ESSD 2020 Conference Abstracts
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Session 1: New trends in drug use
10:00 - 10:30 CEST, Thursday, 24 September
Chair: Bernd Werse (Goethe University Frankfurt)
Participants
Nitrous oxide use among young people – intoxication, risks and policy developments
Vibeke A. Frank, Aarhus University, Sarah MacLean, La Trobe University & Maria D. Herold, Aarhus University
Background: Nitrous oxide (N2O) use for recreational purposes appears to have increased in Denmark and Australia, as well as in other countries such as The Netherlands and the UK, with much of this use occurring among young people. The small bulbs produced as a food additive are reportedly used for intoxication, often referred to as ‘nangs’, ‘noz/nos’, ‘hippy crack’ or ‘whippets’ in English. This increase in N2O use has prompted concern among researchers, professionals, health authorities and politicians, especially after occasional deaths of young people (apparently) caused by N2O use, but also because N2O use can cause severe health harms.
Objectives: Our aim with this presentation is to map out key themes and issues raised in the available literature on N2O inhalation for intoxication among young people, describe and discuss health effects of N2O use, and provide examples of newly implemented policy responses to this use.
Methodology: The presentation is based on scoping study methodology, as developed by Arskey & O’Malley (2005), with which we have identified a range of sources, including research literature, reports and policy documents.
Significant results: Our scoping search shows that only a limited amount of literature is available on the prevalence of N2O use among young people for recreational purposes; that hardly any qualitative studies exists; that it is unclear what levels of use are harmful; and that policy developments differ in relation to whether it is supply, possession and/or use that is regulated.
Conclusion: In conclusion we will speculate about future trends in N2O inhalation for intoxication, future areas for research based on the gaps in the literature, and discuss regulation and harm reduction initiatives that could be implemented.
A public health approach to New Psychoactive Substances (NPS); European epidemiological overview in the general and school populations
Julian Vicente, João Matias, Federica Mathis, EMCDDA, Begoña Brime, Noelia Llorens, PND & Sabrina Molinaro, CNR-IFC
Rational and introduction: Since the early 2000s, many new psychoactive substances (NPS) have been identified in Europe (730 until end 2018) and this has been considered a major drug problem during the last 10 years. However, there is very limited epidemiological information regarding NPS use (e.g. number of users, characteristics, substances used), which is essential for a public health approach, and should be completed with more in-depth assessment including qualitative studies. This is the first European overview of NPS use in general and school populations.
Material and methods: The EMCDDA developed a standard module to assess NPS use in surveys, which included a “general NPS question” and optional questions for specific substances. The module was implemented in many national population surveys (GPS), in the European project on school surveys ESPAD and in the international drug web survey coordinated by the EMCDDA (not included in this presentation).
EMCDDA carried out a specific data collection during 2018-2019 of (aggregated) national GPS results through an detailed template structured by age (15-64 and 15-34 years), gender and timeframes of use (lifetime –LTP-, last 12 months –LYP- and last 30 days –LMP-). Results from ESPAD project were retrieved for the 2015 report and complementary tables www.espad.org (2019 not published yet) and additional analysis of raw data. Results from Spanish national school and adult surveys were used too.
Result: 17 countries reported results from their GPS surveys (carried out between 2014 and 2018). Prevalence of NPS use (general question) among 15-64 year old adults were: LTP ranged between 0.3% and 2.8%, and LYP between 0.1% and 1.4%. Among young adults (15-34 years), LTP ranged between 0.5% and 5.4% and LYP between 0.1% and 3.2%. Among countries with information, in 7 countries prevalence of NPS (general question) use (LTP) were similar to those of ecstasy or cocaine individually, on the other hand in 8 countries, NPS use was notably lower than ecstasy or cocaine.
Conclusions: It is presented the first European epidemiological overview of NPS use in the general population. Results are consistent across countries, with prevalences relatively low and concentrated among young males. In some countries prevalence of NPS (general question) are similar to those of ecstasy or cocaine, but in others are clearly lower. There are differences across countries that may reflect differences in supply and/or in socio-cultural patterns of substance use. Methodological issues, including interpretation of the NPS “general question” (being advisable to include also specific NPS substances), may influence some differences.
Gendered perspectives on academic achievement and performance-enhancing substance use among Danish college students in the ‘performance society’
Jeanett Bjønness, Aarhus University
Objectives: Research report an increased pressure on students to perform well in many European educational systems, as well as an increase in students’ use of prescription pharmaceuticals to improve their concentration and academic performance. This paper examines college students' different motives for, experiences of and legitimations for using prescription pharmaceuticals for academic purposes.
Methodology: The paper is based on i) 36 in-depth qualitative interviews with Danish college students (18-20 years) on the topics of: well-being, stress and performance-enhancing strategies, ii) 16 interviews with supervisors on their encounters with challenged students, and iii) an analysis of the media discourse on young people, stress and substance use in Denmark over the last decade.
Results: The paper explores the relationships between the students’ experiences with and opinions about the use of prescription pharmaceuticals and media discourses on youth, education, well-being and academic performance, in the light of sociological theories about the 'western performance society' where achievement is described as the ideal for the good life. Both the students that have use substances themselves, and the ones that haven’t express quite strong opinions about the fact that some young students feel the pressure to use substances to cope. Most students are ambivalent about non-medical use of pharmaceuticals while under education, but they understand and accept that some feel the pressure to use pharmaceutical or other substances in order to meet societal demands linked to performance, efficiency and resilience. The data reveals gendered differences in how students experience such societal and academic pressure and in the ways young men and women use substances and legitimize medical enhancements as a means to cope with the experienced pressure.
Conclusion: The paper discusses the different forms of ambivalence experienced by the students, and pays particular attention to gendered media-discourses on 'A+ girls' and 'troubled boys'. Indications are that norms about performance (still) differ very much between young men and women. High performance among young women are associated with quite different qualities than high performance between young males. For example, high performing young women are often described as sick and conform, while high performing young men are described as easy-going and festive. Overall, the paper suggests that to be able to understand the complexity of how educational reforms affect young people of different genders, more situated and specific qualitative analyses are needed, that take as the starting point the experiences of the young students themselves.
Session 2: Drug use related implications of COVID-19
11:45 - 12:30 CEST, Thursday, 24 September
Chair: Vibeke A. Frank (Aarhus University)
Participants
Changes of drug use in the general population due to COVID-19
Martin Busch, Charlotte Klein, Tanja Schwarz & Julian Strizek, Austrian Public Health Institute
Currently we are confronted with numerous "myths" about the impact of the COVID-19 situation on the use of psychoactive substances in the general population. Some experts claim that there has been an increase in substance use due to more stress and an increase of leisure time, while others claim that there has been a decrease due to fewer social contacts and consumption situations outside the home (drinking in bars and restaurants, parties, etc.). These claims are largely based on assumptions and hardly on reliable empirical data. The Addiction Competence Centre of the Austrian Public Health Institute conducted a representative online population survey, including around 5,000 individuals, who were asked about changes in their consumption habits regarding alcohol, tobacco, illegal drugs, NPS and about changes in their gambling and gaming behaviour. Causes and motivation for these changes were surveyed as well. Data collection has been completed by now and first results will be presented at the online ESSD conference.
Alcohol consumption and false rumors circulation during the COVID-19 pandemic
Virginia Martínez-Fernández, Miguel Hernández University
From the alarm state decreed in the Spain as a consequence of the health crisis generated by COVID-19, have taken place substantive changes in social functioning. Among them, should be drawn the community isolation as basic measure for the disease prevention among population. One of the marked effects about this disposal, has been the general increase of drugs consumption, specifically regarding to alcohol (WHO, 2020).
Although previously to undertaking measures of social isolation, the alcohol consumption was associated with recreational spaces, during the confinement period, has been noted an increasing trend in the use due to different motivations. In this study, are highlighted two reasons related to severity criteria, that is associated to a possible spectrum of consequences in health field in long term.
On one side, the alcohol consumption acted as an evasion mechanism of mixed anxiety-depressive disorder, in part induced by the lack of social contact or routines disturbance. And on the other side, the spreading of false myths about the alcohol supposed therapeutic effectiveness to remove the virus.
In both cases, although it is unknown the progress about this behavioral pattern, is required propose assurance measures in the public health field, mainly in attention to the possibility of a future resurgence, and therefore, the perpetuation of these social coping style.
Thus, in the present study is proposed to develop a retrospective review about the alcohol consumption levels among adult population during the confinement period in Spain, and the correlation with other possible elicit and maintainer variables of consumption subsequently. In this sense the analysis can provide evidence about the social behavior, in order to contribute to improving the preventive measures among the population with the objective of reducing the impact of a hypothetical resurgence pandemic.
Substance consumption styles during the Covid-19 lockdown: self-control or self-regulation?
Raimondo Maria Pavarin, University of Bologna, Local Health Unit of Bologna
Session 3: Methods and ethics
13:30 - 14:15 CEST, Thursday, 24 September
Chair: Tom Decorte (Ghent University)
Participants
Why we cannot remain flies on the wall: Ethnographic fieldwork in the largest open drug scene in Israel
Hagit Bonny-Noach, Ariel University & Sharon Toys, Ashkelon Academic College
Background and aim. The largest open drug scene in Israel is located south of the city of Tel Aviv, inhabited by the most marginalized people, including people who inject drugs (PWID), sex workers, homeless people, and others.
Because little is known about this open drug scene, our aim was to conduct ethnographic fieldwork that would allow us to see the world from the perspective of hard-to-reach population, and to present their worldviews and voices, which are missing from the public health and social discourse. The pre-field preparation phase suggested that this is a chaotic field, with sensitive topics that include illegal behaviors and victimization. In this presentation we will share various ethical and legal dilemmas as well as issues that arose out of our experience in the course of this fieldwork.
Method. We used a qualitative ethnographic methodology, which included almost 400 hours of daytime and nighttime participatory observations. We conducted 62 semi-formal interviews with permanent and temporary characters in the compound, including 22 women, 32 men and 8 transgenders. We also maintained reflective researcher journals.
Results. We found many health and social disabilities among the population in the area, resulting from multiple addictions and life on the street. We also understood the functionality of the compound for these marginal people.
Additionally, from the beginning of the observations and the interviews we understood that we cannot follow the regular academic strategies and must be more flexible in the field. Although we prepared ourselves when we entered the research field, we did not always know how to act when we witnessed or were told about various illegal activities and victimization. Over time, we found ourselves increasingly involved and could no longer remain objective 'flies on the wall', especially concerning the social and health-related attitudes toward the people who assemble in the compound. The research changed us both as scholars and human beings. We become radical criminologists who want to change the harsh reality we witness, by actively promoting radical harm reduction interventions in the area.
Doing ethnographic drugs research: Ethical and moral dilemmas
Lisa Williams & Jessica Williamson, University of Manchester
Ethnographic methods allow researchers to get close to people and observe how they behave in real life. Whilst this provides researchers with rich and deep insights for developing theories, for drugs researchers it creates a distinct set of ethical and moral dilemmas to be addressed. In this presentation we discuss the potential ethical challenges arising in two ethnographic drugs research projects in the UK. One collects visual data to explore recreational drug taking in the home, the other uses a semi-covert participant observation design to better understand the work of security staff at electronic dance music festivals. We discuss the rationale for our ethical and moral standpoints regarding ongoing informed consent, the limits of confidentiality and the potential for harm or distress to be caused to participants through the disclosure of criminal behaviour, being deceived and feeling exploited. Fleetwood and Potter (2017) argue that ethnography is ‘under threat’ by research governance in academic institutions that are risk averse and want to avoid negative publicity and scrutiny that may arise from researchers in engagement with criminals and potential participation in or observation of criminal activity. We therefore provide advice on how best to satisfy ethics committees that appropriate concerns have been considered and strategies are in place to address them. We conclude that it is still possible to do novel ethnographic drugs research.
Civil Society Monitoring of Harm Reduction in Europe
Rafaela Rigoni, Correlation European Harm Reduction Network, Tuukka Tamm, Finnish Institute of Health & Eberhard Schatz, Correlation European Harm Reduction Network
Civil society organisations (CSOs) play a vital role in developing and implementing effective measures to reduce the harms of drug use. They also increasingly hold governments and donors accountable, among others, by engaging in independent monitoring and evaluation (M&E) of programs. Civil society-led monitoring, in combination with advocacy, is crucial to improve policies and programs’ implementation. Nevertheless, studies on the monitoring of harm reduction are mostly dedicated to applying M&E to services or to discuss the best indicators to do so. So far, no academic literature examines the development of a civil society-led monitoring tool for harm reduction. This paper fills in this gap by describing the learning process of a civil society-led monitoring tool developed by Correlation- European Harm Reduction Network (C-EHRN). The C-EHRN monitoring maps the experiences of harm reduction services providers and service users in 34 European countries, with the help of National Focal Points. Starting in 2018, the tool aims at complementing current harm reduction monitoring systems in Europe, such as the ones from EMCDDA and HRI. It focuses on harm reduction activities related to Hepatitis C, overdose prevention, new drug trends, and civil society involvement in drug policies. This paper analyses the added value and the challenges of developing this tool, emphasising its methodological implications. Among the main difficulties are assuring data reliability and representativeness. Most CSOs have little to no experience with monitoring and research and mostly work in a local-based context. Increasing reliability required adjusting the tool and its indicators to fit CSOs local experiences. If on the one hand, this led to losing the broader focus on (and comparability among) European nations, on the other, it brought the added value of reflecting fundamental qualitative data on service delivery and policy implementation. This allowed to map discrepancies between official policies and policies in practice, as well as identify gaps in current data collection. The C-EHRN monitoring data tells a different story of the daily realities in harm reduction services and in the lives of people who use drugs than what has been reported elsewhere. Such data complementarity can play an essential role in optimising local planning of drug service provision and development of effective and respectful drug policies at the national level. If data quality issues as well as the sustainability of reporting are adequately addressed, civil society monitoring can provide excellent added value for monitoring achievement of EU and global targets.
Session 4: Cannabis: Innovative approaches
14:45 - 15:30 CEST, Thursday, 24 September
Chair: Angus Bancroft (University of Edinburgh)
Participants
The spectre of continued ambiguity: Tensions within cannabis policy change in Ireland
Chris Ó Rálaigh, Technological University Dublin & Sarah Morton, University College Dublin
Background and objectives: Cannabis is the most widely used drug in Ireland, with steady increases in usage and treatment rates. Despite this, the regulation of cannabis has remained effectively unchanged since the adoption of prohibitionist legislation in 1977. However, the context and content of policy toward the recreational use of cannabis is changing across Europe and the Americas (Decorte, 2018) and recent Irish policy actions suggest that alternatives to absolute prohibition may be considered. How such policy decisions evolve is key within the European context, and this study sought to explore the opinions of Irish policymakers toward the regulation of recreational cannabis.
Methods: Semi-structured interviews were held with 8 key informants (elected representatives from a majority of political parties represented in the Irish parliament, policy officers with drugs support agencies and a member of the National Drugs Oversight Committee) in Dublin, Ireland. The study employed Kingdon’s (2014) Multiple Streams Theory of policy analysis to consider whether the current period of policy change in Ireland represented an opportunity for the development of a ‘policy window’ for the implementation of progressive cannabis policy.
Results: Irish policymakers demonstrated a clear willingness to consider alternatives to the current prohibitionist policy. The study revealed strong support for the decriminalisation of recreational cannabis and qualified support for the full legal regulation of recreational cannabis. Mitigating against potential policy change were concerns regarding market-capture by commercial interests. The study also identified a divergence between the personal and professional opinions of Irish policymakers on this issue. This divergence was marked and presented across the political and policy spectrum.
Conclusion: The respondents were willing to consider alternatives models for the use, or sale and supply of cannabis, which delineates a clear break from historical Irish illicit drugs policy. Yet the support for decriminalisation and consideration of legal regulation expressed by respondents in this study is heavily circumscribed by organisational allegiance and views of what is politically acceptable. An historical legacy of policy ambiguity – and a clear and substantial difference between the personal and professional opinions of policymakers – acts as a significant mitigating factor against any potential for policy change. The study highlights the challenges associated with regulatory changes in the drugs policy field and contributes to the potential nuances involved in the emerging debate regarding cannabis policy in other European legislatures.
Cannabis users and stigma: A comparison of users from European countries with different cannabis policies
Kostas Skliamis, University of Amsterdam, Annemieke Benschop, Amsterdam University of Applied Sciences & Dirk J. Korf, University of Amsterdam
Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to which extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey among 1,225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands, and highest in Greece. This indicates that punitive cannabis policy contributes to stigma and liberal cannabis policy contributes to destigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.
Key words: Cannabis, cannabis policy, stigma, normalization
Cannabis use and coronavirus – results of a short online survey in Germany
Bernd Werse & Gerrit Kamphausen, Goethe University Frankfurt
Objectives: To gain insights into the situation of regular cannabis users during the corona crisis, with regard to patterns of use, market development and risk behaviour, in connection with individual situations.
Methods: Between early April and early May 2020, i.e., from the peak of the "lockdown" in Germany until the days after the first loosening measures came into force, a short mainly quantitative questionnaire was put online, directed to people who use illegally procured or grown cannabis at least occasionally. The results were evaluated using standard statistical procedures and a systematic review of answers to the open questions.
Results: Respondents were 91% male; the average age was at nearly 30 years. Almost 40% stated that they work, study or learn either less or not at all since the start of the corona crisis. Approximately half of the subjects worked (almost) exclusively from home. Around one third had less money available than usual. Nearly nine out of ten used cannabis at least weekly, 51% daily. 39% of respondents claimed that during the crisis, they use more cannabis than before, while only 16% use less. In the course of the crisis, the proportion of those who claimed to use more increased. Those working in home office were more likely to increase their use than others. While almost half of respondents stated that cannabis availability declined, a similar proportion stated that it did not change. Around 60% did not notice any price change during the crisis, while other respondents stated that the price of herbal cannabis increased by an average of € 2.50 per gram. A majority of respondents adhered to infection control measures when consuming, mainly with regard to the avoidance of sharing joints.
Conclusions: At least for this sample of people who predominantly use cannabis frequently, there is an overall tendency towards increased use during the crisis, which can be explained on the one hand by more free time, on the other hand by compensating for stress in the "home office" and fears about the pandemic. The majority of respondents report little or no impairment of the illegal market. In certain regions, however, cannabis procurement seems to have become difficult or impossible. Obviously, there are large regional differences in terms of market structures and their susceptibility to disruptions.
Session 5: Drug market dynamics in relation to COVID-19
16:00 - 16:45 CEST, Thursday, 24 September
Chair: Aileen O'Gorman (University of the West of Scotland)
Participants
Buying drugs in the UK under lockdown: Results of the Release COVID-19 Drug Market Survey
Judith Aldridge, University of Manchester & Niamh Eastwood, Release
Objectives: A survey was designed to monitor changes in the UK’s drug supply that may arise following COVID-19 lockdown restrictions.
Methods: An anonymous online survey went live on 9-Apr-20, 17 days after the UK’s comprehensive lockdown measures were implemented. The survey generated 2148 returns in which respondents reported detailed information on purchases, including date, price, perceived quality/purity and difficulties encountered making the purchase compared to pre-COVID norms. We compare transactions made in anticipation of lockdown (n=202) with those made during (n=1175) and after lockdown easing measures were announced (n=628).
Results: The sample: 70% male, 52% 18-24, 92% white, 63% employed/furloughed. Most (72%) purchases reported were cannabis products; followed by cocaine (9%); ketamine (3.6%); LSD (3%); MDMA (2.7%); heroin (2.2%). Fewer than 6% of purchases involved buying a different drug to that sought due to lack of availability. Only 3% reported suspicions that the content of their purchase was not ‘as sold’. More often than not, respondents reported purchases with prices and purity in line with their pre-COVID expectations. Deviations from expected purity became more pronounced over the three reporting periods (from 19% to 24% to 32%), but perceptions that purity was higher than expected were as common as perceptions of lower purity. Purchases reported to be higher in price compared to pre-COVID norms rose: 13% for purchases made in anticipation of lockdown, rising to 18% during lockdown and as lockdown eased. Just over 10% of purchases were described as lower than pre-COVID prices. Difficulty finding a dealer, and finding the drug wanted, increased over the three reporting periods, from 27% to 31% 34%, and from 18% to 20% to 25, respectively. Qualitative data collected as part of the survey will be presented.
Conclusions: Despite difficulties locating wanted drugs and the dealers who sell them, respondents to our survey were in the main able to purchase the drug they sought throughout the UK’s lockdown phases, and broadly in line with their pre-COVID expectations for price and quality/purity. Nevertheless, deviations in price and perceived purity from pre-COVID expectations increased over the three lockdown phases. The direction of these deviations was not exclusively in line with expectations generated by supply restrictions: with some purchases reported to be cheaper and with higher purity/quality compared to pre-COVID purchases. These contradictory findings might be explained as arising from stockpiling purchases made by those later supplying them in anticipation of lockdown, creating pockets of plentiful availability of high-quality product that – at least for a time – generated reports of some lower priced/higher purity purchases.
Drug use patterns and the illegal drugs market in Latvia in relation to COVID-19 pandemic: Results of the European Web Survey on Drugs COVID-19
Agnese Zīle-Veisberga, Ministry of the Interior of Latvia
To assess the impact of the COVID-19 pandemic on the patterns of drug use, the illegal drugs market and access to health services a special round of European Web Survey on Drugs was carried out by the EMCDDA between mid-April and the end of May 2020. In this paper the results of survey in Latvia is analysed, focusing on drug use patterns and the illegal drugs market.
Objectives: to explore the impact of COVID-19 related restriction to the drug use patterns and the illegal drugs market.
Methodology: Analysis of the quantitative and qualitative data of the European Web Survey on Drugs in Latvia. Questionnaire developed by the EMCDDA. Coordination was ensuresd by the EMCDDA (Reitox focal points). In Latvia it was promoted on social networks, in particular targeting residents of Latvia in age between 18 and 50. In total, 616 respondents were included in this self-selection sample.
Results: Overall, herbal cannabis/resin (51.7%), MDMA (16.4%) and LSD (12.7%) were the most frequently used substances among respondents over the past 30 days. Most of the respondents used substances periodically. Seems that COVID-19 related restrictions had rather little impact on the use patterns or the market. Of those who had used substances during the restriction period, 46.5% hadn’t changed anything, 30.2% had used substances less frequently, but 23.3% had used more frequently. Loss of income, health concerns and fewer opportunities to use drugs were the most frequently mentioned reasons to use drugs less frequently. On the opposition, boredom was the most frequently mentioned reason to use drugs more frequently. Of those who had obtained drugs during the restriction period, 62.1% hadn’t experienced any changes, 13.5% bought drugs in larger quantities. Meantime, almost any changes were observed in obtaining drugs on the surface Internet or darknet.
Comments of respondents show that COVID-19 is not a reason to change drug use patterns. Changes were explained with other reasons, mainly values and life-style.
Conclusion: The results of the survey in Latvia don’t indicate considerable impact on the drug use patterns or the illegal market in relation to COVID-19. Most likely this can be explained with rather moderate restrictions. Moreover, by the time the survey was carried out, it was the beginning of pandemic and overall impact might be seen later (economic recession, global trends in drug trafficking, etc.).
Key words: COVID-19, European Web Survey on Drugs, the illegal drugs market, drug use patterns
Acquittance of addictive behaviours recovery-based programmes as social & health response for women in treatment all around Europe
Antonio Molina Fernández, Universidad Complutense de Madrid, Gisela Hansen, Universidad Autónoma de Barcelona, María L. Cuenca Montesino, Francisco Gil Rodríguez, Universidad Complutense de Madrid
Background and objectives: Women in treatment for problems with addictive behaviors are considered a special vulnerability group by the European Monitoring Centre for Drugs and Drug Addiction/EMCDDA. Therefore, it is recommended to adapt the health responses provided by the services to the characteristics of these profiles. Among the health responses, we find programs based on the concept "Recovery", which consists, operationally, of improving quality of life standards for rehabilitation of addictive behaviors. This study has assessed the suitability of different European recovery-based/"Recovery" programmes with the needs of women (identified as “groups of special vulnerability” by EMCDDA).
Methodology: The study was conducted using qualitative methodology: a bibliographic review of articles and reports, direct and systematic observation of centers and programmes and a series of interviews with key informants. Qualitative analysis of primary data (12 interviews with selected informants/ stakeholders, visits to addictive behaviours treatment centers in 7 european countries) and quantitative analysis of secondary data (reports and memories). For bibliographical review it has been used Prisma Declaration tool. During the whole process it has been used COREQ tool.
Selection of informants was done in three levels: policy makers, practitioners/physicians and researchers/academics; relevant stakeholders in addictive behaviours network; working in national, regional and local level; with political and/or technical participation into the network and long-term knowledge about evolution of drug problem in Europe.
Selection of center was done in two levels: harm reduction programs & recovery oriented programs; with a must of specific gender perspective programmes. For direct (non-participant) observation, the dimensions of Efficacy, Efficiency, Relevance, Visibility, Coverage and Social Impact (unexpected effects) were used.
Category of analysis were: Recovery, rehabilitation, social integration, gender perspective, types of drugs, social structure, education, specific groups, harm reduction, substitution treatment, health, social services and employment.
Results and conclusions: Currently, there are still gaps in the introduction of a gender perspective and intersectional analysis in drug- treatment programs, so that attention is not effective. It is necessary to review the design of intervention programs and the specific training of professional staff, to adapt the recovery treatment to gender specificities.
Key words: Addictive behaviours, gender perspective, social& health responses, psychosocial factors, Recovery, women in treatment.
Session 6: Digitisation of drug markets
10:00 - 10:45 CEST, Friday, 25 September
Chair: Judith Aldridge (University of Manchester)
Participants
Waiting for the delivery man: Managing addiction, withdrawal and the pleasures of dope time
Angus Bancroft, University of Edinburgh
A range of work published in the drug field has reinscribed drug user experience as embodied - challenging researchers to think of pleasure beyond transgression and leisure, into the routine micro-time, embodied, material, domesticated, habitual, remote intimacy. The paper examines changes in the material culture of illicit drug use and addiction discourse in the light of changed modes of drug distribution due to the expansion of digitally mediated markets. The concept of dope time is introduced as one kind of social time that is a part of how opioid dependent users present and talk about themselves. Dope time is generated by both the supply system and the experience of addiction and drug consumption. It can be time spent waiting for drugs to arrive, time waiting for dopesickness to start, or to stop, or time in the clinic waiting for treatment. It is also used as a mechanism of social control, such as deliberately introducing waiting as part of treatment regime to test if the addict is ‘serious’. This paper examines the changing quality of dope time in the context of the shift towards digitally enabled drug markets using qualitative and ethnographic data on user experiences. It draws on data from darknet cryptomarket users who buy and sell using the hidden digital infrastructure. It argues that dope time in the darknet changes to being much more defined by the infrastructure. There are obdurate times dictated by the delivery infrastructure, such as shipment times. Its salience is defined by the drug user’s sense as to whether the time spend waiting is intentional. If he or she regards delayed shipments as the responsibility of the vendor or due to deliberate indifference on their part then this time is experienced more harshly. Dopesickness becomes more painful, and anxiety grows where that is the case. One reason for that is that the user is concerned that the drug may not arrive at all. That feature of the infrastructure then changes the texture of dope time for the user. This is partly a matter of greater convenience and choice but also reshapes the idea of time into one mediated by systems rather than interpersonally.
Reducing harm and efficient markets? Surveillance capitalism and a new dialectic of self-exploitation
Meropi Tzanetakis & Stefan Marx, University of Vienna
This paper’s purpose is to examine the embeddedness of cryptomarkets within information capitalism. Previous research has shown that encrypted platforms for the distribution of illicit drugs (among others), are characterised as having important implications regarding the reduction of harm as they make available higher-quality drugs with a lower risk of contamination, less violent encounters compared to offline drug acquisition and enable peer-to-peer information sharing (Bancroft 2017, Barrett et al. 2016, Martin 2014). In addition, cryptomarkets enable more efficient market structures compared to traditional drug markets (Bakken et al. 2017; Tzanetakis 2018). Thus, digitally mediated transactions facilitate the geographical expansion of markets and overcome local limitations regarding accessibility of illicit drugs, sellers and customers.
In this paper, we aim to extend these accounts and situate them in digital capitalism (Fuchs 2013) by arguing that the dialectic of harm reduction practices and market efficiency outlined above have an origin in the political, social and economic regime of information capitalism. Depicted as a new economic order that claims human experiences as free raw material for hidden but legal commercial practices of extraction, prediction and sales, and an economic logic that subordinates the production of goods and services to a new architecture of behavioural modification, Zuboff (2015, 2019) coined the term surveillance capitalism. Surveillance capitalism analyses how the current state of productive resources is organized around realising excess value by exploiting information that people give voluntarily by using and improving online platforms. Based on digital ethnographic fieldwork, we argue that actors perform mostly illicit transactions on cryptomarkets in a similar vein as on aforementioned legal digital markets. Our contribution reflects on the juxtaposition of surveillance capitalism and the capitalist practices within the illicit drug trade via the darknet since the emergence of Silk Road.
Non-medical use of central stimulants and the Corona-Crises – Time to change control policies
Alfred Springer, Medical University of Vienna
Objective: During the last decade an increase in the use of ATS has been observed worldwide. A particular aspect of non-medical use of these substances had become their use for cognitive improvement (study drugs). For a while this use seemed to be typical for the United States, but in recent years it has spread to Europe (World Drug Report, 2015-18; reports in "Nature").
In the current situation, the corona crisis is affecting the motives for consumption and black market offers for all types of psychoactive substances (UNODC, May 2020). In general, there is a shortage and higher prices and a shift of offers into darkness. In some European countries an increase in the use of central stimulants has been reported (Austria, Finland), while a Darknet analysis from Switzerland, for example, reported a decrease in demand for stimulants, as they are mainly consumed in nightclubs. These differences show that there are different motivations even for Darknet purchases. In the current situation, increased demand for central stimulants may also be a sign of a shortage in the supply of mood-lifting medications and psychiatric care in general.
The situation related to COVID 19 may lead to a shortage and a deterioration in the quality of supply, as well as to a shift on the part of consumers towards more risky use and the search for cheap offers of inferior quality. Domestic production can encourage more risky behaviour, as is known from Greece, where methamphetamine for injecting use has been produced in kitchens using ephedrine, hydrochloric acid, ethanol and car battery fluid.
This development requires consideration of appropriate social responses. Concepts and proposals are available that reflect the diversity in terms of controlling the non-medical use of prescription psychoactive substances. These include considerations and proposals for decriminalisation to the point of complete liberalisation of the use of central stimulants for cognitive enhancement, as well as harm reduction considerations for the medicalisation of problematic out-of-control careers in terms of pharmacological substitution (UNODC Discussion Paper on the Treatment of STIMULANT USE DISEASES: Ongoing PRACTICES AND PROVISIONSPECTIVES, March 2019).
Alternatively, the paradigm of radical de-medication is conceivable. This seems to be a basic prerequisite for enabling the pharmaceutical industry to develop technologies that are better suited for non-medical use to improve cognitive abilities than the relatively risky drugs currently available. It seems appropriate to open a discourse on the legalisation of the production and marketing of central stimulants with a demonstrably low risk profile, taking into account the question of whether such marketing should only be available for cognitive (i.e. competitive) enhancement and not also as a tool for other areas of non-medical use and of self-medication.
Conclusions: The use of central stimulants for cognitive enhancement and as lifestyle drugs is increasing and is nowadays additionally influenced by the specifics of the "corona crisis". In a society in which non-medical use of psychoactive substances is illegal and generally rejected, consumers are ipso facto interpreted as non-compliant and therefore run the risk of being paradoxically stigmatized and marginalized. To avoid such harmful social processes, it is necessary to think about the normalized production of improvement technologies. The "responsible use" of such technologies in the sense of Greeley, 2008 and 2010, requires a controlled and regulated supply. In addition, normalized production is a prerequisite for balancing inequalities in the accessibility of improvement technologies.
Session 7: Theoretical approaches towards drug use and policing
11:15 - 12:00 CEST, Friday, 25 September
Chair: Agnese Zīle-Veisberga (Ministry of the Interior of Latvia)
Participants
Debating decriminalization of drug use in the Nordic countries: A comparative analysis of stakeholders’ views in Finland and in Sweden
Tuulia Lerkkanen & Jessica Storbjörk, Stockholm University
Background: Drug use and related harms have increased globally and policy development shows how governments struggle in search of effective policy measures for reducing drug related harms at different levels of society. While some countries have chosen to decriminalize drug use, the Nordic countries are known for their restrictive drug policies. Yet the Nordics also display variations in drug policies and recent decades have shown gradual shifts. In Norway, policy-makers are considering decriminalizing drug use, which has sparked discussions across the Nordics. In March 2020, the Swedish parliament accepted the suggestion by its Social Committee that the Government must evaluate the present national drug policy, but the Government strongly opposes reassessing criminalization. Decriminalization of drug use has therefore been actively discussed in Swedish media. In 2019, a citizens’ initiative calling for the decriminalization of cannabis use was headed to parliament for consideration by MPs in Finland.
Objectives: The aim is to analyze public discussions on decriminalization of drug use in Finland and in Sweden. Which stakeholders are driving the agenda in the public discussions on decriminalization of drug use in Finland and in Sweden, what kind of arguments are used, and what is their likelihood of success?
Methods: The material consists of media texts published in 2019–2020. The theoretical framework adapts stakeholder theory focusing on issues of power and its distribution among stakeholders. By applying the interest/power matrix presented by Ackermann and Eden (2011) to the analysis, the objective is to reveal the role of different stakeholders and reflect their actual ability to influence drug policy in Sweden and in Finland. Justification theory is used as a methodological and theoretical tool to illustrate the perspectives of different stakeholders, how they understand and justify their role and how they criticize or defend criminalization of drug use.
Results: It is likely that the analysis, to be performed in early autumn, will reveal that the Finnish debate is concentrated upon decriminalizing cannabis use, while the Swedish debate discusses decriminalization more broadly and is driven by the urge to remedy drug related mortality. Distribution of power across stakeholders and differences and similarities across the two countries will be elaborated.
Conclusions: The analysis provides an in-depth understanding of the arguments and ideas of different stakeholders and their attempts to influence drug policy. The comparative study brings perspectives to a topic of considerable international concern, decriminalization of drug use and its consequences to society.
Key words: decriminalization, media & Nordic comparison
The symbolic crusade of policing drugs: drug discourses and the self-legitimacy of drug detectives
Steven Debbaut, Ghent University
The issue of what objective reasons there are to justify the criminalization of a certain conduct is a challenging philosophical and criminological question. On a theoretical level I review the possible moral legitimation grounds for criminalizing drugs and I map the present drug discourses throughout a Foucauldian analysis. On the empirical level I perform (Foucauldian-influenced) ethnographical fieldwork within two police drug units and epistemic interviewing with drug detectives. The self-legitimacy of drug detectives is an important societal issue because police officers are the street level guardians of the prohibition (or ‘juridical-repressive’) discourse on drugs. I want to find out if drug detectives are in need of moral justifications to legitimize their power and from which drug discourses they ‘extract’ their language and arguments. Drug detectives may experience a legitimacy deficit for three main reasons. First, drug offences are ‘vice-crimes’ with no direct harm to others. Secondly, there are drug discourses present that compete with the ‘juridical-repressive’ discourse, namely the ‘medical-sanitary’ and the ‘drugs as right’ discourse. Thirdly, there is a body of empirical facts that counters effectiveness claims of drug policing, for example: the policing of drugs has negligible effects on drug use and on drug supply. My ethnographic research agenda in the police organisation is to look at and listen to the (speech) activities in which the police officers produce meaning to their social world. This ethnographic approach highlights ‘the how’ in favour of ‘the what’. In addition, I look into internally and externally published police documents of the police organisations. These documents can provide valuable information because of ‘the language’ that is used. Last, epistemic interviews with drug detectives are established, and these are ‘in connection with Foucault’. It is Judith Butler (2005) who helps to clarify the connection, she declares that Foucault’s view on the subject is in concordance with the benefits of using a Socratic logos, namely: it facilitates people to give an account of oneself. Giving an account of oneself for Foucault (1997) is not to give a narrative of the events that took place in your life to explain how things became how they are, but to be able to show that there is a relation between your ‘logos’, your rationale discourse, and the way you live. In epistemic interviewing, interviewees are not necessarily right (and nor wrong), but opinions and beliefs are debated and challenged in open conversations.
Identity construction of people with polydrug use
Jenni Savonen, University of Helsinki
The stigmatization of illicit drug use creates a challenge for the identity construction of people who use drugs. Particularly, people who have experiences with multiple drug use, dismissively called “polydrug users”, are faced with strong stereotypes regarding their way of use. This study integrates the Social representations theory (SRT) and Social identity theory (SIT) to comprehensively understand the identity talk and negotiations of people with polydrug use. The data are 56 interviews from Finnish people who have experiences of using more than one substance simultaneously in the 2010s. Thematic analysis was used to analyze data.
The results of the analysis showed that the interviewees were very familiar with the social representation of a “polydrug user”, who they also often described as people not in control of their use and who will use anything. However, due to their negativity, the interviewees rejected these definitions as parts of their own social identity and often described themselves as outsiders to this category. Additionally, they renegotiated the social representation to fit their own definitions of polydrug use. As presupposed by the SIT, social identities were negotiated so that interviewees belonged to groups that enhanced their self-esteem: e.g. (poly)drug users in control of their use. The results confirm that the salient social representations of “polydrug use/user” are very negative, and that people engaging in such behavior do not (want to) identify with the social identities offered by these representations.
Key words: polydrug use, social representations, social identity
Session 8: Drug services challenges due to COVID-19
13:00 - 13:45 CEST, Friday, 25 September
Chair: Jessica Storbjörk (Stockholm University)
Participants
How COVID-19 affected PWUD and drug services in Austria at an early stage of containment measures
Ilonka Horváth, Irene Schmutterer & Tanja Schwarz, Austrian Public Health Institute
Background: In April 2020, the European Monitoring Centre of Drugs and Drug Addiction (EMCDDA) conducted a European survey on the effects and implications of the COVID-19 pandemic for people who use drugs (PWUD). The rapid assessment was based on the agency’s trendspotter methodology (EMCCDA 2018) and aimed to gain insights into the impact of COVID-19 on drug use, harms and drug services. The Austrian Reitox Focal Point, located within the Gesundheit Österreich GmbH, joined this scientific initiative and took the opportunity to rapidly map the national situation PWUDs as well as drug services were facing at this very early stage of containment measures.
Methodology: The Austrian rapid assessment has been conducted between 8 and 16 April 2020. The EMCCDA’s questionnaire was sent out to all nine provincial drug coordinators, as the implementation of drug policy is in the responsibility of the federal provinces. The questionnaire assessed challenges and adaptions in regard to drug service provision, patterns of drug use, harms as well as health and social consequences and drug markets.
Results: In total, 25 questionnaires from 8 provinces have been returned, 4 summarizing the situation in the province and 21 containing information from specific drug facilities in 4 other provinces. Drug facilities were challenged by the re-organisation of service provision, including technical changes as for ICT/online services and implementing safety regulations. Drug streetwork as well as drug testing services were facing lock downs, low-threshold services basically focused on NSP only. Night shelters partly have been expanded to include day care provision. Lack of appropriate hygiene and safety measures for professionals and clients involved in OST underlined the urgent need for legal amendments. It was also reported that services were increasingly using mobile or online platforms to mitigate for the current difficulties in providing face-to-face therapeutic services. Admission interviews, treatment initiation, counselling as well as supervising the general health condition of people in OST have been described as a challenge. Changes in drug consumption patterns as well as health consequences have hardly been perceived. However, social consequences have been reported in regard to social isolation, mental crisis especially among those with psychiatric comorbidity as well as an increased need for food donations.
Conclusion: The Austrian rapid assessment provides some insight into the innovations adopted by drug services in response to the COVID-19-related challenges. Like other health disciplines, drug services will be expected to develop and maintain a broad range of structural and individual health protection measures. The wide range of experiences and gains made in terms of innovation and collaboration in the drugs field are anticipated to lead to closer cooperation with system partners and the use of new service models and treatment options post COVID-19.The presentation will highlight the results from the Austrian survey including examples on OST amendments and COVID-19 specific information for PWUDs.
‘Open’ Drug Scenes in Germany – Changes and challenges during the COVID-19 pandemic
Luise Klaus & Bernd Werse, Goethe University Frankfurt
Objectives: The COVID-19 pandemic is particularly alarming in the context of ‘open’ drug scenes and marginalised people who use drugs (PWUD). This includes not only the fact that many of these people are at higher health risk because of pre-existing conditions, but also problems caused by the restrictions of public life, which may affect making money, accommo-dation, buying or selling drugs in public and drug services. In order to document the situation and to be able to promptly point out any problems that arise, we started a qualitative study on this subject on March 31, 2020.
Methods: An online call to professionals in the field of outpatient drug services asked to share experiences regarding everyday life of PWUD in ‘open’ scenes and the situation of drug ser-vices in times of the COVID-19 crisis. The call includes ten open-ended guideline questions regarding the situation. Answers were send via text or voice messages. The call was spread via social media, mailing lists and German journals of drug issues. Thus, the method can be re-garded as an innovative form of an on-line qualitative survey.
Results: The COVID-19 pandemic has major impacts on the financial situation of people who use ‘hard’ drugs: particularly during the heaviest restrictions, opportunities for begging, col-lecting deposit bottles, prostitution, and theft were substantially reduced. The availability of drugs during the COVID-19 pandemic is partially restricted, the overall prices rose slightly. An increased trade in opioid substitutes and medical drugs such as benzodiazepines is observed. The “lockdown”-measures impact drug services in Germany, particularly with regard to low-threshold services. Social work practices had to change rapidly and substantially. Within ‘open’ drug scenes, some groups, like female, homeless or mentally ill drug users, are particularly negatively affected.
Discussion: This ad hoc-study shows radical changes for open drug scenes during the current COVID-19 crisis. Some of these challenges can be regarded as general problems for European open drug scenes, like the possibilities of making money or higher health risks for marginalised PWUD. Further information and “first hand” research with drug users themselves in different European cities need to be explored, to identify measures and possibilities for comparable future crises.
Key words: Covid-19; open drug scence; Germany
Digital technologies and Health Literacy - prevention training
Susana Henriques, CIES-IUL - Centre for Research and Studies in Sociology, University Institute of Lisbon, Universidade Aberta
The World Health Organization (WHO) defines Health Literacy as the set of “cognitive and social skills and the person's ability to access, understand and use information in order to promote and maintain good health”. Health Literacy implies the knowledge, motivation and skills of people to access, understand, evaluate and apply health information in order to form judgments and make daily decisions about health care, disease prevention and health promotion, maintaining or improving their quality of life throughout the life cycle. It is, therefore, the ability to make informed decisions about health in everyday life. In this sense, health literacy skills function as protectors against health risks and problems. Digital technologies are integral and structuring in the daily life of today's societies.
The use of digital technologies in addictions prevention carries risks and potentials directely related to citizens' health literacy skills. This presentation has the following objectives:
i) to present and discuss the importance of health literacy for the mobilization of community assets in the promotion of addictions prevention;
ii) clarify the concepts of e-health (computer-based digital technologies) and m-health (mobile digital technologies);
iii) present some examples that support reflection around the risks and potential offered by the available technological tools – prevention intervention, training of prevention workforce, and practitioners’ professional development.
In summary, it should be noted that, regarding to the effectiveness of interventions, there seems to be positive evidence. However, further research focused on assessing the quality of tools - e-health and m-health -, intervention strategies and results is lacking. A final note for ethical and data protection issues that also pose important challenges, at national, European, global level… and that require fixed political strategies.
Session 9: Patterns of drug use and using careers
14:15 - 15:00 CEST, Friday, 25 September
Chair: Susana Henriques (Universidade Aberta, CIES-IUL)
Participants
Risk and protective factors associated with different types of ATS use careers: results from the European ATTUNE study
Moritz Rosenkranz, Marcus-Sebastian Martens, Heike Zurhold, Peter Degkwitz & Uwe Verthein, University of Hamburg
Objectives: Among illicit drugs, amphetamine type stimulants (ATS) such as amphetamines ('speed'), MDMA ('ecstasy') and methamphetamine ('crystal meth') are the most commonly used substances after cannabis worldwide. At the same time, little is known about the motives of ATS use, what circumstances are associated with problematic or dependent use and what factors contribute to use careers, which develop in a rather controlled and unproblematic way. In order to gain insights into the different pathways of ATS use careers and to identify risk and protective factors, the ATTUNE study was conducted in five European countries (Germany, the Netherlands, UK, Poland and the Czech Republic).
Methodology: ATTUNE was designed as an explorative mixed-method study comprising of a qualitative and a quantitative module. The results of the presentation refer to the quantitative module. ATS users with different use patterns and a group of ATS non-users were recruited in each country and were interviewed with a standardised questionnaire using the CAPI method. After data cleaning, 1656 datasets (CZ: 199, UK: 375, NL: 249, PL: 386, GER: 447) were included in the descriptive as well as the multivariate analyses.
Significant results: Using the detailed ATS prevalence data (lifetime, last year, last month) four different types of ATS consumption careers (i. e. timespan from first to (currently) last use) were identified: rare use, moderate use, frequent use and dependent use. The careers differ regarding various aspects: sociodemographic variables, variables regarding ATS use (e. g. use motives, consumption rules, consequences of use). By employing different multinomial regression models, it was possible to identify risk and protective factors regarding the development of one of the ATS use careers as well as the question if members of one of the career groups are still using ATS or if they became (currently) abstinent. Among others, risk factors for a rather problematic use were: Low educational level, biographical burden, using ATS for coping reasons, mental health problems, and use of methamphetamine. A protective effect was found for: following consumption rules, avoiding use on workdays, a higher self-efficacy, and a reduced urge for sensation seeking.
Conclusion: The comprehensive quantitative analyses of different types of ATS use patterns, in which rare, moderate, frequent and ATS dependent users are compared with each other, show that ATS use when embedded in the leisure and consumption cultures of young adults remains mostly episodic. The investigated patterns of frequent and dependent ATS use show that intensive use, combined with various risk factors increases the probability of developing dependent use patterns.
Effective interventions should take into account the heterogeneity of ATS users' consumption patterns and should consist of information on the effects of individual ATS substances and harm reduction measures on the one hand as well as special drug counselling and treatment services on the other.
Beyond the high - Mapping patterns of use and motives for use of cannabis as medicine in Denmark through an anonymous online survey
Sinikka L. Kvamme, Michael M. Pedersen, Aarhus University, Sagi Alagem-Iversen, Consultant & Birgitte Thylstrup, Aarhus University
Key words: Medical cannabis; User patterns; Motives for use
‘Never drop without your significant other, cause that way lies ruin’: The boundaries of couples’ MDMA use
Katie Anderson, Middlesex University
We maintain that drugs are often taken in order to facilitate another kind of activity, such as conversation, dancing and sex, making the the things people do on drugs key to understanding the pleasures and meaning of drug use (Duff, 2008). For drugs like MDMA and cocaine, social activities are a core component, solidifying friendships (Bahora, Sterk, & Elifson, 2009; Lynch & Badger, 2006), encouraging intimate conversations (Hilden, 2009), bonding with strangers (Duff, 2008) and enhancing emotional communication in couples (Anderson, Boden & Reavey, 2018). However, given that the effects of drug use can stretch beyond the moment, and into broader ways of relating in everyday life (Farrugia, 2015), the interpersonal effects of traditional psychedelics like psilocybin (Watts et al., 2017) and LSD (Griffiths et al., 2006) can also be significant, for example increased compassion towards others or bringing colour back to close relationships (Watts et al., 2017). Hence, we seek to establish the relational nature of drug use – both within the experience and after the acute psychoactive effects have passed.
In this study, we use a concept from psychosocial process philosophy (Brown & Stenner, 2009; Brown & Reavey, 2015), foundation by exclusion, as a lens through which to view the relational effects of MDMA use amongst couples – a rarely acknowledged sub-group of users. The idea of foundation by exclusion asks us to think about phenomena as being created and maintained not only through what is included but what is excluded for that phenomena to function. For example, intimate relationships are often predicated upon the exclusion of emotionally and sexually intimate others. We think about MDMA use as a complex system with what lies just beyond its borders a formative component of that system. We draw on qualitative data from 14 participants from the UK, EU and USA who take MDMA with their partner. We found that other people are excluded from MDMA experiences to varying degrees in order to preserve this emotionally potent space for the couple alone. In fact, MDMA use was often brought into exclusive couple territory, laying claim to these fun, bonding experiences and moments of emotional connection as a shared resource. There were cautionary tales of what could happen if this space was not policed so viligantly, and how significant relational boundaries could be reordered on the ‘love drug’. Finally, we recommend how this approach could be applied to exploring the relational effects of drug use more broadly.
Session 10: Drug policy: Critical reflections
15:30 - 16:15 CEST, Friday, 25 September
Chair: Moritz Rosenkranz (University of Hamburg)
Participants
Mapping NPS Policy in the EU: Legal frameworks, healthcare provision and outcomes
Jessica Neicun, Maastricht University
Objectives: The rise in NPS trade and use as well as the lack of information concerning their risk to drug users’ health pose serious challenges to European public health authorities. The aim of this contribution is to present a general assessment of NPS-related policies implemented by nine European countries through the lens of legal epidemiology.
Methodology: A mapping review of drug-related legal instruments and policy documents was performed. It was followed by comparative content analysis aimed to identify main features of NPS-related policies implemented across Europe (Czech Republic, France, Germany, Ireland, Poland, Portugal, The Netherlands, UK, Sweden). The conceptual framework used for the analysis encompasses law philosophical principles, institutional arrangements and the specificity of policies. Law’s intended and incidental effects on health was assessed based on countries drug-related health outcomes.
Results: The countries under study can be placed in a wide spectrum according to the general principles that define their drug policy. Those who have implemented specific legal responses to NPS are based on different regulatory models, from decriminalisation (PT), decriminalisation of use and criminalisation of possession (GE and UK) to criminalisation (IE). Besides, the implementation of awareness campaigns, drug checking services and health harms monitoring systems are among the public health responses provided by some countries regardless the legal status of NPS. However, prevalence of NPS use seems to be more linked to general availability of psychoactive substances (including illicit drugs) rather than in the effect of law enforcement measures, while harm reduction interventions seem to have a positive impact on preventing intoxications and managing drug poisonings.
Conclusions: There is still limited development towards harmonisation of national drug policies within Europe, particularly with regard to NPS. National approaches to NPS are in line with already existing drug policies, reflecting cultural values towards drug use and national political arrangements, while the homogenization at a European level has mostly been focused on law enforcement. To tackle the challenge presented by NPS, a wider knowledge transfer and adoption of best practices among healthcare professionals across Europe may represent a good way to improve healthcare provision and drug users’ health.
“From searching pockets to treatment”: An investigation of a drug diversion programme in a Danish police precinct
Tobias Kammersgaard, Esben Houborg, Thomas Friis Søgaard & Sidsel Schrøder, Aarhus University
Objective: This presentation will describe a recent diversion project, initiated by a local police precinct in Denmark, which aimed to direct young people encountered by the police in possession of drugs towards treatment services. The police precinct initiated the project because of a dissatisfaction with traditional law enforcement methods, which were perceived to not achieve the intended goal of dissuading young people from using illicit drugs.
Methodology: Based on interviews with 20 police officers, we investigate how these officers understood and related to this new diversion programme and drug law enforcement. Furthermore, we discuss to what extent this diversion programme entailed a reorientation away from punishment and drug law enforcement.
Results: The interviews illustrate how the police did not refrain from arresting and searching young people for the possession of drugs altogether, but rather perceived diversion towards treatment as “another tool in the toolbox”. Rather than representing a complete re-orientation away from the criminal justice system, we show how the diversion programme is indicative of a new dual police approach to youth drug use, entailing a combination of traditional deterrence and diversion approaches.
Conclusion: Drawing on the concept of ‘treatmentality’ (Jöhncke, 2009), we discuss how alternative forms of drug control, might still maintain a range of problematic assumptions about drug use and drug treatment as the ‘obvious’ answer to this. The study illustrates, that even in seemingly progressive diversion and decriminalisation projects, many of the assumptions and modes of control associated with traditional drug prohibition might be reproduced based on a prescriptive morality of citizens to be healthy, risk-averse and responsible (Walmsley, 2019).
The management of cannabis engagement among residents of Riga, Latvia
Kristiāna Diāna Bebre, University of Latvia
Objectives: Despite increasing cannabis normalisation in the Western context, Latvian policy context has not experienced this shift. In the Latvian punitive cannabis punishment policy context, cannabis engagers in Riga do not accept the stigma that is expected to be internalised by them. This undermines the policy aim for deterrence through the engagement of societal disapproval in criminalising cannabis engagement. This presentation focuses on the experiences of cannabis engagers in Riga. The experiences highlight disapproval of policy-maker views and various motivations for cannabis engagement.
Methodology: This presentation is part of a wider PhD study - ‘The Effect and Implications behind Cannabis Criminalisation: Latvia Joining the Discussion’. The PhD aims to locate the cannabis engagers in Riga in the historic and contemporary (inter)national cannabis policy context. The presentation uses data from semi-structured interviews with cannabis engagers aged 27-50. Convenience, snow-ball, and self-identification sampling methods are utilised. The interview transcripts are analysed using thematic analysis.
Analysis: The interviewed participants may be organised in groups corresponding to the motivations for use. Namely, the recreational, spiritual, and medicinal users. All respondents demonstrate an understanding of criminal sanctions for cannabis use, they do not expect these to change, and do not believe they will be affected by it. While the belief of ‘escaping the law’ is more pronounced in the older part of the sample, the younger part of the sample assign this to the strategies of evading law-enforcement. All interviewed participants denote their cannabis provider as a friend or an acquaintance. Younger users also engage encrypted mobile applications to source, book, and rate cannabis strains
Conclusions: Cannabis engagers are effected by the existent cannabis policy in Latvia. The lack of knowledge on part of the policy-makers is a key explanation provided by the cannabis engagers for the existent cannabis policy in Latvia. The interviewed sample do not disclose their engagement to public institutions, which may be problematic to those engaged with cannabis for medicinal reasons. Further, none of the respondents foresee turning to the health services for assistance or advise in regards to any substance engagement, licit or illicit. The two issues relate to the lack of trust in the cannabis related knowledge of policy-makers. The findings of the cannabis use trends and motivations provide a conundrum that policy-makers in countries with punitive cannabis policies should consider.
Key words: Cannabis, motivations, cannabis policy, qualitative research