug scene were produced in underground laboratories or sourced from diverted medicines and sold directly on the illicit drug market. Today, NPS are produced in China and India, imported to Europe in bulk, than processed, packaged, and sold as 'legal highs'. Sometimes sold on the streets as substitutes for meth/amphetamine, ecstasy, heroin or cocaine (EMCDDA website). Recently, ‘legal highs’ business moved to → 2010 / 2011 Amsterdam shops → 2012 / 2013 internet, under-the-counter

3. How to monitor the drug market? Mistery shopping Physical monitoring of the shop Talking to sellers and customers Web scraping - indexing information from the web using technology similar to that used by standard search engines From the unstructured content (XY stores and products on the web for different prices → updated database of shops and substances) Using ‘compare prices’ approach and other marketing tools How does it work: 1. Keywords defining shops - web search 2. Coding of the most visited sites → product database marketing strategy and market behavior response to law enforcement

4. What new substances are actually used? Substances obtained and tested from: Online shops Dance scene Experimenting users Problem drug users Testing of: the actual drug drug in the body New drugs = unknown metabolites = hard to identify the drug In Czech, in cooperation with the Institute of Criminology and Water Management Research Institute - transfer "laundered samples"

4. Early Warning System (EMCDDA) The EWS provides EU Member States with an information exchange mechanism for reporting on the emergence of new psychoactive substances. It is a key element in the European fast-track system for assessing and responding to new drugs. In 2012, the list of substances reported was dominated by 30 synthetic cannabinoids, which mimic the effects of cannabis. Risk assessments of two very different substances in 2012 which were linked to over 40 deaths in Europe. The first, 4-MA (a stimulant) was being sold as amphetamine on the illicit market, while the second, 5-IT (reported to have both stimulant and hallucinogenic effects) In March 2013, the Council of the EU decided to subject 4-MA to controls across the EU.

5. What are the risks of NPS? Information from EWS We (users themselves) do not know what is being actually used. Therefore, to assess the effects of the drugs is difficult. Even sellers do not inform / know the risks What was done is: Analyses of Discussion forums on the internet (e.g. Erowid) Qualitative research (with individuals identified via internet) How NSD user reduces risk: at first enjoys the smaller amounts of the drug effort not to combine with other substances searching for information on the substance

Drug policy implications Since 04/2011: 33 new illegal drugs & Amsterdam shop owner put in jail for promoting drug use proposal to amend Act No. 167/1998: New drugs banned by the Government Order, but not as Law Attachments = acceleration process Germany classifies suspicious substance on a temporary list, from which it passes to a permanent ban only if a substance proves as hazardous within a year introduce risk-assesment to the Czech legislation, so the costs of the ban do not outweigh its benefits

Implications for prevention Clear message: 'Legal‘ not meaning without risk and possible harm Step 1 Educate the providers Produce education and prevention materials Step 2 Include NPS in prevention education The messages must be age sensitive Provide information - Raise awareness but be aware of risk of being instructive! Boys seem to be more vulnerable than girls (gender sensitive info) Improve Refusal skills

To conclude There is a lot of unknown. However, this should not stop us from doing anything. A lot can be done if we take quick and efficient actions on the policy, prevention and treatment levels.

Thank you for your attention