NPS use in Norway. Presented by Ellen J. Amundsen, Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health/ NIPH

Transcription

1 NPS use in Norway Presented by Ellen J. Amundsen, Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health/ NIPH NPS-EURONET Conference Lisbon 16 th April 2018 Based on research of many distinguished researchers and investigators, see references! Main contributor: Ola R. Bilgrei, NIPH

2 Driving time in Norway from Kristiansand to Kirkenes, the town most north east towards the Russian border, is 37.5 hours at 70 km per hour Driving time from Lisbon to Oslo is 34 hours, with a faster speed of course Geography means a lot for traditional sales of drugs not for internet sales

3 Norwegian drug realities in brief Illegal use of pharmaceuticals (morphine) started out among health personnel - and among some of those who got prescriptions The first clinic to treat such dependence was established in 1961 first in Europe (?) In the mid 60ies, use of cannabis started spreading among young people and from the mid 70ies, heroin, especially in Oslo At that time there were some use of amphetamines and LSD In the 90ies heroin spread over larger parts of the country Low level of cannabis use etc, among young people today - compared to most European countries High level of overdoses many of them in the cohort of problem drug users with drug onset in the 70ies and 80ies

4 Sources of information on NPS use General population surveys, self-reported from 2012, yearly Surveys in recreational user populations: Nightlife patrons (2014, 2017), music festivals (2016 ): self-reported, saliva testing and now testing in urinals (NPS-Euronet) Suspicious driving, blood test, yearly publication Fatal overdoses, blood tests, yearly publication Police and custom seizures, publish per half year Wastewater, ? Early Warning System EMCDDA, consecutive Internet drug forums In-dept interviews with NPS users

5 Ever use of heavy drugs among year olds Oslo Vedøy og Skretting. Ungdom og rusmidler. SIRUS rapport 5/2009. Figur 5.2

6 NPS use years and years, År: Year / Noen gang: Ever / Siste 12 måneder: Last 12 months Source: GPS NIPH

7 NPS use ever, last 12 months, last month and last 48 hours, self-reported, nightclub patrons (n=1099, Oslo, 2014) Per cent Source: Nordfjærn et al 2016

8 Blood tests, suspicious driving Very few cases of synthetic cannabinoids, and no findings of fentanyl derivates among tests for 6329 persons in 2017 Findings of designer benzo, new regime of testing from 2016 Source: Rusmiddelstatistikk Funn i blodprøver hos bilførere mistenkt for ruspåvirket kjøring Oslo University Hospital 2018

9 Autopsy testing for suspicious deaths Autopsy tests in 2017 established positive findings of NPS in 8 out of 1876 cases, 0.4% Mostly fentanyl derivates (alfentanil (2), acetylfentanyl (1) og cyclopropylfentanyl (1)) or designer benzodiazepines (enazepam (1), flubromazolam (1), etizolam (1)) Arylalkylaminet 5-APB in one case In 2016: 10 out of ca 2000, 0.5% Mostly designer benzodiazepines One case of Metoksetamin, a derivative of ketamin Approximately 90 per cent of those who die of a drug induced death have an autopsy, mainly problem drug users. This indicates that NPS is not commonly used among them Source: Obduksjonsstatistikk. Funn i blodprøver fra obduksjoner i 2017

10 1200 Number of seizures NPS Syntetiske cannabinoider Syntetiske katinoner Fenetylaminer Arylalkylaminer Tryptaminer Arylsykloheksylaminer Piperidiner Piperaziner Diazepiner Psykoaktivt plantemateriale Andre NPS Source: Kripos, 2018

11 Wastewater Source:Reid et al.(2011) Quantitative assessment of time dependent drug-use trends by the analysis of drugsand related metabolites in raw sewage

12 NPS from seizures and biological tests, Early warning info All different NPS Syntetic cannabinoids First time in Norway

13 Summary NPS use in Norway Some experimental NPS use among young grown ups, also outside the main cities Low level of recent use among both recreational drug users and problem drug users

14 Why a reduction in NPS use? I A key part of the development of the new psychoactive drug market has been the close link to the internet, not only for purchases and sales, but also for the exchange of user information (Bretteville-Jensen, Tuv, Bilgrei, Fjeld, & Bachs, 2013) Users and potential users have searched the internet to share and find user information and gradually created their own online forums, dedicated to discussions about NPS use (Soussan & Kjellgren, 2014) The many internet discussions probably had an important role in the rapid spread of substances (Sumnall, Evans-Brown, & McVeigh, 2011). The online vendors, the user forums and the massive media interest meant that anyone who was curious about the new drugs was exposed to a large amount of information and related user experiences Initially, NPS's user-generated online discussions was enthusiastic and positive, which helped accelerate market developments (Bilgrei, 2016) Source: Bilgrei OR (2016) From herbal highs to the heroin of cannabis : Exploring the evolving discourse on synthetic cannabinoid use in a Norwegian Internet drug forum. IJDP; 29:1-8

15 Why a reduction in NPS use? II Many experienced adverse effects and overdoses, however, and eventually the user-generated internet discussions was dominated by warnings against experimenting with the drugs (Bilgrei, 2016). Discussions in the user forums went from being positive to being deterrent Online discussions are also characterized by a focus on security and harm reduction among users (Soussan & Kjellgren, 2014). In this way, the negative reviews of NPS will cause many to perceive the potential risk of use as too high (Bilgrei, 2016; Bretteville-Jensen & Bilgrei, 2015). This can help explain why there has been no further growth in the use of NPS in Norway The harm reduction logic is no longer generated top-down and dominated by professionalized voices, but rather user-led and produced through interaction in large user groups on the internet (Boothroyd & Lewis, 2016; Irwin & Fry, 2007) Still, there are people in Norway who are experimenting with these drugs and new substances are made available on the market. Particular concern is devoted to the emergence of new and highly potent fentanyl derivates Source: Bilgrei OR (2016) From herbal highs to the heroin of cannabis : Exploring the evolving discourse on synthetic cannabinoid use in a Norwegian Internet drug forum. IJDP; 29:1-8

16 Thank you for your attention!