combining monitoring data to evaluate responses to nps ... · • this presentation: • using...
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Combining monitoring data to evaluate responses to NPS: the case of 4-FA in the Netherlands
Margriet van Laar, Head Drug Monitoring & Policy department
With Ruben Vrolijk, Esther Croes, Lonja, Schürmann, Daan van der Gouwe, Laura Smit-Rigter, Matthijs Blankers, a.o.
Lisbon Addiction Conference, October 2019
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<nr>
Background
• Growing number of New Psychoactive
Substances
• Each year NPS are brought under control of
drug laws, based on risk assessments using
multiple sources and (health-related) indicators
• However, generally no ‘follow-up’ after
prohibition
• This presentation:
• Using multi-indicator data to evaluate responses to
policy measures: case of 4-fluoroamphetamine (4-
FMA) in the Netherlands
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Effects 4-FA: in between amphetamine and MDMA
11-11-2019 3
Users appreciate the effects of 4-FA: less intense than ecstasy
(less perceptual changes, dizziness) but more entactogenic than
amphetamine
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4-FA Timeline
DIMS4-FA first time detected in XTC
sample
DIMS4-FA first time in sample sold
as 4-FA
MDIFirst 4-FA incident NVIC
1st Intoxication
reported
DIMSIncrease 4-FA samples
MDIIncrease 4-FA
incidents
jan-08 jan-09 jan-10 jan-11 jan-12 jan-13 jan-14 jan-15 jan-16
DIMS: Drug Monitoring Information SystemMDI: Monitor Drug Incidents
NVIC: National Poisons Information Centre
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4-FA: “ECSTASY LIGHT…”?
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Timeline 4-FA (cont.)
1-8-2016 First fatal incident
1-9-2016
Health warning Campaign
7-12-2016 Risk assessment
25-5-2017 4-FA Schedule I Opium Act
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Sources/indicators related to 4-FA
1. General population surveys (2016 – 2018)
2. Survey among nightlifers, with one year follow up (2017)
3. Market data: samples of 4-FA of consumers (DIMS)
4. Drug-related emergencies
5. Online drug forum analyses
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Lifestyle Monitor additional Substance use module; Statistics Netherlands in collaboration with RIVM and Trimbos Institute
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1. General Population Surveys (18+): 2016 & 2018 last year prevalence of use
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2. Substance use among party-and clubgoers (15-35 yrs) in 2016
3.2
0.4
0.7
0.9
1.0
1.4
2.0
2.1
3.0
7.5
9.0
9.5
10.3
12.3
24.5
24.5
25.1
37.3
46.2
52.8
11.4
32.2
68.8
98.3
0 20 40 60 80 100
other
4-MEC
spice
methylon
mefedron
methoxetamine
benzoFury (6-APB)
h. mushrooms
LSD
GHB/GBL
Ritalin
2C-B
truffels
ketamine
cocaine
4-FA
amphetamine
nitrous oxide
ecstasy
cannabis
e-sig
water pipe
tobacco
alcohol
2013:
8,5%
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Follow-up survey among 372 4-FA users (April 2017)
• Patterns of 4-FA and other drug use, including combined use
• Motives for 4-FA use
• Self-reported changes in use and reasons for changing use
• Perceived effects, adverse events and health problems
• Risk perception (compared to ecstasy)
• Harm reduction (‘damage control’)
• Sources of information on 4-FA
• Warning campaign: exposure, opinion and (self-reported) effects
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2017 follow-up: changes in use? (April 2017)
• Most-frequently given reasons to reduce or stop using 4-FA:
– mental and physical health consequences
– the information about the negative effects
• Most users received the warning via social and national media
• For two third of the users who had heard the warning, this also changed their perception of the risk
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3. Drug checking – DIMS: decrease samples after warning and ban
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..however.. samples sold as 4-FA increasingly contained 4-FMA
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4. Proportion of 4-FA related emergencies at first aid posts of large scale events
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5. Google trend & drug forum analysis
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Increase in number of posts on 4-FA
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Sentiment analysis
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New NPS legislation in 2020
• Legislation for generic system in preparation, based on four classes of NPS
Phenethylamines
Synthetic cannabinoids
Fentanyls
Cathinones
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Conclusions
• Most sources and indicators consistently pointed at an increase in
popularity of 4-FA until 2016 and a downward trend after the
warning campaign and subsequent prohibition in 2017
• GPS does not seem to be sensitive, but longer term trend is awaited
• All other sources have added value and give complementary
information
• They suggest that the warning may have been effective in limiting
use; and probably the ban has reduced availability of 4-FA
• However: it is important to be aware of unintended consequences:
4-FMP; return to ecstasy ? (increasing emergencies)
• Future: also waste water analysis (gives local patterns)