New drugs, new trends and new responses? A European backdrop for local interventions. Jane Mounteney, EMCDDA

Transcription

1 New drugs, new trends and new responses? A European backdrop for local interventions Jane Mounteney, EMCDDA

2 What s going on? Four perspectives Long term trends, monitoring? Broad market dynamics, responses? Short term patterns, observations? Local trends? 2

3 European Drug Report (EDR) package 3

4 Cannabis use, mixed trends Quarter of adults have used Almost 1% of adults daily users Most frequently reported drug by new treatment entrants 4

5 Cannabis supply Increase in herbal cannabis Domestic production, innovation Cultivation of plants high in THC Resin catch up? 5

6 Heroin: decline in new treatment demand But increase for opioids other than heroin New heroin clients almost halved Ageing cohort In 2012, in 17 countries over 10% of first-time opioid clients 6

7 Cocaine: continued signs of decline Quantity of cocaine seizured stable (drop from 2006) Declines in 11 of 12 new surveys Seizures decline from 2008 Decrease for first-time treatment entrants 7

8 Ecstasy: increased availability of high purity MDMA powder Low and stable prevalence trends Seizures decline small rebound Upturn mirrored in purity data 8

9 Multiple faces of methamphetamine in EU Pervitin, CZ Slamming, UK S(H)ISA, Greece Amphetamine, Norway Crystal, Turkey, Greece 9

10 What s going on? Market dynamics Paradigm shift / IV heroin to synthetic to complexity Natural and travelled products decline, synthetic and local increase Marketplace with competing old and new products Heroin drought, low quality stimulants Off line to online markets Old and new drugs, surface and deep Role of precursors increasingly recognised 10

11 NPS.. filler, mirror, error, competitor Fill the gaps at times of shortage or low quality Cheaper substitute for the real thing Getting around drug tests, prison etc Mirror products already available Error in production, contaminant e.g. 4-MA Competitor, e.g. mephedrone

12 What s going on? Responses Expansion of OST, 50% coverage HIV and DRD prevention successes, lowest new detections IV related Aging cohort with complex needs Cannabis treatment expansion Online interventions Best practice, standards increasing Catch up game re responses to NPS 12

13 What s going on? Now..? Quality wars Purity increases 13

14 What s going on? Now..? Quality wars Purity increases Heroin rebound? High risk practices, small groups (glocal) Cryptomarkets expanding 14

15 What s going on with NPS, new drugs,.? Five broad and overlapping groups. Most are synthetic substances Legal highs: sold openly, often as branded products in sophisticated packaging. Sold on the Internet, in head shops and by street-level drug dealers. Also called bath salts, plant food, incense Research chemicals: largely sold online as zip-locked bags of powder with labelled chemical content Medicines: diverted within EU (pregabalin, benzydamine, gabapentin) or imported (phenazepam, phenibut) Dietary supplements: aimed at lifestyle users, sold on in bricks and mortar shops and online (e.g. ebay). Phenibut, DMAA, NADEP Designer drugs: sold on illicit market as ecstasy (mcpp, PMAA) or speed (4-methylamphetamine) or heroin (fentanyls). Users mostly unaware that they are taking them 15

16 New psychoactive substances no signs of decline 81 reported to EWS in substances monitored Largest group synthetic cannabinoids 30 other compounds 16

17 6 Risk assessment of NPS in I-NBOMe (hallucinogen) MDPV (stimulant) AH-7921 (opioid) Methoxetamine (ketamine-like properties) 4,4'-DMAR, MT-45 Target main segments of illicit drug market 17

18 NPS prevalence in Europe 2014 Flash Eurobarometer, young adults aged % of respondents reported lifetime use of legal highs, with 3% reporting use in the last year slight increase from 5% reporting lifetime use in a similar survey in 2011 From Ireland (9%), Spain, France, (both 8%) and Slovenia (7%), to Malta and Cyprus (<1%). 18

19 Eurobarometer 2014 (n ) 19

20 Ongoing concern: injection of synthetic cathinones Mephedrone and MPDV, have carved a space in the illicit stimulants market in some countries. Prevalence levels remain low but injection a concern Widespread IDU: HU, RO Pockets IDU: ES, UK, IE, AT Chem-sex 20

21 Synthetic cannabinoids, use and problems rare, but increasing Synthetic cannabinoids new dimension Use limited, but can be highly potent related emergencies a growing problem in some countries 21

22 Responses, EU projects with an NPS focus LOCAL-PASS I-TREND NPS among problems drug users EU-MADNESS PSYCHONAUT WEB ReDNet SPICE SYNWEB (1998) SPICE II Euro-DEN ALICE RAP DROSICAN SAVE OUR NET CHAMP 22

23 EMCDDA & NPS responses EWS network, monitoring, risk assessment, developing toxicovigilence Seizures collected Monitoring NPS laws Focused analyses e.g. Injection of synthetic cathinones & synthetic cannabinoids POD A and E, EuroDEN Health and social responses, meeting, welcome your input!

24 European responses analysis 2014 NRs Many countries, laws and shop closures Provision of information, education and prevention activities Training courses or conferences Internet information and counselling User-led initiatives, forums and blogs consumer protection advice, Linking with drug testing and pill checking services Internet chat applications - 'online-outreach' Responses in nightlife and recreational settings rarely distinguish between NPS & established drugs such as MDMA Low numbers of NPS users entering treatment. Targeted provision linked with club drug clinics 24

25 EU look at responses NRs, 30 countries NPS have manifested in different ways in individual countries and responses reflect these differences. Hungary and Romania, where the injecting of cathinones has been reported, needle and syringe exchange services play an important role. United Kingdom, treatment services engaging with mephedrone clients - development of specific treatment guidelines or toolkits. NPS in all groups, all settings, mainly low but exceptions 25

26 What s going on now? Local trends Heroin, small increase, OD s up Spice, low and stable GHB,GBL stable

27 Bergen Earlier Warning System Rapid & reliable identification and reporting of new and emerging trends in substance use

28 BEWS design Established 2002 System reports 6 monthly Uses 50+ data sources Mix of quantitative & qualitative data Multi-indicator - sensitive & routine sources Follow the drug (17) Combined monitoring & earlier warning function

29 BEWS SOURCES RAPID ASSESSMENT STUDIES SBK ROUTINE DATA KEY INFORMANT PANEL SCHOOL PANEL MEDIA MONITORING SCHOOL SURVEY

30 Bergen GHB, GBL increase SUBUTEX STEROIDER KOKAIN CANNABIS HEROIN GHB XANOR DOLCONTIN ROHYPNOL

31 Model - rapid identification and response to emerging drug trends City level drug monitoring system early identification SBK Rapid assessment & response capability early intervention

32 RAR report patterns of use, user groups and responses Outreach team and researchers Systematic, manual based Multiple sources Users input Community involvement Local action plan

33 Finishing thoughts, how much new needed? 1. We need to understand the whole drug market to understand the role of NPS, often a filler 2. No such thing as an NPS user, poly substance use the norm 3. Hard to be substance specific when they change every week 4. But look outside the box or we will miss new ideas 5. Grey is this years black, new and old drugs mix, grey market etc 6. If you innovate, triangulate, and get validity from multiple sources 7. NPS mimic old drugs market segments, so responses can too! 8. All actions have counter reactions e.g. dark web and police raids 9. NPS (as opposed to OPS like tobacco) a chance to locate harm reduction at the core 10. Document, evaluate, refine & make sure things don t get lost 11. All new drugs trends and new responses once started locally 12. Think big, transferability, think sticky and clean up 33

34 Keep the past in mind, what we know works In the Maori language the past was described as ngaa raa o mua, 'the days in front', whereas the future was 'behind', kei muri (Metge 1976:70) 34