Harm Reduction & New Psychoactive Substances. Who’s up to the Challenge?

Jean-Paul Grund, PhD

CVO – Addiction Research Centre, Utrecht

Department of Addictology, Charles University, Prague

Harm Reduction & NPS

Who’s up to the Challenge?

New drugs,

new &

challenges,

new harm reduction? EUROHRN @ Amsterdam

Thursday 2nd October 16.30 – 17.30

New Psychoactive Substances

Homemade drugs

The Internet

The future • New Harms?

• Harm Reduction 2.0

Presentation Outline

But it did get easier,

way easier..

First, a lesson from history

Lifetime use of 'legal highs' in the EU

15–24 year olds, percentage by country, n > 12000

“In certain countries some new substances

that imitate the effects of illicit drugs are being

sold as legal substances in the form of - for

example - powders, tablets/pills or herbs. Have

you ever used such substances?”

The Rise of a New Dawn: New Psychoactive Substances (NPS)

Huge growth in number, type and

availability 303 new drugs notified 2005–2013, 67 notified in 2013 so far…

More than 200 have been

notified since 2010

New NPS in the EU

2012: 73

2013: 81

Timeline of NPS

Desomorphine (Permonid™)

opiate analogue

Analgesic effect: 10 x morphine

Toxicity: 3x morphine

short half-life,

need for frequent administration

2/10/14

Homemade Drugs

Cheornaya, Vint, Jeff, Krokodil

This is not Breaking Bad!

Breaking Worse: Bad Chemistry

Breaking Worse: Bad Chemistry hurts

WARNING!

GRAPHIC

CONTENT!!

2/10/14 strana 12

Diffusion of drug trends: Heroin in the Netherlands 1972~

2/10/14 strana 13

Cultural Capital

Major Port City

Timeline of Cyber Space

(Just the Surface…)

jpgrund@compuserve.com Internet sales of “Legal Highs”

Homemade Drugs – an Act of Defiance in Eastern Europe

Tor network Bitcoin

1874 1980 1989 1990 1999 2002 2003 2008 2011 2014

What happens under the Surface

Krokodil RU, UK USSR ╪

Cheornaya Vint, Jeff

PIHKAL

Heroin

Krokodil GA

Krokodil Panic US

Silk Road

Silk road shut down by the DEA (10-2013)

Silk Road 2

Evolution

Pandora

Blue Sky

Cloud Nine

Hydra

Andromeda

Agora

Twitter, Instagram 18

A glimpse of the future of drug markets?

”There are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns -- the ones we don't know we don't know.”

Donald Rumsfeld

New Harms: What do we know?

• Substance related • Unknown drugs

• Unknown Potency – some extremely

potent (µg) – Overdose!

• Set related • … … “Legal Highs” & the Unprepared

• Setting related • BBVs?

• Who is your dealer?

• Absence of regulation

New Harms: What do we know?

Where there used to be Grass, Acid, Speed, Brown & Blow…

Where you used to buy from a dealer (a real person), you now buy online or you cook your own…

Harm Reduction 2.0

A disconnect between drug use 2.0 and

harm reduction movement

A growing gap between “official” harm

reduction and spontaneous, peer

driven harm redux

P2P HR went online

• User forums, blogs

• bluelight.ru; drugs-forum.com;

legalhighsforum.com.”

(1) uncovering the substance facts, (2) dosage and administration, (3) subjectively experienced effects, (4) support and safety

“The main characteristics of the discussions

in general were a concern for safety and harm reduction.”

Tor network Bitcoin

1874 1980 1989 1990 1999 2002 2003 2008 2011 2014

PIHKAL

Silkroad

Molecular 3D Printer

2/10/14 strana 25 strana 25

The Future: Homemade Meets NPS?

Tor network Bitcoin

1874 1980 1989 1990 1999 2002 2003 2008 2011 2014

PIHKAL

Silkroad

Molecular 3D Printer

2/10/14 strana 26 strana 26

The Future: Homemade Meets NPS?

LC: “In 5-10 years we will be ordering our

medications online, prescription software,

personalized to our genetic make up, will be

streamed to our 3D printer at home.”

Tor network Bitcoin

1874 1980 1989 1990 1999 2002 2003 2008 2011 2014

PIHKAL

Silkroad

Molecular 3D Printer

2/10/14 strana 27 strana 27

The Future: Homemade Meets NPS?

JPG: “Before that, we will be printing our recreational

drugs at home. We’ll pay for the software or develop

these in online ‘connoisseurs’ clubs.”

Thank you for your attention!

E: jpgrund@drugresearch.nl

T: @HeisenbergXL

W3: drugresearch.nl

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(Most images: Internet. Thanks2Authors!)