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Drug Safety Testing, Welfare & Harm Reduction in Nightclubs, Festivals

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Drug Safety Testing, Welfare & Harm Reduction in Nightclubs, Festivals Drug safety testing, welfare & harm reduction in nightclubs, festivals & other leisure events Professor Fiona Measham * Chair in Criminology, University of Liverpool, UK * Co-Founder & co-Director, The Loop UK & The Loop AU Overview: 1. What is the problem? ➢ Drug-related deaths, high purity & additional risks at festivals 2. What can we do? ➢ Drug safety testing / drug checking 3. What is the UK evidence on efficacy & wider impact? ➢ Disposals, DR medical incidents & DR hospital admissions (1) What is the problem? UK DRDs are highest on record & amongst highest in Europe (EMCDDA 2017) “Policing practices undertaken in the name of the public good have demonstrably worsened public health outcomes” Csete et al, The Lancet , 387 (10026): 1427. 2018: 92 1999: Vietnam banned 2010-16: deaths safrole oil production 49mg➔165mg MDMA 2000: Large scale safrole oil in pills production in Cambodia from 6 festival deaths camphor tree 2011-16: 112➔371 2000/1: UK prevalence cocaine-related DRDs peaked Early 2000s introduction of high purity MDMA crystal 2nd Wave 1st Wave 2007 Cambodia banned safrole oil production 2007/9: Mass seizures of safrole oil in Cambodia leading to ➔ High & variable purity illegal global drought. Shift to Chinese chemical synthesis of piperonylmethylketone (PMK) instead of extracting PMK drugs are key driver for increased from safrole oil UK drug-related deaths “I’ve just dealt with too much death” Perfect storm (Jason Kew, Windsor police, 1/2018) • Prevalence of self reported drug use – highest in Europe • Purity – highest on record • NPS missold as street drugs: fentanyl analogues in opiates, cathinones in MDMA, cannabinoids in cannabis • Drug-related deaths – highest in Europe & highest since ONS records began (ONS, 2018) • Price – relatively low (E pills £5, ketamine £20/g, MDMA & cocaine £40/g) • Harm – £10.7bn estimated harm from illicit drug use in UK (PHE 2017) • Police – 20% cut to budgets by Home Office in 2010, disgruntlement with central govt, cuts linked to increased crime, reconsideration of enforcement priorities, leadership changing with new fast track graduate recruitment programmes • Policy regime – centralised prohibition, regional police operational independence, localised diversion initiatives growing across UK • Reframing festival drug policy from zero tolerance to 3Ps (Prevent, Pursue, Protect) based on UK counter terrorism policy “Atypical intoxication” – UK festival drug use • Theoretical perspectives on festivals: carnivalesque suspension of everyday social controls, a moral holiday (Matza), ‘Temporary Autonomous Zones’ (Hakim Bey), ‘time out’ from everyday life (for onsite agencies as well as customers) • Prevalence: National (UKFA, 2017) & international surveys (EFA, 2018; Hesse & Tutenges, 2012; Lim et al, 2010; Martinus et al, 2010) indicate festivals have higher prevalence of drug use than general population • Extended time period – 4+ days without constraints of work, home & family • Excessive – over ½ report taking drugs at festivals; over ½ take larger quantities than usual & ¼ take wider range of drugs. Over 9 in 10 also drank alcohol with their drugs (Turner & Measham, 2020) • Polydrug use – ½ of festival drug users taking 2+ illegal drugs in same session • Polysubstance use – over 9 in 10 polydrug users also drinking alcohol • Atypical – 1 in 12 only take drugs at festivals – increased risk • ➔ More drugs, longer sessions, all together • Window of opportunity for customers to access drugs & for drugs services to access drug users in an unique intense drug using space UKFA 2017 • ➔ Time to test & time to talk UK festivals are big business: £2,500m industry Small <25k customers Medium 25-75k Large >75k Glastonbury ¼ million (2) What can we do? How could ‘drug safety testing’ help reduce drug-related harm? 1. Providing information & intelligence to onsite and offsite PWUD, medical & emergency services, including monitoring trends in supply and use; 2. Identifying & removing from circulation high risk substances eg. missold drugs, variable purity, contaminants & adulterants; 3. Providing an opportunity for trained, experienced healthcare staff to deliver targeted health & safety advice, individualised harm reduction & referral to onward local drugs services, to harder to reach/ hidden populations not otherwise engaged with medical or drugs services; 4. Uniquely, drug safety testing can make the connection between what was actually obtained and what individuals thought they obtained, to measure the nature & extent of market missellling & target messages for maximum effect. What is ‘drug checking’? • Direct public engagement • "Drug checking services invite (not postal or via 3rd parties) members of the public to anonymously submit psychoactive • Lab level forensic analysis (not drug samples for forensic analysis & just reagents) then provide individualised feedback of results & counselling as • Individual consultation (not appropriate" (Barratt et al, 2018:1) just test results) https://ndarc.med.unsw.edu.au/resource/bulletin-no-24-global-review-drug- checking-services-operating-2017 • + Aim: harm reduction • Pragmatic & non policy dependent health service • Introduced in UK in 2016 – at a festival History of ‘Drug Checking’ 1. Mid 60s-70s: ‘street drug analysis’, California 2. Late 80s onwards: ‘drug checking’ in continental Europe 3. 2010s onwards: ‘safety testing’ in UK, Canada & Australasia Barratt, M., Kowalski, M., Maier, L., & Ritter, A. (2018), Global review of drug checking services operating in 2017, Drug Policy Modelling Program Bulletin No. 24. Sydney: NDARC, UNSW European ‘drug checking’ services http://www.emcdda.europa.eu/system/files/attachments/6339/EuropeanResponsesGuide2017_BackgroundPaper-Drug-checking-harm- reduction_0.pdf 1987 onwards: Safer House, Amsterdam 2016 onwards: The Loop, UK Evolution of UK ‘drug safety testing’: 2010- Shadowed ‘Back of House’ 2013- ‘Halfway House’ onsite FEWS 2016- ‘Front of House’ at 2 festivals 2017 FOH @ 3 festivals 2018 FOH @ 7 festivals & 5 city centre events, BOH at 5 festivals Loop Lab analytical process 1 2 4 3 5 Fentanyl strips for opiates 6 Bespoke GCMS with DU chemistry dept & mass spec manufacturers (3) What is the UK evidence? 3 summers of UK festival testing Total MAST MAFEWS MAST MAST MAST festivals Front of Halfway Total Total healthcare Total house house samples consultations service testing testing tested users 2016 3 2 1 350 300 1,000 2017 4 3 1 1,800 1,500 4,000 2018 13 8 5 3,000 2,000 5,000 UK Test Results • 50% MDMA, 20% cocaine, 20% ketamine, 10% other (bulking agents, contaminants & fillers) • MDMA ½ pills ½ crystal • MDMA content of pills very high & variable: mean 168mg MDMA • 1 in 5 substances missold • 2018: ~1 in 20 MDMA crystal samples n-ethylpentylone (very longlasting cathinone, very similar in appearance & smell) • Displacement in NPS missold as established street drugs: decline of methylone & rise of n-ethylpentylone missold as MDMA linked to Chinese legislative control of methylone • 2019: n-ethylpentylone banned • As with SCRAs, displacement to each new generation NPS with greater harm – the ‘perversity of prohibition’ Behavioural Outcomes ‘Drug checking’ = forensic test + healthcare consultation = • Individual context: medical & drugs histories, current drug, alcohol & medication use • “Safest way to take drugs is not to take them at all” ➢9 in 10 service users never previously spoke about drug or alcohol use to healthcare staff ➢2 in 5, after hearing information about the strength of their sample & appropriate dosage, intend taking a smaller quantity of that drug in future; ➢1 in 5 dispose of further substances in their possession, either self disposal or disposal to the Loop for onward safe police destruction; ➢1 in 20 ask for signposting to a local drug treatment service ➢Significantly more females, younger and new initiates use the service & dispose of drugs. Older, male & regular users have more reliable supply lines & (think they?) already know more about harm reduction. x2 Festival Results Reductions in onsite drug-related medical incidents • Alerts to users, to festival, to police & emergency services embedded in intelligence on local drug market • Early presentations, confidence to treat onsite • 2016 95% reduction in hospitalisations Secret Garden Party (Measham, 2019) • 2017 25% Boomtown (Independent report to Boomtown, 2017) • 2018 12% Love Saves the Day (Red Cross, 2018) • But: • Challenge to disaggregate data on drug-related medical incidents & hospital admissions • Care with alerts – evidence-based, linked to genuine risk of harm, beware alert fatigue, pressures from funders to be seen to be doing something Not just festivals… • Community-based – fixed site or mobile testing • Wider reach, more inclusive • Any drug using communities • More proactive, ahead of special occasions • Embedded in existing infrastructure (drugs services, MSIC, NSP, policing initiatives) • More potentially productive engagement *if* straight & sober • NL - £1m govt funded national testing centres • ➔ The Loop supported introduction of testing at DCRs (Vancouver, Copenhagen, Sydney) & introduced city centre drug safety testing at 5 events in 2018 & in partnership in 2019 for the 1st HO licensed testing pilot: drugs services, youth and community centre, church… The feedback loop Service Users On-site Academic emergency research services at daily SAGs Global: share Multi Regional & data, alerts & national EWS eg. reference Agency NEIU, Greater standards with Manchester Drug overseas drug Safety Early Warning
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