NPS ‐
Pragmatic Risk Assessment ‐ Practical Prevention ‐ The Drug Prevention Approach. Rainer Schmid
Ph.D. & MSc.(Tox)
and
Anton Luf The ‚checkit‘ Project, The City of Vienna, and Medical University Vienna, Austria
[email protected] [email protected]
….this was the beginning in the 90‘ies….
‘Simple’ World: Lots of Ecstasies…
….and the situation today! >….this 450 New Psychoactive was the beginning Substances have been detected until today…’
in the 90‘ies….
So many different structures (and nothing known on their risiks)!
Frightening !??
‘Simple’ World: Lots of Ecstasies…
•
NPS: We see different pharmacological classes of action (independent from the structure) => we need a differentiated classification….
•
•
Amphetamine- und Ecstasy-type action @ z.B. Fluoramphetamine, Mephedrone, Butylone, ...
•
Cocain-type action @ z.B. Dimethocaine, 4-Fluorotropocaine, ...
•
Ketamine-type action @ z.B. Methoxetamine, ...
•
Hallucinogenic action @ z.B. 4-Acetoxy-DMT, 5-MeO-DALT, 25B-NBOMe...
•
Cannabis / THC-type action @ z.B. JWH-018/073/250 etc., AM-2201, CP-47,497,...
different psycho-pharmacological spectra of action = we should focus on different consumer groups ….and not onto different substances!
What is needed in Prevention is more efficient ‚Harm Minimization‘ !
From: New Scientist 2012
Thus:…encouraging and strengthening risk awareness of the different drug user groups!
„ …but do users (of NPS) get the necessary and credible information they need,…. …. to reduce personal harm and to be able to build up their risk competence efficently?„
Is it actually possible for consumers of psychoactive substances to assess their risks and to try to limit harm ?? ¾ Identity of substances (most of the times) is actually not known – many times phantasy names – ¾ The composition (of drug mixtures) is unknown .... it only allows them to consume ‚blind‘ ! ¾ Concentrations of active ingredients in drug samples vary …. they cannot be dosed with minimal risks ! ¾ Substances are deliberately sold as different drugs …. they only can be consumed under incorrect risk assumptions! ⇒ In this situation users know, they are ‘risk-incompetent’, so they will not consume with minimal risks (even if they try!!)
The
Project
• A low-threshold prevention project for recreational drug consumers, addressing drug information, where consumption takes place, at music events, • in combination with on-site drug-testing, • using a scientific appproach. o Founded by the Drug Coordination of the City of Vienna 1997 o in cooperation between Suchthilfe Wien and the Medical University of Vienna (General Hospital of Vienna - AKH Wien) • Grants by: &
Fields of Work
event assistence The ‘checkit’ activity zones
Mobile Lab Counselling area
Sampling tent
Display of drug analysis results
Why ‚drug-checking‘ ? • To increase credibility and acceptance, to efficiently reach targeted groups. • Actual Information - for actual prevention, • An efficient measure for risk reduction, • Special actual warnings of dangerous substances to consumers, in the sense of the European Early Warning System of the EMCDDA • And constant observation of the actual drug market situation is possible.
…that's why differentiated drug testing is necessary in combination with drug counselling On-site Mobile Lab, with 4 paralell HPLC systems (coupled with LC-MS). analysis time: 7 min, 25 samples / h (off-site: a high-res. Q-TOF is available).
Drug Checking – Targeted Groups Prevalence Europa Substance
Last 12 mo., Lifetime young Prevalence adults (15-34 15-64 yea.*) yea.) *)
Lifetime Prevalence Risk group (Techno Scene) **)
Cocain
2,2 %
1,2 %
45 %
Amphetamine
2,5 %
0,9 %
70 %
Ecstasy
2,3 %
1,0 %
70 %
14,2 %
6,6 %
90 %
Cannabis
*) European Drug Report 2013: Trends and developments, May 2013 **) Wiese & Verthein, Drug-Checking für Drogenkonsumenten – Risiken und Potenziale, Sucht 60(6), 2014, 315-322
… and the reality in drug consumption … Substances, which consumers assumed, they have bought (checkit! Year 2014) MDMA/XTC
417
Amphetamine
219
Cocaine Kokain
128
LSD
41
Other substances Andere Substanzen
39
Ketamin
37
unknown unbekannt Katamine
35
Metamphetamine Methamphetamin
16
NPS
13
n=945
Risk Assessment: And what drugs they actually got …. Review of all drugs analyzed 2015 (n=825)
Critical result 15%
Expected result 23%
Unexspected result 32% High dose 30%
• (only) 23 % of all samples contained the ‚expected‘ substances • 30 % of all samples contained the ‚expected‘ substances, but in high doses! • 32 % of all samples did not contain the ‚expected‘ substances (or contained additional additives) • 15 % of all samples were rated as particular problematic health risk!
Purity of presented drugs (‚checkit!‘ 2006 – 2014) Purity: MDMA, XTC & Speed % of samples with ‚expected‘ content
100 90 80 70 60 50
MDMA
40
XTC
30
Speed
20 10 0
2006
2007
2008
2009
2010 year
2011
2012
2013
2014
Ecstasy ‐ Doses [%] High dosed‘ Ecstasy Pills (> 100mg / tablet) % XTC tablets with MDMA dose > 100 mg
70 60
14
50
6
40
17
7
7
21
12
30 20
31 10
14
20
18
34 25
29
0
2009
2010
2011
2012
2013
2014
2015
% XTC über 200 mg MDMA % XTC 150‐200 mg MDMA % XTC 100‐150 mg MDMA
Ecstasy ‐ Doses MDMA in XTC‐tablets (2009 bis 2015) 400
MDMA dose / tablet [in mg]
350 300 250 200
Limit: ‚High Dose‘ (100mg)
150 100 50 0
2009
2010
2011
2012
2013
2014
2015
Cocaine adulterations Adulteration in Cocaine samples 100 90 80 % der Proben
70 Levamisol Levamisole
60
Phenacetin Phenacetine
50
Local Anesthetics Lokalanästetika
40
Caffeine Coffein
30
Cocaine with adulteration Cocain mit Streckmittel
20
Cocaine w/o adulterants Cocain ohne Streckmittel
10 0 2010
2011
2012 Jahr
2013
2014
What is achieved with the ‚checkit!‘ drug testing approach? 2010
2011
2012
2013
2014
# of analyzed samples / year
459
744
934
1023
945
# of event nights
14
14
13
15
12
# of samples / event
33
53
72
68
79
Max. number of samples analyzed / hour
11
11
17
24
25
# of samples identified (on‐site)
405 (88%)
668 (90%)
863 (92%)
938 (92%)
856 (91%)
# of psychoactive substances, which can be directly identified
60
65
106
131
158
quantitatively
17
17
30
27
28
…and the New Psychoavtive Substances (NPS)? NPS in Testergebnissen
2010
2011
2012
2013
2014
unexspected NPS
10,0 %
13,3 %
9,7 %
8,9 %
4,1 %
exspected NPS
8,9 %
4,3 %
3,2 %
1,8 %
0,8 %
samples with NPS / event
19,0 %
17,6 %
12,9 %
10,7 %
4,9 %
…play little or minor role at music events in the Viennese area (CB1‐agonists not included)!! Possible causes for the observed decrease of NPS at music events: • The Austrian „New Psychoactive Substance Law“ (since 2012) • Easy availability of ‚classic‘ recreational drugs (Xtc, amphetamine…) • Prevention‐measures had impact and created critical awareness!
…towards a rational risik assessment … (…. and some are (actually) more dangerous!) EWS: Daeth cases in contex with in Belgium and Holland.
4-methylamphetamine
Austria: Deathcase after consumption of 4-MEC (4-Methyl-Ethcathinone).
EWS : Several death and emergency cases in Europe after consumption of
Methoxetamine
Canada (Jan. 2012): Ecstasy laced with (p-methoxy-methamphetamine) (PMA) blamed for 5 Calgary deaths.
: … what do we learn from our current Drug Policies? •
• •
•
• • •
The ever increasing numbers of NPS have driven the functionality of the (prohibitive) National Drug Laws ad-absurdum: But most NPS substances, when consumed, are equally (or even more) risky, than many of the controlled substances! Global Internet markets and commerce cannot be controlled by National and International Drug Laws. Specific and efficient prevention strategies have to be developed for the different drug consumer groups, addressing credibly the various risk when consumed. Enhanced risk-competence and sensibility towards all drugs independently has to be enforced (especially to younger) drug consumers (similar to other risk activities in society). The development of new emerging (high risk) drug consumption patterns must be quickly identified and analyzed in a timely manner. (Prohibitive) Drug laws should be limited only to substances with a high ACTUAL risks potential. Market incentives for psychoactive substances should always be minimized
Finally…. ¾ We should not be too focused onto the (possible) impact of market mechanisms in the environment of NPS. ¾ In contrary, much more differentiated information is (badly) needed about the different consumer groups of NPS and on their consumption motives & patterns. ¾ Consumers of NPS must be approached with adequate respect, at eye level, acknowledging their attitude towards drug use: ¾ Only when the needed preventive risk-reduction information is accepted (- if credible! -), the goal, minimizing harm for society, is reached.
Thank You for Your Attention!
[email protected] [email protected]
