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Federal Research Programme on Drugs FEDERAL RESEARCH PROGRAMME ON DRUGS NPS-care Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective Tina Van Havere (University of Applied Sciences and Art Ghent), Freya Vander Laenen (University of Ghent, IRCP), Charlotte Colman (University of Ghent, IRCP), Peter Blanckaert (Sciensano), Lies Gremeaux (Sciensano), Sarah Simonis (Sciensano), Anton Van Dijck (University of Applied Sciences and Art Ghent) Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective NPS-care Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective Contract - DR/02/79 FINAL REPORT PROMOTORS: dr. TINA VAN HAVERE (University of Applied Sciences and Art Ghent) Prof. Dr. FREYA VANDER LAENEN (University of Ghent, IRCP) Prof. Dr. CHARLOTTE COLMAN (University of Ghent, IRCP) Dr. LIES GREMAUX (Sciensano) Dr. PETER BLANKAERT (Sciensano) RESEARCHERS: SARAH SIMONIS (Sciensano) PRINCIPAL RESEARCHER: ANTON VAN DIJCK (University of Applied Sciences and Art Ghent) Federal Research Programme on Drugs 2 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective Published in 2020 by the Belgian Science Policy Office (BELSPO) WTCIII Simon Bolivarlaan 30 Boulevard Simon Bolivar 30 B-1000 Brussels Belgium Tel: +32 (0)2 238 34 11 - Fax: +32 (0)2 230 59 12 http://www.belspo.be http://www.belspo.be/drugs Contact person: Aziz Naji Tel: +32 (0)2 238 35 72 Neither the Belgian Science Policy Office nor any person acting on behalf of the Belgian Science Policy Office is responsible for the use which might be made of the following information. The authors are responsible for the content. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without indicating the reference : Van Havere, T., Vander Laenen, F., Colman, C., Gremaux, L., Blankaert, P., Simonis, S., & Van Dijck, A. (2020). Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective. Final Report. Brussels : Belgian Science Policy Office 2020 – 162 p. (Federal Research Programme on Drugs) Federal Research Programme on Drugs 3 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective ACKNOWLEDGMENTS AND LIST OF MEMBERS OF THE FOLLOW UP COMMITTEE Thanks to our partners MEMBERS OF THE FOLLOW UP COMMITTEE Martijn Onsia & Eric Genbrugge (Safe ‘n Sound), Lucia Casero (Eurotox), Katia Huard (FPS Public Health), Ferrara Maurizio (Info-drogues ASBL), Sarah Wille & Filip Van Durme (NICC), Paul Calle (Maria Middelares & UGent), Marc Vancoillie & Stephanie Ovaere (DJSOC/Federal Police), Roy Somers (AZ Herentals), Tessa Windelinckx (Free Clinic, coördinator Flemish Needle & Syringe Programs), Bérénice Libois & Matthieu Mean (Modus Vivendi), Jochen Schrooten (VAD), Claude Gillard (FGOV Justice), Sara Van Malderen (FOD Justice), David Fraters (CAD-Limburg). Federal Research Programme on Drugs 4 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective Table of content TABLE OF CONTENT 5 CHAPTER 1: UNDERSTANDING NEW PSYCHOACTIVE SUBSTANCE USE IN BELGIUM FROM A HEALTH PERSPECTIVE 11 1. Introduction ............................................................................................................................................. 11 2. What are New Psychoactive Substances? ............................................................................................... 11 2.1. Definition of ‘New Psychoactive Substances’ (NPS) 11 2.2. The origins and evolution of NPS 13 2.2.1. A brief historical perspective on NPS 13 2.2.2. Characteristics of the NPS phenomenon. 14 2.2.3. ‘Legal highs’; the legislative factor 15 2.3. Terminology and concepts 15 2.3.1. Synthetic or natural? 15 2.3.2. ‘New’ or old? 16 2.3.3. ‘Cross-overs’: ketamine and Gamma-Hydroxybutyric Acid (GHB) 16 2.3.4. ‘Psychoactive Substances’ 17 2.4. New and newly used NPS 17 3. Classification of NPS ................................................................................................................................ 18 3.1. General taxonomy 18 3.2. Classes of NPS, forms and usage 19 3.2.1. Synthetic cannabinoids or Synthetic Cannabinoid Receptor Agonists (SCRA’s) 19 3.2.2. Stimulants 20 3.2.3. Empathogens 20 3.2.4. Synthetic Opioids (SO) 20 3.2.5. Depressants 20 3.2.6. Hallucinogens/psychedelics 21 3.2.7. Dissociatives 21 4. Legislation surrounding NPS .................................................................................................................... 21 4.1. The international dimension of NPS legislation 21 Federal Research Programme on Drugs 5 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective 4.2. European legislation on NPS 21 4.3. National NPS laws: from observer to conductor 22 4.4. Belgium’s generic legislation targeting NPS 23 4.4.1. The national Drug Law of 1921 23 4.4.2. The generic Drug Law of 2017 24 4.5. Prohibition as a precaution 24 5. Current reports on NPS ........................................................................................................................... 25 5.1. Epidemiology of NPS use 25 5.1.1. Prevalence of NPS use around the world 25 5.1.2. Prevalence of NPS use in Europe 26 5.1.3. The use of NPS in Belgium 27 5.1.4. Other information sources 29 5.2. NPS as a (public) health issue 29 5.2.1. The ‘unknowns’ surrounding NPS 29 5.2.2. Substance (market) characteristics and health consequences 30 5.2.3. Health hazards, acute and chronic effects of NPS use 30 5.2.4. Challenges to the specialized health care field 31 6. The NPS-care project ............................................................................................................................... 31 6.1. General outline 32 6.2. The user’s perspective (Part I) 32 6.3. The professionals’ perspective (Part II) 32 6.4. Inventory of good practices in prevention, treatment and harm reduction for NPS users and feasibility study (Part III). 33 6.5. Research report 33 6.6. Ethical considerations 33 CHAPTER 2: THE USE OF NPS AND THE NEEDS REGARDING PREVENTION, TREATMENT AND HARM REDUCTION: THE USER’S PERSPECTIVE 42 1. Introduction ............................................................................................................................................. 42 2. Methods .................................................................................................................................................. 43 3. Results ..................................................................................................................................................... 44 Federal Research Programme on Drugs 6 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective 3.1. Context and motivations of NPS use 46 3.1.1. Specific profile of NPS users 46 3.1.2. Motivations of NPS use 47 3.1.3. Connection between NPS, classic illicit substances and alcohol 52 3.1.4. Mode of use, evolution in use and consequences 53 3.2. Health needs 55 3.2.1. Users’ specific measures and harm reduction 55 3.2.2. The users’ perspective on (health) needs 57 3.2.3. Online market 59 3.2.4. Drug legislation and illegal status 60 3.3. Conclusion 61 CHAPTER 3: THE USE OF NPS AND THE AWARENESS OF USERS: THE SAMPLE COLLECTION 75 1. Introduction ............................................................................................................................................. 75 2. Methods .................................................................................................................................................. 75 3. Results ..................................................................................................................................................... 76 3.1. Pharmacological aspects 76 3.2. Social aspects 79 3.2.1. The terminology 79 3.2.2. Information 81 3.2.3. Source of acquisition 82 4. Conclusion ............................................................................................................................................... 82 CHAPTER 4 - TAILORED PREVENTION AND CARE FOR NPS USERS: THE PROFESSIONAL’S PERSPECTIVE 85 1. Introduction ............................................................................................................................................. 85 2. Methodology: two-step mixed method design ....................................................................................... 86 2.1. The Nominal Group Technique 86 2.1.1. Composition of the NGT’s 86 2.1.2. The NGT process 87 2.1.3. Analysis 88 2.2. The online survey 89 Federal Research Programme on Drugs 7 Project DR/02/79 - Understanding New Psychoactive Substance (NPS) use in Belgium from a health perspective 2.2.1. The survey as part of a mixed method design 89 2.2.2. Design of the NPS care survey 89 2.2.3. Central content of the NPS care survey 89 2.2.4. The inventory of needs presented in the NPS care survey 90 2.2.5. The collection of survey responses 91 3. Results NGT’s ........................................................................................................................................... 92 3.1. General information: location, timing and sampling 92 3.1.1. Dutch speaking NGT’s (NGT1 and 2) 92 3.1.2. French speaking NGT’s (NGT 3, 4 and 5) 92 3.2. Primary analysis: description
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