Considering the prevailing policy-environment, where the unknown purity, adulteration, contamination, and deliberate or accidental misselling of drugs can compound the inherent dangers associated with drug use, safety models such The Loop’s Multi Agency Safety Testing are of vital necessity. Such services are an indispensable resource for those who use drugs across society; at festival and nightlife venues, at home, in drug consumption rooms, and other environments. They are also invaluable to service providers for detecting, monitoring and responding to newly evolving trends. 

Purity

Drugs may contain from 0-100% of an active substance.  You might experience no effect from one batch and you could overdose from the next. There can also be significant differences within batches.  As Kevin Flemen notes in this article:

“Crush – dab – wait has become a key message about starting with low doses of MDMA. Developed by the Loop, it is a field-appropriate method of taking a smaller drug dose on a moistened finger and waiting for one to two hours before taking further doses. In practice it can be hard to crush dense tablets in festival settings and if the drug in question is highly potent (such as a SCRA or a fentanyl) even dabbing could be a risk”.

Drug purity can, and does, vary wildly from batch-to-batch and within batches.  Last year, The Loop analysed ‘ecstasy’ pills which were found to be 100% concrete. Conversely, ecstasy pills with potentially lethal doses of MDMA have been detected throughout Europe. These wild inconsistencies are also commonplace in cocaine, amphetamine and heroin markets.

Adulteration, contamination and misselling

• The European Monitoring Centre on Drugs and Drug Addiction has detected over 600 New Psychoactive Substances (NPSs) which may be present in any given drug sample. Recently, one of these substances (ADM-FUBICA) was sold as MDMA and led to a number of hospitalisations in Manchester.
• A recent study by John Hopkins University based on DanceSafe data found that only 60% of analysed substances sold as MDMA contained MDMA or the closely related MDA. The majority of adulterants detected were methylone and other cathinones whose safety profiles are not well understood. Three samples contained the extremely harmful PMMA.
• A Swiss study found that 97% of cocaine samples were adulterated.  The adulterant levamiscole was detected in approximately 65% of cases.  This adulterant is associated with a number of serious side effects, including skin lesions and renal dysfunction.
• In Canada, British Columbia has recently seen a dramatic increase in overdoses. Between January and April 2017, approximately 72% of these overdoses  involved fetanyl. Vancouver Coastal Health -which tested for fetanyl at InSite– found that 83% of heroin, 82% of crystal meth, and 40% of cocaine samples tested positive for fetanyl. Reagent Tests UK sell a test kit which tests for fetanyl and DanceSafe’s kit tests for fetanyl and a number of analogues. 

Multi Agency Safety Testing (MAST)

MAST allows people who use drugs to submit samples for analysis by trained professionals. Results are communicated to service users by trained drug workers as part of brief interventions.  The service is also provided to agencies on-site. Similar services such as the Austrian ChEck It, the Swiss SaferParty, the Spanish EnergyControl, and the Dutch Jellinek, have been operating for approximately two decades. MAST  can occur either through ‘front of house’ or ‘back of house’ testing and  “ we should aim for a gold standard testing system that includes both, in order to maximise public health benefits and minimise drug-related harm”.

‘Front of House’ Testing:

• Fixed-lab-based drug safety testing services allow people to come in and drop off a sample for testing, e.g.  ChEckIt, SaferParty, Jellinek and EnergyControl;
• At-event testing, e.g.  The Loop, ChEckIt, SaferParty, CHECK!N, and DanceSafe;
• On-site testing  in Drug Consumption Rooms happens in Canada, Spain and Denmark. The Vancouver-based InSite is conducting fetanyl screening on-site, CAS-Baluard provides testing in Spain, and the drug consumption room in Copenhagen has just started providing a drug checking service.

‘Back of House’ Testing:

• WEDINOS (Welsh Emerging Drugs and Identification of Novel Substances), allows Welsh people to send in samples for laboratory analysis for free;
• Spanish-based EnergyControl and US-based EcstasyData allow anyone to send in samples to analyse for a fee.

Benefits of MAST:

Provides information on the quality and purity of drugs to the people using them;

Provides a point of contact for brief interventions with people who use drugs, around their drug use;

Generally leads to safer consumption patterns (for example, when NPSs are detected, drugs are often discarded);

Can greatly enhance information gathering of substance use in given areas, and increase the responsivity of emergency services to newly emerging trends  e.g. WEDINOS has detected several previously unidentified NPSs,  the Trans-European Drug Information Project (TEDI)  monitors trends through-out the European region and the Nightlife Harm Reduction Network of the Americas is developing similar capacities.

Since their inception, festivals have been associated with dancing, sex, and the use of alcohol and other drugs (AOD). However, these celebrations can also present high risk environments arising from the use of AOD, long durations of dancing without breaks, adverse weather conditions (e.g. high or low temperatures), unfamiliar environments, bright lights, loud music, decreased sleep and poor nutrition.

Adverse reactions to AOD, mental health problems, dehydration, exhaustion, sunburn, hyperthermia, hypothermia and other negative effects can occur as a result.  The use of AOD may also lead to an increased likelihood of engaging in risky sexual practices.

Festival welfare services are services which aim to reduce the risk and effect of several of these problems.  UK-based Chill Welfare, for example, aims to “keep people safe by reducing the harms caused by alcohol and other drugs, support mental wellbeing and promote sexual health”.  Check out Katy McLeod’s presentation at Students for Sensible Drug Policy Ireland’s 2017 annual conference (which Youth RISE co-sponsored) here.

They present an opportunity to engage with people experiencing acute problems, people who would normally not engage with services, and people who are at-risk of AOD, mental, sexual health and other problems.

Potential Benefits:

Crisis intervention and de-escalation;

Drug, sex and mental health promotion;

Referral to services;

Data collection e.g. Early Warning and Emerging Trends.

Festival welfare services may include:

Chill out spaces;

Emotional support;

Rest and recuperation;

Linking with services.

Such services ideally work in collaboration with the medical and security teams on-site at festivals.  They often include a stationary tent, rest and recuperation space, and outreach teams. Some services incorporate needle and syringe programs. Projects like Zendo  and Kosmiaid specialize in psychedelic harm reduction.

Services such as Eve und Rave in Switzerland, EnergyControl in Spain and DanceSafe  in the United States and Canada exist for around two decades.

• Eve and Rave started initially to provide drug checking and information at parties. Today, it hosts an online forum (German language) and supports Safer Party at large Swiss festivals where it helps provide welfare services in three – sometimes four – languages.
• EnergyControl conducts peer-to-peer work, produces informational leaflets/pamphlets, sets up information stands and display cases in night life settings, trains nightlife professionals (e.g. event organisers, bar workers ), co-ordinates the Trans-European Drug Information Project (T.E.D.I.) (See: here) and hosts an anonymous online international drug checking service.
• DanceSafe “a 501(c)3 public health nonprofit that promotes health and safety within the electronic music and nightlife communities”  has approximately 20 autonomous chapters and was represented at around 150 festivals last year. Chapters sell reagent tests (See: Reagent Testing).  DanceSafe also provide an online education course (i.e. the DanceSafe Training Program) and helps support the Erowid Centre– run EcstacyData.org laboratory pill testing program   with  Isomer Design. 

Other Useful Resources:

Daath Psi Help Manual (English)

Zendo Psychedelic Harm Reduction Education

Harm Reduction or Psychedelic Support? Caring for Drug-Related Crises at Transformational Festivals

A majority of youths get some of their information concerning drugs online.  Many have a general mistrust of the drug education they received in schools which is often piecemeal, based on scare tactics, delivered by nonprofessionals,  and consisting of inaccuracies and half truths.

Many turn to online resources such as Erowid, Bluelight, Drug Wise, Psychonaut Wiki,  Drugs Forum, r/Drugs, Universo de la Drogas (Spanish), DrugStory, Pillreports, drugsand.me , touchbase  etc. to learn about drugs; interactions; harm reduction techniques; and to engage in peer communication.  

Concurrently, online drug markets  have developed in recent years both on the surface web and the deep web.  An European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)overview of research on the phenomenon can be found here:’The Internet and Drug Markets’.  A 2015 Irish survey of university students found that 4.5 % of respondents reported that they procured their drugs through online sources.

The Silk Road was probably the most well known of these online markets, having gained notoriety during the high profile trial of suspected founder Ross Ulbricht. As one of the world’s first and largest online marketplaces, it is partially responsible for popularising the concept of cryptocurrencies (e.g. Bitcoin– which is hitting record highs) and the TOR browser. Today, many different cryptocurrencies can be used including Ethereum, DASH and Monero and many market places have replaced Silk Road e.g. AlphaBay and DreamMarket. 

As Buxton and Bingham, 2015 note in their policy brief:

• For vendors and purchasers who use the sophisticated, user friendly and increasingly secure Dark Net sites, hidden markets present a safer environment for drug transactions and they reduce the multiple risks (coercion, violence, arrest, exposure to other drugs) associated with ‘street’ sales
• Research demonstrates that anonymised user forums and online chat rooms encourage and facilitate information sharing about drug purchases and drug effects, representing a novel form of harm reduction for drug users and an entry point for drug support services.

Dr. Fernando Caudevilla (a.k.a. ‘Dr.X’) is a pioneer in the field of deep web harm reduction. He operated several forums where he answered a wide range of drug-related questions.   A catalogue of some of his exchanges can be found here.  He also works with Energy Control which provides an international drug checking service which can be accessed here . 

Fernando considers deep web marketplaces “one of the most important things that has happened in relation to drugs in the 21st century” and believes that they present an important opportunity to engage in harm reduction interventions (e.g. Deep Web Marketplaces: An Opportunity for Harm Reduction) with both users and vendors.

He blames prohibition for leading to a situation whereby people feel more comfortable talking anonymously to a stranger online rather than their doctor in the real world.  The deep web can provide a space where people can exchange honest and credible information with far less fear of stigma, discrimination or legal reprimand.  This can facilitate the development of  more honest conversations surrounding drugs between harm reduction professionals and consumers; consumers and vendors; and vendors and researchers (e.g. Van Hout and Bingham, 2014)

Information spreads quickly.  An online community can rate and comment on vendors.  If a product is low quality, consumers are likely to complain and the vendor is likely to lose business.   Fernando cites the example of Energy Control discovering some PMMA in a batch of ‘Superman pills’ using drug checking techniques. PMMA has been linked to numerous deaths around the world. When EnergyControl released this information many vendors stopped selling pills similar to these.  As he notes “it is a semi-regulated market”.

Slowly, authorities are  recognising Information Communication Technologies (ICT) as valuable resources in reducing drug-related harm. A recent European Commission Drug Action Plan proposes:

“.. enhanced use of information and communications technologies (ICT) for prevention purposes, such as awareness raising activities, targeting young people in particular. It also encourages measures to better address the needs of older drug users and vulnerable communities as well as focusing on the reduction of health and social harms caused by drug use”.

It will be interesting  to what extent such interventions will develop in the deep web!

Minister of State for Justice with special responsibility for Equality, Immigration and Integration  David Stanton and Tánaiste (Irish Deputy Prime Minister) and Minister of Justice and Equality Frances Fitzgerald at the launch of Ireland’s National Women and Girls Strategy 2017-2020: creating a better society for all

Source: Department of Justice and Equality Event Pictures

Ireland’s Department of Justice and Equality recently launched its  National Women and Girls National Strategy.

Youth RISE attended as a result of a joint submission on ‘Women and Drugs’ with Students for Sensible Drug Policy Australia, America, Ireland and United Kingdom; Help Not Harm; and with input from Judy Chang (International Network of People Who Use Drugs), Gerard Roe (BeLong To Youth Service) and Youth RISE IWG Catherine Nyambura (ATHENA Network).

What we recommended:

“The use of drugs is associated with stigma and discrimination. Language can help shape culture and we agree with INPUD that ‘abuse’, ‘addict’, ‘junkie’ and other pejorative, stigmatising and dehumanising language should be avoided and replaced with humanising terms such as people who use drugs (PWUDs), people who inject drugs (PWIDs) and/or people who are dependent on drugs. Women who use drugs  are often subject to additional marginalisation and discrimination which compounds their fundamental inequality.   This is particularly evident in the context of criminalisation, injecting drug use, HIV status, pregnancy, parenthood, homelessness and engagement in sex work.   Additionally, services for these groups often lack gender-specific focus e.g. drug services, homelessness services, HIV responses etc.”

Their commitment:

• The new Drug Strategy will aim to increase the range of wrap around services to meet the needs of women who are using drugs and/or alcohol in a harmful manner, including those with children and those who are pregnant.  

What we recommended:

“Pregnancy and uncompensated domestic work (including childcare) place unequal demands on women’s time which can limit their participation in the labour force. This contributes to the gender pay gap – a measure of financial inequality.  Paternity leave along the lines of the Swedish model and abortion-on-demand would make great strides in addressing this fundamental inequality.”

Their commitment:

• Implement a range  of measures to address child care issues, the participation of women in the labour force and to reduce the gender pay gap;

• To monitor the outcome of the governmental committee on changes to abortion legislation (8th Amendment) following the outcome of the Citizens Assembly.

What we recommended:

“Much of the attention to date toward women and girls has focused on them as recipients of services and/or targets of interventions.  Adolescent girls and young women should be empowered  as peer advocates within their communities.”

Their commitment:

• Girls and young women  are supported in their social and emotional development through the provision of community based youth services;

• Support and resource women’s community development, as a means to provide services and support for socially excluded women –  National Collective of Community Based Women’s Networks (NCCWN) ;

• …the Social Inclusion and Community Activation Programme (SICAP) will provide key supports to those most in need in our communities including disadvantaged women, Travellers and Roma women and women with disabilities, in all Local Authority areas throughout the country.

What we recommended:

“Sexual education, as experienced by some of our members, was often piecemeal and couched in gender normative interpretations of sexuality.  Many of our members have reported homophobic perspectives and other general inadequacies in the sexual education they received. This is particularly worrying in context of young sexually active women, MSM and transgender people (particularly transgender women) being key affected populations disproportionately impacted by HIV (WHO,2016).”

Their commitment:

• Hold a referendum on Article 41.2.1 of Bunreacht na hÉireann regarding a “woman’s life within the home”;

• Develop an initiative  to explore how to consult children and young people on addressing gender stereotyped norms;

• Establish a programme of activity, including research, awareness-raising and cultural activities, to promote positive gender norms and to challenge negative gender norms;

• Consider in the forthcoming National LGBT Inclusion Strategy how best to improve health outcomes for LGBTI persons;

• Issue Ireland’s first national Lesbian Gay Bisexual Transgender (LGBT+) Strategy for Young People.

What we recommended:

“Issues around  consent and respect are often  inadequately addressed.  Whilst we applaud movements regarding consent at third-level we consider this far too late. With respect to both of these issues, more work must be undertaken to foster greater respect and develop healthier attitudes towards consent. Such efforts should include the recruitment of male peer advocates- which we recognise as a key resource in combatting GBV. The increased risk of women who use drugs to be subject to GBV must be addressed.”

Their commitment:

• ..support initiatives to encourage men and boys to be champions of gender equality ,drawing on the Men Advocating for Real Change, HeForShe, MAN Up and White Ribbon initiatives;

• Enhanced legislative protections and supports put in place for victims of gender-based violence;

• Requests from non-governmental organizations in relation to targets, outcomes and indicators in the Second National Strategy on Domestic, Sexual and Gender-based Violence 2016-2021 to be examined.

We recommended:

“Ireland must ratify the Istanbul Convention of which it is a signatory.”

Their commitment:

• Implement the actions contained in the Second National Strategy on Domestic, Sexual and Gender-based Violence 2016-2020 required to enable Ireland to ratify the Istanbul convention.

We recommended:

“..we believe that we must follow the  UN Bangkok Rules on Women Offenders and Prisoners and IRPT (2013) guidelines for low level offences in context of general human rights and  gender-specific issues such as pregnancy and caregiving which are negatively impacted through imprisonment.  Imprisonment for low-level drug offences is not good practice, and it is not proportionate sentencing.”

Their  commitment:

• “..conducting further research into the particular needs and circumstances of female offenders and the reasons behind the growth in the use of imprisonment for women, placing greater focus on step down facilities for female offenders, the use of gender appropriate community sanctions, promoting greater contact between offenders and their children) and also the greater use of supported and temporary release, access to rehabilitation and reintegration programmes and development of alternative sanctions to imprisonment.”

• A step down facility from prison for female offenders to be opened.