Side event: Drug checking services: Improving public health and safety

Organized by the Governments of Austria and Spain, Acción Técnica Social, Asociación Bienestar y Desarrollo,
ReverdeSer Colectivo Programa de Análisis de Sustancias, Trimbos Instituut and Transform Drug Policy Foundation

Chaired by Zara Snapp (ATS): We thank the support of the governments in the realisation of this event and invite other MS to do the same. We don’t come here to talk about problems without evidence. We do not come to complain about prohibition, but to show how to address challenges and propose solutions. NPS is one of the challenges constantly mentioned by governments. In recent years, we have seen how countries that have drug checking programmes have had fewer deaths. In places such as England, Ireland and Argentina are exploring these programmes too. Energy Control, Trimbos and CheckIt collaborate with governments on these projects.

Steve Müller (CheckIt!): We have ran the project for over 20 years. I want to start with something: the most common misconception with all kinds of people, is the very nature of the services. Most people think it’s only about chemical analysis. But this is not quite right. Drug checking is about providing general information about drugs, advice concerning some aspect, support for people who need it, ongoing support, group work and monitoring the market. This integrated model has certain advantages that are bigger than the mere sum of their part: they are attractive, relevant for the user, credible and appropriate…and more effective; because they’re personalised. It connects with the clients’ realities. Effects on users? 10% end up taking the whole pill analysed; whereas 80% end up taking less. What about if it shows there’s a high dosage of MDMA? 21% would not use it at all; 66% would take less. What about if there are other substances? Almost 40% would avoid the pill. IDC acts as a contact tool, for users who do not engage with traditional services; it is effective as early intervention; and it is a catalyser for individual risk management; effective harm reduction and market monitoring tool (detects trends – availability, contaminations, purity, patterns of use, etc.).

Zara Snapp (ATS): Founded in 2008. We work with institutions and people who use drugs to design and implement policies working with legal and illicit psychoactive substances. We focus on risk and harm reduction, using peer education. Three main programmes: CAMBIE (comprehensive harm reduction programme for people who inject drugs – responding to a growing trend in Colombia); Coca Regulada Paz Garantizada (a project scoping for the regulation of cocaine, recognising that the current Peace Agreement sidetracked the conversation); Echele Cabeza Cuando se de en la Cabeza (comprehensive risk and harm reduction programme). It’s a project focused on reducing the risks of consumption of different psychoactive substances. (…) Echele Cabeza was founded in 2010 as a pilot around providing information. IN 2013, Energy Control supported us to launch the drug checking programme. We have done 136 interventions in parties, festivals and raves; 61,300 people impacted; and 210,000 indirectly. 21K followers on social networks around the world. Official permission to do substance analysis obtained in 2014. We have released 24 early warnings, making sure that users know of dangerous pills/substances in the market. We identified 4 new NPS in Colombia, that had not been identified before in the country. We provide information, work on the public opinion through communication flyers and installations, early warning systems, we work with the private sector too to make them understand the importance of substance analysis services. WE have established linkages with the Ministry of Justice and other public authorities. We also do surveys on satisfaction and behaviour change. 86% consume drugs for pleasure; only 1.9% to “avoid problems”. Most people want to reduce risks, but some also want prevention information. 43% acknowledge it’s health information. 89% find this information useful. 83% said they didn’t use the substances when the result showed it wasn’t what they expected/wanted. 95% are motivated by concerns on quality. How does this translate into public health indicators? We have seen a decrease in ER admissions (in Bogota, which is where we tend to work) in the two years after implementation. This is the only programme focused on these populations. We cannot prove causation but we suggest a correlation. 250,000USD saved per year for the city of Bogota. We also saw a reduction in polydrug use and fatal overdose (probably related to the work of CAMBIE, which provided naloxone, and was reported to be used in 45 instances of overdose). In terms of recommendations: NPS are an emergent challenge, we need to change our focus. Substance analysis is an effective way to address these. It generates resilience. It fosters positive partnerships with consumers and institutional authorities. Most users can be responsible.

Brun Gonzalez (ReverdeSer – Programa de Análisis de Sustancias): We’re a peer-led project with no government support. Difficulties in funding because many funders do not finance harm reduction that doesn’t target injecting drug use. We also talk about the histories of these substances, why some are legal and some are not; generate political and contextual awareness on how to deal with the risk and the market at the current moment in time. We provide information based on our “Universe of Drugs” platform. From the first moment we tried to copy Energy Control’s model. Providing information, but then also chemical analysis. We don’t have funding to have sensitive and sophisticated equipment. We work with chromatography because of this. We have a space to attend psychoactive crisis also, to manage difficult situations. Some of the aspects require technical knowledge, some others is about helping people to go through complicated situations. Using this as a mechanism and a strategy to engage in conversations about drugs and their risks. The idea is generating conversations with party organisers and circles of friends, open up a dialogue. We did not charge for these interventions; but given that we try to make this sustainable, we started charging party organisers. For certain substances, like LSD, we use a UV light. If the result is ambiguous, we use reagents; and if we have trouble, we use thin-layer chromatography. We do not provide quantitative results because of the lack of resources. But we can identify ranges of purity, for instance. In terms of results: in 2015, 260 tests, mostly MDMA and LSD, 43% showed negative results. We have had people come back to the service. We are exploring a network to work on a “broad spectrum of harm reduction”. We have to be discreet and quiet. We don’t publish warnings and alerts. It’s a legally grey are a and you never know who you’re going to upset…

Mireia Ventura (ABD – Energy Control): Energy Control’s drug checking service was born in 2000. We initially offered the service just in nightlife spaces. We then started offering the service in drop-in centres. We have continued to expand thanks to the trust of our clients/people who use drugs. IN 2014, we opened the service to the international community; particularly drug users purchasing substances in the deep web. We have analysed 2432 samples from 50 countries, mostly US, UK and Australia. We have different levels of collaborations: drug users (our target group and thebasis of collaboration with other instances), but also National Focal Point (SEAT) and other organisations (mass media, medical institution, suppliers, universities). Our collaborations have helped us publish in high-impact scientific journals, but also reach the public opinion through our engagement with media. Thanks to our warnings, we have contributed to flush dangerous substances off the market (influencing suppliers). We also engage physicians to make them aware of the risks of the substances we’re finding. In terms of warnings, it depends on the toxicity of the substance. WE are worried about some alarms. A lot of NPS are sold as classic drugs. Alpha-PVP sold as “ecstasy”, for instance. It’s important to now these NPS are worrying, particularly their use as adulterants. We have launched international warnings, like last week in Australia (a toxic substance was being sold as MDMA); it has become our second most visited page on our website. We also launch alerts in the deep web. In terms of our target group, we have reached hard-to-reach users (60% wouldn’t have contacted drug related prevention services). 100% say they will recommend the services to their friends. 64% declare that they are not going to consume the substance when it is adulterated. 100% avoid consuming a substance when it’s not what they expected. We are collaborating to advocate for higher awareness about this: with families of victims of overdoses related to misinformation, with civil society in celebrating the international drug checking day, etc. Why drug checking? It facilitates monitoring the illegal market, they are trustworthy to young people, so it’s an opportunity for interventions, it creates awareness of new and dangerous drugs (a dynamic phenomenon), easier to engage hard-to-reach population. We think it’s time for governments to take the initiative and eliminate legal barriers and extend the services around the world.

Daan van der Gouwe (DIMS – Trimbos): 25 years, supported by our government. A very effective service to focus on drug-related risks. DIMS is a network of testing facilities aiming to gain insgith into the market. We test 15,000 samples. Mostly ecstasy, cocaine, lsd, amphetamines, and some NPS. We were among the first to detect a very worrying trend of increasing purity (for a long time, 80mg per table; in 2015, average was 150mg per table – Doubled in less than 10 years, which is having an impact on adverse effects). We also collect information about price. NPS are not used that much in the Netherlands, except for 4-FA. It’s a new substance increasingly submitted to our services. About to be banned. It was sold as speed, initially. But people have started submitting samples with people’s knowledge of the substance. The number of samples submitted went from 1 in 2007 to 708 in 2015. We also raised the alert related to “Superman” pills, which contained 173mg of PMMA, and no MDMA…yet was sold as ecstasy. We produced a press release, submitted news items to media, distributed flyers. No-one died in the Netherlands… but unfortunately there were fatal cases in the UK.


Questions

1 – On the trends, what have you been seeing that is new?
2 – Do you consider, and if so, how do you manage the risk of dealers advertising their products to users?

– Steve Muller – We are observing increasing purity. NPS are hardly used in Austria, by the people who use our services. People more often than not get what they expected, but the purity/dosage is very variable
– Brun Gonzalez – Displacement of classic substances. Methamphetamine replacing ecstasy and even cocaine. Blotter papers (supposed to be LSD) actually containing NBOMES, DOC, DOB, 2C compounds.
Zara Snapp – Producers also identify “successful” pills that end up being copied, but with lesser quality.
Mireia Ventura – In terms of new substances detected: increase in dose of LSD, inclusion of adulterants (NBOMe, etc.). We never ask if a person deals. WE treat all submissions as if they were drug users. Most dealers are drug users anyways.

 

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