Side event: NPS market monitoring: Outcomes of the Scanner Project

Organized by Youth Organizations for Drug Action with the support of the Asociación Bienestar y Desarrollo, the Flemish centre for expertise on alcohol and other drugs and ReGeneration

SCANNER PROJECT: UNderstanding the dynamics and consequences of NPS use in rapidly changing drug markets

Jochen Schrooten, VAD – Flemisch centre for expertise on Alcohol and other Drugs: Half of the population said they have used NPS. 70 NPS were reported in the data. In terms of substances, it’s mainly stimulants and psychedelics. There are many psychedelics because COVID-19 pushed us to gather more data, in festivals, where psychedelics are quite prevalent. 2CB one of the most popular but also 1PLSD and NBOMEs. ATS are less popular than synthetic cathinones. In terms of gender, in general, NPS use in this survey population is quite balanced between men and women. Usually men use more party/recreational drugs. When you go in further details, looking at 3MMC, more women than men using for instance. Even higher odds for women using 4MMC. Interesting because it’s quite new. Related to 2CB, more men using. Why is it that women seem to be using more NPS? Stigma? Availability? We don’t know but it’s something to consider. Related with age, a classic pattern of younger populations are using more party drugs. We see this particularly strongly in patterns of use around synthetic cathinones. Now, in terms of the FESAT network (the helpline) —people who reach out to the helpline have rarely mentioned NPS. But the substances mentioned are similar. Lessons learnt? General use of NPS is high in these outreach populations. They tend to be younger (17-26y), women use similarly to men. 70 NPS but no opioids. More interest in psychedelics and ATS (west) and synthetic cathinones (east)..Another interesting result: with this data we can show that the outreach groups are trusted so that this data can be gathered. The organisations working with drug checking services were very good to collect good data and even more data. Take-home messages: Is banning drugs the solution? This week CND banned 3MMC. Is that the solution? Is banning drugs always the solution? We must be aware on the top level of decision making they feel this is part of the solution but services see collateral damage —if you ban one substance there’s a new one to substitute. 3MMC is disappearing but now there 3CMC, which is clearly more toxic and dangerous. What we find, again, is that civil society organisations are powerful to reach out to these target populations by lack of funding…our work is very limited. Please, invest in selective prevention and harm reduction because stigmatising, criminalising. If we want to talk about demand reduction, it’s to empower people who use drugs to understand their drug use and helping them lessen their drug use.

Irena Molnar, ReGeneration: We work in the Western Balkans, where harm reduction programmes are underfunded, poorly available and drug checking isn’t available…whcih makes the data collection work complex. We work in nightlife and advise the government. In this monitoring process we checked the prevalence of NPS use. Thanks to YODA, we had the opportunity to participate as other European projects. It allowed us to compare the quality of data. And with it we can advocate for and improve our harm reduction services. The methodology was different. Psychedelics and cathinone based NPS primarily, but a rise in ATS NPS. Without the drug checking services to confirm that, we only get perceptions of use —there’s no confirmation. Providing harm reduction services in real time is difficult because we can assume things, but if you’re in a festival, assuming what people use isn’t ideal, it can lead to erroneous advice. Grateful to the government of Serbia because with their help we started a conversation on drug checking services and early warning systems in Serbia. IN the legal system, only 3 articles related to drugs: possession, dealing and facilitation. The facilitation work makes it impossible for us to deliver information related to drug checking. So, for instance, no harm reduction on sniffing because it’s considered facilitation. We also had activities related to sharing fentanyl test stripes in different countries to monitor fentanyl in our countries with users. SErbia was the only country that didn’t participate in this because fentanyl test stripes would be agains the law. 180,000 people from the Russian community live in Serbia —many leaving RUssia due to war or because they come from minoritised sexual minorities. MOstly young, some use drugs, some live with HIV, and some are LGBTQ+…and their access to harm reduction services is nil. We did question them and 30% are using NPS in the last week / month. Not being able to know and confirm the substance they’re using is dangerous because we cannot provide honest evidence based advice. This project was eye opening in that regard and gave us a lot of information to advocate for including the organisations on the ground. CSO knowledge on drug checking and the situation on the ground is … 

Alexis Goosdeel, EMCDDA: Drug checking has been monitored by emcdda for over 20 years. Over the last 25 years, evolution in much more professional drug checking programmes. Started with pill testing in many countries —limited means, technology, tests. In Belgium, it was the Marquis text which just let you know if something was amphetamine or… That’s the first obstacle. Over the years, huge evolution and professionalisation of services. Two drivers: technological evolution —much more and better tool for analysis; but also reduction of the size/cost of the equipment and programmes. But also staff have become highly scientific as you can see today. This makes the uniqueness of drug checking programmes in the EU and elsewhere. Interesting opportunities: 1. Protection of consumers, harm reduction interventions, prevention and, even if there’s still not full consensus in every Member States on the use and implementation of these programmes, growing concern that with the evidence of festivals potential to die from the use of substances of unknown and toxic contents, which is why there’s a conversation happening. 2. Production of knowledge: the European EWS has allowed us to discover more than 900 NPS. Some of these substances are very new and we don’t have much info about their mechanism of action, neurotoxicity, or antidotes in case of acute intoxication. 3. Monitoring and real-time monitoring in particular. THose 3 pillars are the basis of our work in this space. Concrete opportunities? Negotiation by the European institutions of the expansion of the mandate of EMCDDA with a new name, mission and resources. For instance, it is foreseen to establish a broader european alert system on all drugs, not only NPS. We will further develop the platform that we’ve craesd and cooperated with a network of drug checking programmes, a network of drug consumption rooms, etc. We’ve also to consider those partners not only as data providers but customers too as we can develop support in the future. Challenge is technological support, which is part o the future mission of NPS, broadening the network of DCRS, and drug checking projects, supporting member states with scientific evidence on matters of needs and accessibility of drug checking and DCRS, support for training materials if and where needed to help the establishment and evaluation of these programmes. One challenge is also efforts by member states to ensure political consistency within the Eu Drugs Strategy. Strengthen EU drug preparedness: better capacity to anticipate, improve, further develop our capacity to alert, respond and better tools for methodological support to better evaluate responses. Scanner Project is a great contribution to this effort. Important funding initiative of the Commission. The Commission in this has been very forward looking, only region of the world 26 years ago deciding to create an EWS on NPS. Scanner Pojrect essential contribution to the Reitox network and critical input for the new network of laboratories to be launched next year.

Mireia Ventura, Energy Control: First pill testing of Energy Control in 1999. Answering the problem of PMA appearing on pills. At the end of 1990s, consumption of ecstasy and drug checking services detected reduction in MDMA and increase in substitution by PMA. Substances that work different..y PMA is much more toxic and the onset time is much longer so people thought they were light MDMA pills and re-dosed. And PMA’s lethal dose is close to effective dose. Which was causing people to die. So we started using reagents. It allowed us to distinguish whether we had PMA or not. And it allowed us to gain the trust of people and understand that we can provide useful information. These services are very helpful in providing this specific information about drugs. MOre and more, the world of NPS was being complicated — we couldn’t just focus o pill testing because there were combinations of substances (more than 900 substances detected over the past year at the EU level). Which is why we offered drug checking as a way to overcome this problem, thr¡ough technification —no use of marquis reagent test, use laboratories within clubs, close monitoring of these substances. WE now have the TEDI network from 2011 —now with 22 drug checking services from 14 countries. Many of us were pioneers, with more than 30 tears of experience. Since 2017, we’re part of the monitoring system of the EMCDDA. And we’re also part of the sentinel programme with specific information. We also could do proficiency testing with all involved rug checking services. Important to validate ourselves too, so we were doing these tests. By analysing different batches, covering all NPS, even if most were opioids, synthetic cannabinoids and opioids. Every lab was using the techniques we already had and comparing results. Proficiently tests scores ranged from 80 and 97.5% of accuracy. Most common issues. Unidentified compounds, and confusion between structural isomers and structural analogues. The conclusions were that participating drug services did have the tools to provide accurate feedback needed from people use drugs. Recommendations to analyse NOS? Access to different analytical laboratory techniques (GC-MS). Access to open source MS libraries and update them regularly because ethe world of NPS evolves really fast. Having stationary drug checking services for continuous monitoring. Research on online drug markets. Collaborate with EWS —using the alerts we have with several criteria (2 warning alerts: orange for potential or actual adverse effects, for which the target group is the national focal point; and red: possibility of fatalities or serious poisoning, in which case target groups are also general population because of high risk). We’ve only used red alerts in EC three times. Because you need to ensure people trust that when there’s a red alert, it’s because it’s a really serious matter. Example of the SUperman pill in 2017, with very high concentration PMMA. Lessons learned? Drug checking services have the capacity to properly analyse NPS —and to have information that people who use drugs and national focal points need. Services are good observatories with advantages over other sources of information in “real time”, because consumption and through direct contact (collaboration and trust with drug using communities). We’re extremely effective as a result in removing particularly risky substances from the market because people who use drugs take this information and share it. At festivals, for instance, you detect some warnings…at the end of the festival, these substances are not circulating anymore. Important ot be able to share this information and work with all relevant stakeholders in the response.

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