New Psychoactive Substances and Other Drugs

NEW PSYCHOACTIVE SUBSTANCES AND OTHER DRUGS

NOS Alive Festival 2017 Drug Use Survey

VASCO CALADO ELSA LAVADO LÚCIA DIAS

Monitoring and Information Department Statistics and Research Division General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD)

December 2017

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Index

Acknowledgements ...... 5 Introduction...... 7 Methods ...... 9 Procedure ...... 9 Sample ...... 9 Results ...... 14 Drug use ...... 14 Alcohol – risk behaviours ...... 16 Illicit drugs ...... 17 Drug use: sociodemographic variables ...... 20 Perceptions and Social Representations ...... 29 Discussion ...... 37 Conclusions...... 39 Bibliography ...... 40

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Index of Figures and Tables:

Fig. 1- Distribution of respondents by day of event (N=887) (%) ...... 10 Fig. 2 – Gender (N=864) (%) ...... 10 Fig. 3 – Age groups (N=866) (%) ...... 10 Fig. 4 – Age groups by gender (N=844) (%) ...... 11 Fig. 5 – Place of residence by NUT II (N=884) (%)...... 11 Fig. 6 – Nationality (N=885) ...... 12 Fig. 7 – Professional status (N=869) (%) ...... 12 Fig. 8 – Academic qualifications (N=875) (%) ...... 12 Fig. 9 – «What’s your favourite genre of music? » (multiple choice ) (main categories) (N=759) (%) 13 Fig. 10 – «What bands are the motivation for coming to the festival?» ( multiple choice ) (main categories) ...... 13 Fig. 11 – Binge drinking and Drunkenness prevalence (N=887) (%) ...... 16 Fig. 12 – NPS and Illicit drugs prevalence (N=887) (%) ...... 17 Fig. 13 – Illicit drugs lifetime use prevalence (N=887) (%) ...... 18 Fig. 14 - Illicit drugs last 12 months use prevalence (N=887) (%) ...... 18 Fig. 15 - Illicit drugs last 30 days use prevalence (N=887) (%) ...... 19 Fig. 16 - Illicit drugs last 48 hours use prevalence (N=887) (%) ...... 19 Fig. 17 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by age (N=866) (%) ...... 20 Fig. 18 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by age (N=866) (%)...... 21 Fig. 19 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by gender (N=864) (%)...... 21 Fig. 20 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by gender (N=864) (%) ...... 22 Fig. 21 - NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by activity status (N=869) (%) ...... 22 Fig. 22 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by activity status (N=869) (%) ...... 23 Fig. 23 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by academic qualifications (N=875) (%) ...... 24 Fig. 24 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by academic qualifications (N=875) (%) ...... 24 Fig. 25 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by nationality (N=885) (%) ...... 25 Fig. 26 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by nationality (N=885) (%) ...... 25 Fig. 27 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by day of event (N=887) (%) ...... 26 Fig. 28 – – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by day of event (N=887) (%) ...... 27 Fig. 29 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by music preference ...... 27 Fig. 30 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by music preference, (N=759) (%) ...... 28 Fig. 31 – Knowledge of the term ‘New Psychoactive Substances’ (N=887) (%) ...... 29 General Directorate for Intervention on Addictive Behaviours and Dependencies

Fig. 32 – Knowledge of the term ‘New Psychoactive Substances’, by NPS lifetime and last year use (%) ...... 29 Fig. 33 – If you know what are NPS do explain the meaning, as a view of the totality of respondents with lifetime use of NPS (%) ...... 30 Fig. 34 – Acquisition of any NPS last year or before (N=887) (%) ...... 31 Fig. 35 – Mode of acquisition of NPS last year or before ( N) ...... 31 Fig. 36 – Acquisition of any illicit drug (excluding NPS) online, last year or before (N=887) (%) ...... 32 Fig. 37 – ‘Does any friend/acquaintance, last year or before, has been into hospital urgency due to NPS intake?’ (N=887) (%) ...... 32 Fig. 38 – Occasional/regular NSP use risk perception (N=887) (%) ...... 33 Fig. 39 – Occasional/regular NSP use risk perception, considering only recent NSP users (N=9) (%) . 33 Fig. 40 – Higher/lower NSP use health risk perception in comparison with illicit drugs (N=887) (%) . 34 Fig. 41 – Higher/lower NSP use health risk perception in comparison with illicit drugs, by recent drug use (N=887) (%) ...... 35 Fig. 42 – ‘If you think that NPS intake has higher/less health risks than common illicit drugs, explain why’ ...... 36

Table 1 – Psychoactive substance use prevalence – Lifetime (LTP), Last 12 Months (LYP), Last 30 Days (LMP) and Last 48 Hours (L48h)(N=887) (%) ...... 15 Table 2 – Portuguese young population’s NPS use prevalence (LTP, LYP and LMP), according to the several recent studies (%) ...... 37

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Acknowledgements

A special thanks to all the participants of the 2017 NOS Alive Festival who generously agreed to be interviewed abdicating some of their time and contributed decisively to the completion of this study. Thanks also to the interviewers that, with great commitment and professionalism, conducted the interviews: Ana Henriques, Ana Rita Félix, Frederico Raposo, José Almeida, Joana Bernardo, Lara Fidalgo, Margarida Dias, Pedro Florindo, Rita Manguinhas and Sara Henriques. Many thanks to Professor Álvaro Lopes for this document’s translation to English.

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Introduction

This study is the result of a partnership between the General Directorate for Intervention on Addictive Behaviours and Dependencies (Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências - SICAD), Egas Moniz – Cooperativa de Ensino Superior, C.R. L. (Egas Moniz) and the National Institute of Legal Medicine and Forensic Sciences, I.P. (INMLCF), within the framework of the European project NPS- Euronet ( http://www.npseuronet.eu ), which has as main objective to develop multiple integrated approaches to improve the ability to identify and assess health risks of some New Psychoactive Substances (NPS) and estimate the size of their use and existing patterns of consumption in Europe.

The project NPS-Euronet in Portugal has the involvement of Professor Álvaro Lopes and Mário João Dias for the triangulation of data from analytical chemistry and epidemiological approaches through the population that attends recreational settings. In this sense, in addition to the collection for chemical analysis of wastewater treatment plant influents, a questionnaire was designed and applied to the public of the music festival NOS Alive-2017 , which took place in Lisbon in the month of July. SICAD collaborated in the design and implementation of the questionnaire and in the analysis of the results presented here.

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Methods

Procedure

A previous and tested methodology for similar contexts (Calado & Lavado, 2016) was used, which consisted in applying a semi-open questionnaire to the public about to enter the precincts of a summer music festival, in this case the NOS ALIVE-Lisbon 2017 during the three days of the event: 6, 7 and 8 July 2017. The interviews were conducted under the supervision of the authors, having been conducted by interviewers appointed for that purpose and who have been given specific training to best perform the task. The procedure resulted in a convenience sample consisting of 887 respondents.

Sample

The sample was distributed relatively equitably among the three days of the festival (Figure 1), and includes more female than male respondents (Figure 2) and is composed mostly by young people and young adults (63% of the respondents have less than 25 years and 92 % less than 35 years). The average age is 24 years, with a mode of 18 and median of 22 years, being that the male elements are in the majority only in the age group 25-34 years (figures 3 and 4). The respondents reside mainly in the Lisbon region (Figure 5) and are almost all with Portuguese nationality, being those from foreign countries no more than 10% (Figure 6). Reflecting the youth of the sample, most respondents are students (Figure 7) and have educational qualifications at the secondary school level or less (Figure 8). Rock, Indie music and Pop stands out as the preferred music genres (Figure 9), while Foo Fighters , The Weekend and Imagine Dragons were 9 the bands that brought more respondents to the festival. (Figure 10).

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 1- Distribution of respondents by day of event (N=887) (%)

8 July 6 July 30,6% 33,1%

7 July 36,3%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 2 – Gender (N=864) (%)

male 43,1% female 56,9%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 3 – Age groups (N=866) (%)

35-44 years 45-54 years 10 6,1% 2,2%

25-34 years 28,8% 15-24 years 62,9%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Fig. 4 – Age groups by gender (N=844) (%)

15-24 years 36,9 63,1

25-34 years 53,1 46,9

35-44 years 49,0 51,0

45-54 years 47,4 52,6

0% 20% 40% 60% 80% 100%

males fem.

Test Chi-square: X 2=18.997, d.f.=3, p=0.000 Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 5 – Place of residence by NUT II (N=884) (%)

30 55,4

10 16,4 13,9 2,0 1,6 0,6 10,1 0 north center lisbon alentejo algarve islands foreign countries

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL 11

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Fig. 6 – Nationality (N=885)

foreign countries 10,8%

Portugal 89,2%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 7 – Professional status (N=869) (%)

other situation* 5,7%

working 36,1% student 58,2%

* 24 unemployed, 23 working/students, 2 in other situations not specified. Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 8 – Academic qualifications (N=875) (%)

Master/PhD 3rd Cy.or < 13,9% 12,1%

BSc / Degree course 30,3% Second.School 43,7%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Fig. 9 – «What’s your favourite genre of music? » (multiple choice ) (main categories) (N=759) (%)

rock 49,7

indie/alternative 23,3

pop 18,8

hip hop 10,3

heavy/punk 5,9

electronic 4,9

0 10 20 30 40 50 %

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 10 – «What bands are the motivation for coming to the festival?» (multiple choice ) (main categories) (N= 845) (%)

foo fighters 33,2

the weekend 18,4

imagine dragons 14,9

the xx 11,6

alt j 11,6

depeche mode 9,3

0 5 10 15 20 25 30 35 %

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL 13

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Results

Drug use

Table 1 presents the prevalence of alcohol related harmful behaviours (binge drinking and drunkenness), and new psychoactive substances (NPS) and illicit substances use, the latter here designated as common or traditional illicit drugs. In terms of prevalence, binge drinking and drunkenness are generalized practices among the population under study. Among the illicit drugs it is clearly the use of cannabis the most prevalent, being the use of cocaine, ecstasy (and other amphetamine type drugs), LSD (and other hallucinogens) and the synthetic cannabinoids relevant at the level of experimentation (lifetime), but of little expression for a recent use (last 12 months). The other illegal substances are not of more than residual consumption. The prevalence of NPS current use (30 days) is less than 1%. However, the majority of the latter claimed to have taken one of these substances in the 48 hours prior to this inquiry. NPS consumers are also consumers of other illicit drugs (mainly cannabis), and only 7% of respondents who consumed a NPS in a lifetime scale claim having never used another illegal drug. When analysing recent and current consumers of NPS, all have used other illicit drugs at the same time periods.

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Table 1 – Psychoactive substance use prevalence – Lifetime (LTP), Last 12 Months (LYP), Last 30 Days (LMP) and Last 48 Hours (L48h)(N=887) (%)

P48H P30D P12M LTP (at least

once)

n % n % n % n %

Alcohol

Binge drinking 191 21.5 504 56.8 680 76.7 735 82.9

Drunkenness 76 8.6 306 34.5 513 57.8 638 71.9

NPS 4 0.5 6 0.7 9 1.0 56 6.3

Synthetic cannabinoids 3 0.3 4 0.5 6 0.7 38 4.3

Synthetic cathinones 0 0.0 0 0.0 0 0.0 7 0.8

Plants 1 0.1 1 0.1 2 0.2 19 2.1

Phenylethylamines 0 0.0 1 0.1 1 0.1 2 0.2

Piperazines 1 0.1 1 0.1 1 0.1 3 0.3

Cocaine analogs 0 0.0 0 0.0 0 0.0 4 0.5

Ketamine 0 0.0 1 0.1 1 0.1 2 0.2

Others NPS 0 0.0 0 0.0 0 0.0 3 0.3

Illicit drugs 77 8.7 175 19.7 288 32.5 453 51.1

Cannabis 76 8.6 169 19.1 280 31.6 445 50.2

Cocaine 4 0.5 17 1.9 28 3.2 52 5.9

Ecstasy 3 0.3 11 1.2 27 3.0 53 6.0

Amphetamines 2 0.2 7 0.8 12 1.4 25 2.8

LSD 2 0.2 5 0.6 11 1.2 43 4.8

Opioids 1 0.1 3 0.3 4 0.5 10 1.1

Anabolic steroids 0 0.0 1 0.1 1 0.1 1 0.1

Other illicit drugs 1 0.1 3 0.3 4 0.5 7 0.8

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Alcohol – risk behaviours

The population under study reveals great familiarity with alcohol consumption: most respondents (77%) declared binge 2 behaviours in the last year before the inquiry and a little more than half (58%) declared to have been drunk in a severe 3 form in the same period. The percentages go down considerably when one considers only the last 30 days, but still 22% of the respondents consumed alcohol in a binge way and 9% have been severely drunk in the 48 hours preceding the inquiry (Figure 11).

Fig. 11 – Binge drinking and Drunkenness prevalence (N=887) (%)

% 100

40 82,9 71,9 76,7 57,8 56,8 20 34,5 21,5 8,6 0 LTP LYP LMP L48h

Binge Drunkenness

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

______

2. Drinking 5 or more glasses (if male) or 6 or more (if female) of any alcoholic beverage on the same occasion .

3. Staggering, difficulties in speech, vomiting and/or not remember later on.

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Illicit drugs

About half of the respondents consumed illicit drugs (excluding NPS) sometime before, 1/3 did it in the last year before the inquiry and 1/5 in the last 30 days. Those who consumed this type of substances on the previous 48 hours preceding the inquiry totalize 9% of the sample. NPS consumption is much less expressive, being virtually non-existent when considering the 48 hours, the 30 days or 12 months prior to the inquiry 4, with only some expression in terms of experimentation (Figure 12).

Fig. 12 – NPS and Illicit drugs prevalence (N=887) (%)

% 60

51,1 20 32,5

19,7

6,3 1,0 0,7 0,5 8,7 0 LTP LYP LMP L48h

Any NPS Any drug (exc. NPS)

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Among the illicit drugs, it stands out clearly cannabis use (only 2% of illicit drugs lifetime users never consumed cannabis). Cocaine and ecstasy have much smaller, but still relevant prevalence use, while all the other drugs considered present recent and current consumption at levels below 2% and 1%, respectively. Among NPS, synthetic cannabinoids, but also products derived from plants (such as salvia 17 divinorum or the kratom, for example) stand out, with prevalence of lifetime consumption at the level of some so-called traditional drugs such as hallucinogens or amphetamines. However, when one considers the most recent periods (last 12 months or 30 days), the use of this type of substances is scarce, in any case less than 1% (Figures 13, 14, 15 and 16).

------

4. It should be considered the small number of recent and current consumers of NPS when further on a cross intersection of data with the variable situation vis-à-vis the consumption of NPS will be made. The fact that the group of those who used this kind of substances in the past 12 months preceding the inquiry is reduced to only 9 individuals caused some unviability to analysis and forces a carefully reading of the results of the analyses carried out.

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Fig. 13 – Illicit drugs lifetime use prevalence (N=887) (%)

Any NPS 6,3 Synthetic cannabinoids 4,3 Plants 2,1 Synthetic cathinones 0,8 Cocaine analogs 0,5

NPS Piperazines 0,3 Phenylethylamines 0,2 Ketamine and other dissociatives 0,2 Other NPS 0,3

Any drug (excluding NPS) 51,1 Cannabis 50,2 Ecstasy 6,0 Cocaine 5,9 LSD 4,8 Amphetamines 2,8 Opioids 1,1 Anabolic steroids 0,1 Other common drugs 0,8 0 10 20 30 40 50 60 % Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 14 - Illicit drugs last 12 months use prevalence (N=887) (%)

Any NPS 1,0 Synthetic cannabinoids 0,7 Plants 0,2 Synthetic cathinones 0,0 Cocaine analogs 0,0

NPS Piperazines 0,1 Phenylethylamine 0,1 Ketamine and other dissociatives 0,1 Other NPS 0,0

Any drug (excluding NPS) 32,5 Cannabis 31,6 Ecstasy 3,0 Cocaine 3,2 LSD 1,2 Amphetamines 1,4 Opioids 0,5 Anabolic steroids 0,1 Other common drugs 0,5 0 10 20 30 40 50 60 % 18 Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Fig. 15 - Illicit drugs last 30 days use prevalence (N=887) (%)

Synthetic cannabinoids 0,5 Plants 0,1 Synthetic cathinones 0,0 Cocaine analogs 0,0

NPS Piperazines 0,1 Phenylethylamines 0,1 Ketamine and other dissociatives 0,1 Other NPS 0,0

Cannabis 19,1 Ecstasy 1,2 Cocaine 1,9 LSD 0,6 Amphetamines 0,8 Opioids 0,3 Anabolic steroids 0,1 Other common drugs 0,3 0 10 20 30 40 50 60 %

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 16 - Illicit drugs last 48 hours use prevalence (N=887) (%)

Cannabinoides sintéticos 0,3 Plants 0,1 Synthetic cathinones 0,0 Cocaine analogs 0,0 Piperazines 0,1 NPS Phenylethylamines 0,0 Ketamine and other dissociatives 0,0 Other NPS 0,0

Cannabis 8,6 Ecstasy 0,3 Cocaine 0,5 LSD 0,2 Amphetamines 0,2 Opioids 0,1 Anabolic steroids 0,0 Other common drugs 0,1 0 10 20 30 40 50 60 % Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL 19

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Drug use: sociodemographic variables

Analysing the NPS use prevalence by age, one can conclude that the highest percentage of consumers is found in younger age groups: 15-24 and 25-34 years. The age group of older respondents (45-54 years) have a high prevalence in lifetime use but, as the age group of the 35-44 years, does not declare NPS consumptions in the last 12 months, 30 days and 48 hours (Figure 17).

Fig. 17 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by age (N=866) (%)

% 16

8 13,3 6

4 5,3 2 3,5 1,90,9 1,6 0,00,00,7 0,8 0,0 0,0 0,6 0,4 0,0 0,0 0 LTP LYP LMP L48h

15-24 25-34 35-44 45-54

Test Chi-square (among users and not users): lifetime, last year, last month and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

20 In the case of other illicit drugs, at the level of experimentation, the intermediate age groups (25-34 and 35-44 years) have the highest prevalence of consumption, while in the last year before the inquiry the younger respondents (15-24 and 25-34) were the ones who used more these substances. When one considers the current consumption (last 30 days and last 48 hours), it turns out that prevalence decreases with age, being that no respondent belonging to the oldest age group (45-54) claimed to have consumed any illicit drugs in these time periods (Figure 18).

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Fig. 18 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by age (N=866) (%)

% 70

62,3 30 61,0 45,5 20 42,1 34,1 33,7 10 22,0 15,1 5,3 17,3 9,4 0,09,4 7,2 3,8 0,0 0 LTP LYP LMP L48P

15-24 25-34 35-44 45-54

Test Chi-square (among users and not users): lifetime - X 2=19.928, d.f.=3, p=0.000, last year - X 2=14.611, d.f.=3, p=0.002, last 30 days and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

When considering gender, male respondents use considerably more illicit drugs – either traditional or NPS – than females. The difference between the two genders is, in the case of the NPS, greater in experimentation and recent consumption and, in the case of other illicit drugs, proportionately more significant in current consumptions (figures 19 and 20).

Fig. 19 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by gender (N=864) (%)

% 10

6 21

4 8,1

4,9 2

1,3 0,5 0,8 0,8 0,6 0,4 0 LTP LYP LMP L48P

male fem

Test Chi-square (among users and not users): lifetime – not significative and last year, last 30 days and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Fig. 20 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by gender (N=864) (%)

% 60

30 57,5

45,5 20 37,9

27,2 24,5 10 16,3 12,6 5,7 0 LTP LYP LMP L48h

male fem.

Test Chi-square (among users and not users): lifetime - X 2=12.201, d.f.=1, p=0.000, last year - X 2=11.110, d.f.=1, p=0.001, last month - X 2=8.977, d.f.=1, p=0.003, last 48 hours - X 2=12.883, d.f.=1, p=0.000 Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Unemployed and working students respondents, included in the category 'other situations', are those who have most used NPS and other illicit drugs on a lifetime basis, while students showed lower prevalence’s at the level of experimentation (fig. 21 and 22).

Fig. 21 - NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by activity status (N=869) (%)

% 20

16,3 22 5 8,0

4,3 1,0 1,0 2,01,0 0,3 0,00,8 0,0 0,0 0 LTP LYP LMP L48h

student employed other situation

Test Chi-square (among users and not users): lifetime – - X 2=13.023, d.f.=2, p=0.001 and last year, last month and last 48h – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

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Fig. 22 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by activity status (N=869) (%)

% 70

65,3 30 60,5

44,1 20 32,4 32,8 32,7 10 21,7 20,4 16,6 9,5 8,0 2,0 0 LTP LYP LMP L48h

student employed other situation

Test Chi-square (among users and not users): lifetime – X 2=25.086, d.f.=2, p=0.000, last year, last month, and last 48 hours – not significative Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

The highest NPS consumers on a lifetime basis are those with higher academic qualifications, especially those with degree-level qualifications, followed by those with a Master's degree or PhD. In terms of experimentation, those with the lowest NPS use prevalence are the respondents with lower qualifications. However, when one examines recent and current use, one concludes that the respondents with lower qualifications are those who stands out, along with those with degree-level qualifications. Concerning common illicit drugs, the pattern of use is quite similar: the bigger the academic qualifications, the greater the lifetime use prevalence. For current consumption are precisely the respondents with lower qualifications who consume more and those with higher qualifications the ones that consume less (figures 23 and 24).

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 23 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by academic qualifications (N=875) (%)

% 10

9,4 4 7,4

4,7 2 2,8 2,3 1,9 1,5 0,30,8 0,9 0,30,0 0,9 0,3 0,8 0,0 0 LTP LYP LMP L48h

3º C. or lower Gram.Sch. polit./BSc MSc/PhD

Test Chi-square (among users and not users): lifetime – - X 2=8.460, d.f.=3, p=0.037 and last year, last month and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 24 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by academic qualifications (N=875) (%)

% 70

40 62,3 30 60,4

46,6 20 34,3 33,0 34,0 30,2 27,0 10 21,7 21,9 20,7 10,710,4 8,6 9,8 4,1 24 0 LTP LYP LMP L48h

3º C. or lower Gram.Sch. Polit./BSc MSc/PhD

Test Chi-square (among users and not users): lifetime – X 2=32.206, d.f.=3, p=0.000, last year, last month and last 48houres – not significative Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

The respondents of foreign nationality present greater NPS use prevalence than those of Portuguese nationality, being the difference proportionally more significant at the level of the recent and current consumption. In relation to other illegal drugs, although less pronounced, there is a similar profile: in comparison with those of Portuguese nationality, foreign respondents are bigger consumers of this kind of substances, the difference being proportionately more significant to the level of the last 30 days and 48 hours (figures 25 and 26).

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New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 25 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by nationality (N=885) (%)

% 10

9,4 4

6,0 2 3,1 2,1 0,5 0,8 0,4 1,0 0 LTP LYP LMP L48h

portugal foreign

Test Chi-square (among users and not users): lifetime – - not significative, last year, last month and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 26 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by nationality (N=885) (%)

% 70

30 61,5 49,9 20 40,6 31,6 30,2 10 18,5 12,5 8,2 0 LTP LYP LMP L48h

portugal foreign 25

Test Chi-square (among users and not users): lifetime – X 2=4.547, d.f.=1, p=0.040, last 30 days - X2=7.390, d.f.=1, p=0.010; last year and last 48 hours – not significative Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

The prevalence of NPS and other illicit drugs varied considerably depending on the day of the festival (figures 27 and 28), revealing that the extension of psychoactive substances use in this kind of events is different from audience to audience, which in turn depends largely on the type of music played. In fact, when one analyses illicit drugs use prevalence, one concludes that consumption levels vary greatly on the preferred 5 genre of music. In fact, the fans of Heavy music/Punk are those who have more experience on NPS lifetime use, while in recent and current consumption stand out those who prefer Indie/alternative music. On the other hand, fans of electronic dance music ( House, Techno, Trance ) have the lowest NPS lifetime use prevalence. Regarding illicit drugs, it is precisely those who prefer electronic dance music who consume more, either at the level of experimentation, recent or current use. In this case, in comparison with NPS, the differences between styles of music are more pronounced. Pop music fans have the smaller consumption levels of common (traditional) illicit drugs (Figures 29 and 30).

Fig. 27 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by day of event (N=887) (%)

% 10

9,0 4

6,1

2 3,3 2,0 0,41,0 0,6 0,40,3 0,4 0,6 0,6 0 LTP LYP LMP L48h

1st day 2nd day 3rd day

Test Chi-square (among users and not users): lifetime - X 2=8.068, d.f.=2, p=0.018; last year, last month and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

------5. As the question about the style of preferred music could have more than one response, only the first choice was considered, as the more immediate response

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 28 – – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by day of event (N=887) (%)

% 60

30 57,5 51,7 20 42,8 37,4 34,8 24,4 10 22,8 20,2 15,9 10,5 9,3 5,9 0 LTP LYP LMP L48h

1st day 2nd day 3rd day

Test Chi-square (among users and not users): lifetime - X 2=12.707, d.f.=2, p=0.002, last year – X 2=12.205, d.f.=2, p=0.002, last month and last 48 hours – not significative Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 29 – NPS use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by music preference (N=759) (%)

% 25

20 18,5

10 8,8 6,8 4,3 4,0

5 3,4 2,9 2,1 1,8 1,4 1,0 0,9 0,9 0,9 0,7 0,3 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0 rock pop indie/ altern. hip hop electr. heavy punk

LTP LYP LMP L48h 27

Test Chi-square (among users and not users): lifetime, last year, last month and last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 30 – Illicit drugs use prevalence: Lifetime, Last year, Last 30 days and Last 48 hours, by music preference, (N=759) (%)

% 70 68,0 59,3 60 52,6 52,1 51,8

50 48,0 40,7 40,4 36,0 40 35,3 32,1 32,0 29,0

30 25,9 24,6 22,9 20,5 20 12,1 11,1 11,1 10,5 10,0 9,1

10 6,0

0 rock pop indie/ altern. hip hop electr. heavy punk

LTP LYP LMP L48h

Test Chi-square (among users and not users): lifetime - X 2=15.601, d.f.=7, p=0.029, last year and last month – not significative; last 48 hours – not valid Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Perceptions and Social Representations

The clear majority (71%) of respondents did not know the term New Psychoactive Substances (Figure 31). Naturally, the ignorance about the term is greater among non-consumers of NPS. In fact, when one limit the analysis to NPS users, the panorama is different, although the lack of knowledge is still considerable: half of NPS lifetime users stated knowing the term, while recent consumers are apparently better informed: 67% claimed to know the term (Figure 32).

Fig. 31 – Knowledge of the term ‘New Psychoactive Substances’ (N=887) (%)

Yes 29,1% No 70,9%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 32 – Knowledge of the term ‘New Psychoactive Substances’, by NPS lifetime and last year use (%)

LTP (N=56) LYP (N=9)

Does not Does not know Yes, Knows 29 know Yes, knows 33,3% 50,0% 50,0% 66,7%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

The 203 respondents who declared to know the term New Psychoactive Substances linked it mainly to chemicals and synthetic substances handled in the laboratory and to the stores ( smartshops ) that until 2013 sold these psychoactive products in Portugal. Worth mentioning are also the 7% and 6% that associated the term to the legal dimension and to substances with hallucinogenic properties, respectively. Restricting the analysis to the 22 NPS lifetime users that declared to know the expression, one concludes that, in comparison to all respondents who knew the term, they tended to associate the term more to the legal dimension and to a greater psychoactive power and less to their chemical and synthetic nature. The association to special stores is significant in the responses of both groups of respondents (Figure 33).

Fig. 33 – If you know what are NPS do explain the meaning, as a view of the totality of respondents with lifetime use of NPS (%)

4,5 synthetic/chemistry 25,6

22,7 smart shops 25,1

22,7 legal 7,4

4,5 acids/halucinogenics 6,4

new drugs 4,9

9,1 more potent 2,5

artificials 2,0

0 5 10 15 20 25 30

Lifetime NPS (N=22) global (N=203) %

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Only a small percentage of respondents acquired NPS6. In fact, the percentage of respondents who purchased this kind of substances throughout life and in the last 12 months were 3% and 0.6%, 30 respectively (Figure 34). Even when restricting the analysis to those who consumed NPS ever, or in the last year before the inquiry, 52% and 44%, respectively, have never acquired these substances. Those who have acquired more than a year ago have done it at open door shops (smartshops ), but also through friends and street market. When considering the past 12 months, the primary means of acquiring NPS was through friends, and no one claimed to have purchased this type of substances in stores (Figure 35). As in the case of the NPS, the Internet does not seem to have real importance as a way of acquiring illegal substances said traditional (Figure 36).

------6. Afterwards, it was explained to respondents who have revealed that they were not familiar with the term New Psychoactive Substances that these substances are those that in Portugal, until 2013, were of free sale in certain shops ( smartshops ). Even in a diffuse and imprecise form, most of these respondents seemed to know what we were talking about or at least had an idea.

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 34 – Acquisition of any NPS last year or before (N=887) (%)

3,0

0,6

0 yes, last year yes, before last year

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 35 – Mode of acquisition of NPS last year or before (N)

13 shops / smart shops 0

6 street market 1

9 friend / acquaintance 4

1 internet 1

0 2 4 6 8 10 12 14 N before last year last year

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 36 – Acquisition of any illicit drug (excluding NPS) online, last year or before (N=887) (%)

0,6

0,4

0,6

0,2 0,3

0 yes, last year yes, before last year

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

No respondent claimed to have recurred to a medical emergency service due to consumption of NPS, while 4% say that some friends or acquaintances have done it in the past 12 months prior to the inquiry. The percentage who said that friends and acquaintances recurred to an emergency medical service for the same reasons for more than 12 months is a little higher (7%) (Figure 37).

Fig. 37 – ‘Does any friend/acquaintance, last year or before, has been into hospital urgency due to NPS intake?’ (N=887) (%)

% 7

32 5

4 6,9 6,5 3

2 4,4 3,6

0 last year before last year

friend acquaintance

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

The respondents tend to consider NPS consumption a risk behaviour, especially when this is done on a regular basis. The percentage that considers such a behaviour of low or no risk is small: 12% in the case of an occasional consumption and 1% in the case of a regular consumption. There is also a relevant percentage (1/5) of respondents who stated that did not know to evaluate the degree of risk (Figure 38). When one restricts the analysis to NPS users, the situation is different, in that it tended to ascribe lower risk to consumption of this type of substances: for example, none of the recent users considered the occasional consumption of NPS something of elevated risk. In this case, the lack of risk is completely different whether it's occasional or regular consumption. The first is considered something of a low or moderate risk, and the second is regarded as a high-risk behaviour or moderate. Even in the case of recent users, the percentage of respondents who stated not knowing how to answer the question is higher than the recorded among all respondents (Figure 39).

Fig. 38 – Occasional/regular NSP use risk perception (N=887) (%)

Occasional Regular

no risk no risk low risk low risk mod. risk does not 2,0% 0,3% 1,0% 9,6% does not 9,4% know know 19,7% 18,9% moderate high risk risk high risk 34,5% 34,2% 70,3%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

Fig. 39 – Occasional/regular NSP use risk perception, considering only recent NSP users (N=9) (%)

Occasional Regular 33 no risk high risk no risk low risk 0,0% 0,0% does not 0,0% 11,1% know does not moderate 22,2% know low risk risk 33,3% moderate 44,4% 22,2% risk high risk 33,3% 33,3%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

The percentage of respondents who think that the use of NPS carries more health risks than the use of traditional illicit drugs is far greater than those that think otherwise: 42% and 6%, respectively. A substantial percentage do think that it depends (on substance) or can't answer: 19% and 32%, respectively (Figure 40). When one restricts the analysis to NPS users, the situation is quite different, revealing a better knowledge and more consolidated views (which is reflected in less answers 'depends' and 'don't know’). They are also the ones that assign either a lower or greater risk to the consumption of this kind of substances. Respondents who did not used any illicit drug in the past year preceding the inquiry stand out as those that think the use of NPS offers greater health risks than the other illicit drugs, but also those who most consider that such depends on or don't know how to answer (Figure 41).

Fig. 40 – Higher/lower NSP use health risk perception in comparison with illicit drugs (N=887) (%)

does not less know 6,3% 32,2% more 42,2% depends 19,3%

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Fig. 41 – Higher/lower NSP use health risk perception in comparison with illicit drugs, by recent drug use (N=887) (%)

Users of NPS during last year (N=9)

does not less know 11,1% depends 22,2% 11,1% more 55,6%

Drug users (excluding NPS) during last year (N=288)

less does not 4,5% know 29,5% more 49,0% depends 17,0%

No consumption of any drug during last year (N=599)

less does not 7,2% know more 33,6% 38,9% depends 20,4% 35

Source: SICAD-DMI-DEI / INMLCF / Egas Moniz, CRL

General Directorate for Intervention on Addictive Behaviours and Dependencies

New Psychoactive Substances and other Drugs: NOS Alive 2017

Among those who justified their opinion, the main reason was to consider that NPS have higher health risks than the other illicit drugs because they are chemicals and synthetic substances, as opposed to other illicit drugs (such as cannabis ), which are seen as natural products and therefore less harmful to one’s health. Secondly, there is the opinion that NPS are more dangerous to health because they are substances about which not much is known, once again as opposed to traditional illicit drugs. (Figure 42).

Fig. 42 – ‘If you think that NPS intake has higher/less health risks than common illicit drugs, explain why’ (N=496) (%)

chemichals 26,4

less known 12,7

depends 11,7

artificials 8,1

the same 7,1

legal 5,0

more potents 3,8

more addictive 1,8

less controlled 1,8

more dangerous 1,0

less dangerous 0,4