Home » Side event: Drug checking for monitoring, prevention and harm reduction

Side event: Drug checking for monitoring, prevention and harm reduction

Organised by the Netherlands with the support of Canada, Czechia, New Zealand, Portugal, Switzerland, the United States, the European Union, the Centre on Drug Policy Evaluation, the New Zealand Drug Foundation and Safer Drug Policies Norway

Moderator: Victor Sannes. Let me thank the cosponsors of our side event.

Mr. Daan van der Gouwe, drugs researcher at DIMS, Trimbos Institute, Netherlands. I want to share some considerations with you. Our service dates back to the 1980s, with a Safe Drugs System programme in the 1990s in festivals, and then we grew to the scientific monitor we have now. We are subsidised by the MoH. Some of the milestones are that we started as an on- and off-site service. But on-site in festivals is no longer allowed now. We are actually nation-wide throughout the country where people can bring drugs for analysis. The number of samples has increased from very few in 1993 to 19,000 samples right before COVID in 2019. We are now getting a record now in 2022. We’re mainly dealing with ecstasy and other recreational drugs. We have seen from the start that the purity of ecstasy has evolved. Luckily the purity has gone down now, which is good from a health perspective. But we have this monitoring to issue prevention messages. We also monitor extra-risky substances on the market. The Red Alert Pink Superman was not MDMA, it was very lethal. Another one that is more recent is liquid MDMA. It was not supposed to be on the market, and was quite lethal. This is how we deal with our monitoring data. It’s a real time monitoring of trends on the market. We can rapidly intervene and inform drug using communities, and we are an essential part of effective early warning systems, working closely with the EMCDDA. We also do risk assessments. This is simply a life-saving harm reduction tool. We have issued a special edition of ‘Drug Checking: From guerrilla to government agent: The full spectrum of harm reduction’. Drug checking services from all around the world have participated in this issue including from Colombia and Ukraine. Drug checking services from Europe also have a network (www.tedinetwork.org). We also have guidelines on drug checking services. I also want to thank the MoH which has supported us for many years, through financial and moral support. Drug checking remains a controversial issue, and it’s important that we have their support to do the work.

Fiona Measham, Professor in Criminology, Founding Director of The Loop, UK and Australia. I want to discuss the past 10 years of the UK. What happened with the Loop is that we focused on non-public testing to identify substances and build stakeholders relations, issues alerts and get the public used to testing. We tested behind the scenes in party settings. We started in 2013 in a festival. We then had 3 years of public services to collect data and evidence and publish in academic papers. This was all festival based. Phase 2 focused on community based drug checking. In 2018 we delivered 5 pilots starting with Bristol with a free, anonymous service. We started the governance around the service. We then requested charity status. It was recognised that this was a legal activity in the UK. We have appointed a Board of Trustees, CEO, administrator, trainer and operational manager. We have looked at how to measure the effectiveness of drug checking, with 10 key outcomes: positive (self-disposal, taking a smaller dose, being more careful with poly drug use, alerting friends, extending time of use), negative (taking a larger dose, buying more on site – that could be positive if information is fed back to the dealer, but could also be negative), and neutral. If people find that the sample is not what they think it is, a third throw them away, and alert their friends. Most take less than they had originally anticipated, very few took more. 95% of those who used the service had never talked to a drug service before, this was a new conversation about their drug problem. 20% asked for referral for future problems. There are also wider benefits which could be gained from other drug services on problematic substances and avoiding poisoning or overdoses. We have a large reach for the Loop alert: it goes to 1/2 a million users, and it’s picked up by media outlets. There is good reach to the community. 2023 is a big year for our service: we have a University guidance in May, we will expand our licence to Bristol city centre and will be rolled out to other cities in England and in Scotland in three cities. There are also challenges: it’s a complex service to deliver in multiples of cities, the professionals working in chemistry and healthcare are part of the multidisciplinary team. We are also in a budgetary crisis right now, so funding is an issue, but it does reduce the health burden in the UK. We also don’t have a best practice framework in terms of governance, we will be looking at that. The licensing is also an issue, it is for chemists handling the drugs, but none for the service users and healthcare staff (legal grey area). Finally, we have a whole raft of new insurance that disproportionately affects the sector (personal, professional, medical malpractice, etc.). The financial threshold is high. We have parliamentary support from the Health Committee and the DCMS. We hope to get a Labour government that will support us directly.

Mr. Dominique Schori, Head of the Swiss Drug Information Centre, Zurich. I will focus on the political process that the drug checking service has gone through. The reason why it was established was because of political pragmatism, the will to collaborate, financial resources to fund harm reduction services. Switzerland became famous for its open drug scenes in the early 1990s with many harms for PWUD. To better understand how the heroin market evolved, Bern started its 1st pilot project to monitor the heroin market and inform users of dangerous compounds. Other harm reduction services followed. At the time, the subculture of techno partying and recreational drugs became more prominent. Political pragmatism was not the only key factor, the discussion shifted from a moral to a pragmatic approach: PWUD should have access to harm reduction. We had to deal with the reality that people still take drugs. So we started a project in the late 1990s. Legal assessments from 1997 found that drug checking did not violate Swiss law. This resulted in political from the Swiss population. The narcotic law was revised in 2008 with 61% of support from the population. There is an increasing number of substances being tested in Zurich. It is the biggest source of data of the market in Switzerland with real time information. The coverage of drug checking services is quite good, but still low in the French and Italian parts of the country. There has been a professionalisation of the drug checking services, studies to bring new evidence, and standardisation of services to ensure new services can start more easily. We need to talk about hard to reach populations, but also hard to reach services. We have to adapt our services for cannabis users and those engaging in chemise. We also have relations with forensic labs about potentially dangerous drugs, collaborating with the police, the EMCDDA and UNODC. One aspect that is important is that our drug checking service allows young people to access the service, even if it’s controversial.

Ms. Helena Valente, Scientific and Technical Advisor of Kosmicare, Portugal. Kosmicare is a Portuguese harm reduction NGO, including drug testing and mobile injection service. Drug use is decriminalised in Portugal, as is harm reduction, and there was a legal framework at the time to implement harm reduction. We have more limited resources than the Netherlands, but drug checking started being implemented. We have a drop in centre in Lisbon, we work in large events in Lisbon, we have partnerships with the safe consumption rooms in Lisbon as well. In 2022, Kosmicare contacted over 16,000 PWUD, who all have access to our drug checking data, even though not all of them have their drugs tested. Some people are testing for larger groups. Over 75% of them are already experienced users, with an average age of 29 years old. But this is their first point of contact with the health field, so drug checking can bring people into contact with health services and more formal structures for the first time. We’ve also done monitoring and evaluation of our surveys. We’ve done this with 500 people, including longitudinal surveys, and the papers are available to ready. Of those who received an unexpected result, 86% didn’t take the drugs, and 11% took a smaller dose. A lot of harm reduction strategies were adopted. Drug checking works as an effective harm reduction tool, and deals with the anarchy of the illegal drug market. What we also realised is that it has the potential to reach people from many different groups. Drug checking was implemented in large events and party settings, but now we are working with the safe injection rooms. And this is very effective. The information provided was extremely useful for people working in the drug consumption room. The type of behavioural outcomes from people are different, but we provide behavioural change from all groups, those younger and more wealthy from festivals, those older and more vulnerable from safe injection rooms. We work with the European Early Warning System, so this is a very important monitoring tool for the illegal drug market.

Ms. Emily Hughes, Principal Science Advisor, New Zealand Drug Foundation. NZ is the first nation in the world that has a fully legalised drug checking system under the Misuse of Drugs Act, administered by the MoH. As part of the requirement by law, samples cannot be used in the court of law, so trust with the community has increased, and so has support from the police. The law has enabled integration with the Early Warning System, funding and regulation of drug checking services which has ensured quality and access to the service. Drug checking prevents real time harms, we compare data with other outputs. From here, drug high risks can be dealt with and warnings can be prioritised. We can also provide bespoke services where needed. Results are validated by government-funded labs, which increases trust in the service. There are various examples of messages we’ve shared. Drug checking can also impact a small, volatile drug market. We’ve got a market of stimulants and it’s very volatile. It’s a unique market. We’ve seen an increase in market transparency, including online markets, with people representing drugs for what they are. And that’s increased since the drug checking service was available. We also have peers accessing services and dissemination of findings. We have a better data visibility on the market. In 2022, we had over 5000 samples, 57% were what people were expecting, 12% were not consistent, 21% were partially consistent, 8% were unknown substances. This is massively important considering the recent increase in overdose deaths. There is still considerable work to be done to achieve equitable access to drug checking, including from Indigenous communities.

Mr. Danilo Ballotta, EMCDDA. We can see how much progress there has been since the 1990s in this field, from a grey area and not knowing what these services meant, with controversial debates about the services. Even at the EMCDDA at the time we didn’t know how or whether to talk about it. We now have a lot of successful data, so congratulations for fighting for these results. We value your work with the Early Warning System, we are in touch with the Tedi network, and we have created a platform to facilitate communication on data collection. We will have a new mandate, we will be called European Union Drug Agency in a few months. We have seen the transition from traditional indicators towards new cutting-edge indicators: quick, cheap, reliable and on time. This is very important because we go fast. As a regional agency, you give us what was the past, what is the present, and what are the real risks for the future. Drug checking provides a list of new indicators that enables us to be prepared.. And we can advise you on what could hurt you. We hope to be able to invest more in these studies and provide more visibility to these services.

Questions and answers:

Daan. We don’t have standardised technology available, we have different techniques for analysis. We have guidelines on setting up the services, but when it comes to analysis, each country has different techniques and budgets.

Helena. Within the EU project, we did a proficiency ring test, testing different methods with unknown substances to see if we got different results. The results were interesting and quite consistent. So even with different budgets you can reach different results.

Question. We don’t have any of these services in the USA. We see a lot of suicides in the USA related to toxic substances.

Victor. What we try to show here is that you can do drug testing in different ways. We’ve seen different experiences and we’re willing to share those with other countries where it’s not yet available. So please get in touch with the panellists to help one another. Drug checking helps saving lives and that’s one of the most important things with harm reduction. I thank all the speakers for their presentations.

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