New Psychoactive Substances among People Who Use Drugs Heavily. Towards Effective and Comprehensive Health Responses in Europe. 5-country RAR report Lenka Vavrincikova, Hana Fidesova, Barbara Janikova & Jean-Paul Grund New Psychoactive Substances among People Who Use Drugs Heavily. Towards Effective and Comprehensive Health Responses in Europe. Department of Addictology First Faculty of Medicine Charles University in Prague General University Hospital in Prague Czech Republic February 2016 JUST/2013/DPIP 4000004774 (1/3/2014 to 28/2/2016) Disclaimer "This publication has been produced with the financial support of the Drug Prevention and Information Programme of the European Union. The contents of this publication are the sole responsibility of the implementing partners: Agência Piaget Para o Desenvolvimento – APDES (Portugal), Charles University in Prague – CUNI (Czech Republic), De Regenboog Groep (RG) (The Netherlands), Carusel Association (Romania), Programs of Development, Social Support and Medical Cooperation – PRAKSIS (Greece), SANANIM (Czech Republic), and MONAR – Association, Outpatients Clinic in Krakow (Poland), and can in no way be taken to reflect the views of the European Commission." New Psychoactive Substances among People Who Use Drugs Heavily. Towards Effective and Comprehensive Health Responses in Europe. 5-country RAR report Lenka Vavrincikova, Hana Fidesova, Barbara Janikova & Jean-Paul Grund Acknowledgements Financial support for this study was provided by the Drug Prevention and Information Program of the European Union under the EU-DPIP project: “New Psychoactive Substances among PUDH - Towards Effective and Comprehensive Health Responses in Europe” JUST/2013/DPIP/AG/4774. Institutional support was provided by Charles University in Prague No. PRVOUK-P03/LF1/9. We would like to thank both our core partners Agência Piaget Para o Desenvolvimento in Porto, Portugal and De Regenboog Groep in Amsterdam, The Netherlands and our implementing partners, Sananim, Prague, Czech Republic; Praksis, Athens, Greece; Monar, Krakov, Poland; APDES & Vila Nova de Gaia, Portugal; and Carusel, Bucharest, Romania, the local RAR teams, focus group participants and external (peer) experts for their contributions and dedication to the project. It was a pleasure working with you all. 1 Contents 1. Introduction .............................................................................................................................................. 4 1.1 Aims of the RAR study ....................................................................................................................... 4 1.2 Key RAR questions ............................................................................................................................. 4 1.3 Target countries and partner organizations ...................................................................................... 5 1.4 Key concepts of the project ............................................................................................................... 5 1.4.1 Operationalizing the project definition of NPS - New to Whom? ............................................................ 5 1.4.2 Defining Target Groups – People who Use Drugs Heavily (PUDH) ........................................................... 6 2. Methodology ............................................................................................................................................. 7 2.1 The Desk review ................................................................................................................................ 7 2.2 Assessment of NPS availability in offline and online drug markets ................................................... 7 2.3 The Focus Group Methodology ......................................................................................................... 8 2.4 RAR analysis ...................................................................................................................................... 9 2.5 Study Limitations ............................................................................................................................. 10 2.6 Report structure .............................................................................................................................. 10 3. Findings ................................................................................................................................................... 11 3.1 Five-country desk review of the national NPS situation ................................................................. 11 3.1.1 The Czech Republic ................................................................................................................................ 11 3.1.2 Greece .................................................................................................................................................... 14 3.1.3 Poland .................................................................................................................................................... 16 3.1.4 Portugal .................................................................................................................................................. 18 3.1.5 Romania ................................................................................................................................................. 20 3.2 Assessment of NPS availability in offline and online drug markets in the participating countries . 22 3.2.1 Czech Republic ......................................................................................................................................... 1 3.2.2 Greece ...................................................................................................................................................... 2 3.2.3 Poland ...................................................................................................................................................... 3 3.2.4 Portugal .................................................................................................................................................... 5 3.2.5 Romania ................................................................................................................................................... 6 3.2.6 Discussion ................................................................................................................................................. 7 3.3 NPS stakeholder focus groups ........................................................................................................... 8 3.3.1 Czech Republic ......................................................................................................................................... 8 3.3.2 Greece ...................................................................................................................................................... 9 3.3.3 Poland ...................................................................................................................................................... 9 3.3.4 Portugal .................................................................................................................................................. 10 3.3.5 Romania ................................................................................................................................................. 11 3.3.6 Discussion ............................................................................................................................................... 11 3.3.7 Focus Group Conclusion ......................................................................................................................... 17 4. Discussion: similarities and differences between the five countries ...................................................... 18 4.1.1 Availability of NPS in the participating countries ................................................................................... 18 4.1.2 Extent and nature of NPS use among PUDH .......................................................................................... 19 2 4.1.3 Factors in choosing NPS ......................................................................................................................... 20 4.1.4 Positive and negative effects reported; health consequences .............................................................. 21 4.1.5 Interventions and policies targeting NPS ............................................................................................... 23 4.1.6 Pointers for intervention and policy development ................................................................................ 23 5. Conclusions ............................................................................................................................................. 24 6. Country Summaries ................................................................................................................................. 26 The Czech Republic .................................................................................................................................................. 26 Greece 27 Poland 27 Portugal 28 Romania 29 7. References ............................................................................................................................................... 30 8. Annexes: data reporting and grid analysis forms ...................................................................................