Blog from Club Health 2011 - Eurad

Monday 12th December 2011

The first day of the conference, opens with a presentation from Brigitte Luggin, Representative from the Czech Republic to the European Commission, who highlights the work of the European Commission to try and curb the age of first drug use, in order to bring about reductions. Importantly, Brigette refers to the current work of the European Commission in tackling new pscyhoactive drugs, sometimes refered to as legal highs, which leads on nicely to a presentation by Dr Fiona Measham, from Lancaster University, on mephedrone.

Fiona's presentation certainly poses some interesting questions, such as:

• At what point does a chemical become a drug?

• Why was the emergence of mephedrone not predicted earlier? (given the decrease in availability of MDMA and the reduction in purity of cocaine which both occured about the same time as mephedrone emerged)

• Does the emergence of new legal highs mean that there are real markets for them? (or should we be looking at other more popular drugs and what is happening to them to predict what will happen with legal highs?)

• Was there moral panic about mephedrone in the UK when it first emerged?

All interesting points but referring in particular to the last one, Fiona points out that moral panic would insinuate that there was an over-reaction and how could this even be assessed when the effects of mephedrone were completely unknown when it first emerged. As Fiona put it, do you drag your heels when you could be saving lives?

So did the legislation on mephedrone have an effect in the UK? It seems so..Fiona points to evidence showing reduced availability following the legislation in the UK. There also didn't seem to be any displacement to other legal highs, although she wanders whether we might see an increase in ecstasy in the future (no evidence for this one as yet it seems).

In terms of control policies, the following were discussed: blanket bans on chemically similar chemicals or those having a similar stimulant effect, temporary banning orders, trading standards legislation and education/harm reduction, though Fiona recognises the last one may pose problems due to the lack of information which may be available on the new drugs. One thing however, does seem to need to be addressed...in Fiona's research, availability for purchase on the internet seemed to be a key factor in influencing young people to use it, they found it quite convenient purchasing it online (although those underage without credit cards may have found it somewhat harder to get mephedrone through this route).

So, what are in these legal highs? The research Fiona alluded to, showed that out of 17 samples, only 1 sample contained the substance it claimed to be, so as Fiona put it with legal highs, we simply "don't know what we don't know". So how should they be treated? Fiona alluded to options like self-regulation that we are seeing in the alcohol industry (any ideas of how that one is going? I still haven't seen many health warnings on alcohol labels yet apart from France, but of course they have legislation for that related to pregnant women drinking alcohol). Others (including some of our affiliates) say that member states are behind in terms of addressing the issue of legal highs, with Ireland and England having already introduced measures to help to tackle legal highs.

The conference closed tonight with in some ways, quite an up-beat presentation from trendspotter/trendfollower Tom Palmaerts, from Trendwolves, Belgium, who drew reference to attitudnal changes in young people, where there appeared to be a greater desire for slowing down within a fast pace life (i.e. think of a quiet spot in a crowded cafe), recent penchant for blurred motion photography and a slowing down of music, even of electronic music.

As part of Tom's work, he has found that young people (perhaps unsurprisingly, given current political and economic conditions) are less optimistic this year about their own futures and that at the same time, role models are changing from rock stars to social entrepreneurs who have more of a social consciousness and to people who inspire social creativity. He also talks about the social nature of eating and changes in restaurant design, large shared tables, food cooked in front of us. In terms of food consumption, he talks about the growing desire for supporting good causes at the same time of consuming (think Starbucks, who are donating money to homeless meals at Christmas in London, so buy a drink and give at the same time) as well as a growing concern for quality (for alcohol use, he sees the emergence of more local breweries, an increase in cocktail mixologists) and for parties, he sees a growing inclination for partying but in a slow way...food raves, focus on quality, focus on exchange (clothes swap parties) etc...It's certainly an interesting idea but I'd like to know more about how this may impact on drug use...still with the recent report from the EMCDDA there are some positive signs about whether the cocaine buble has burst and whether cannabis may even be on the decline and there is, of course, something we should also remember, that the majority of young people do not use drugs. However, I still want to know more about this philosophy that Tom speaks of...will these attitudnal changes be seen across all social groups and especially those most affected by unemployment? I will certainly be following Tom's trendspotting from now on...

Tuesday 13th December 2011

Well, yesterday we heard about how we should look to the future to estimate how drug use will change in the future but today we are definitely getting the message not to forget the lessons of the past. This point was highlighted by Dr Chris Luke of the Cork University Hospital in Ireland, who suggested that we need to look closer to recent history for solutions to club health problems and not necessarily just the future.

During his talk, Chris pointed to his work as an emergency room doctor in Liverpool ten years ago when the club Cream in Liverpool was becoming a huge pull to dance-goers from all over Europe and where he could clearly see the personal consequences of drug use. Just like he did then, Chris advised that we need to look to our emergency rooms now to tell us what new drug trends are emerging and what their consequences are. So, on reflection to his work, what can Chris tell us about the current club scene? Well, as he says, “the health hazards associated with the club scene remain real and occasionally lethal” and he highlights the main hazards as cocaine (as well as other drugs such as mephedrone), crime and conflagration. At last year’s conference, Chris predicted that the internet would pose the greatest challenge to drug use in the club environment over the last year, so what does he predict for the coming year? Well…he tells us not to forget the growing globalisation of the western clubbing scene, as well as the global effect of drug use, something we at EURAD are very well aware of.

Mid-morning, some of the focus of the conference is on cocaine in particular, where a small-scale study, conducted by Kirstie Soar from the University of East London, shows that those who may (by some, not by us at EURAD) be classified as recreational cocaine users (defined by Kirstie as those engaged in full-time employment, intranasal ingestion and no more and use of no more than 10 occasions per month) still exhibited worrying psychological effects from their use (such as reduced inhibitory control, poorer learning, poorer attention functioning and poorer planning skills compared to non-users). The initial results of her research show exactly the problem of classifying users as ‘recreational’, when people who may be categorised like this still do experience consequences from their drug use and as Kirstie says in her presentation, any use has physical or psychological consequences and may also act as a gateway to other forms of ingestion.

As many EURAD affiliates recognise, drug use also needs to be seen as a continuum or on a scale and not just as separate episodes of unrelated drug use. We do hope to see more research from Kirstie in the future. Later on in the day we hear from Alex Bucheli, who without any hesitation defines recreational use as harmless use and it occurs to me that isn’t it interesting to see that those who deal and see the consequences of what Alex may call recreational use, take an entirely different view, (like Dr Chris Luke, who earlier in the day stated that drug use in the club scene is harmful and occasionally lethal). Although the presentations at this conference do not appear to be tackling the physical consequences of drug use in the club scene, there are some interesting presentations on the psychological consequences, so I look forward to the presentation tomorrow which will focus on psychological abnormalities associated with MDMA (ecstasy) use.

The next few presentations focus on online support services for cocaine users, for example, Snow Control and COCACHECK, during which, I can’t help but notice that both of these services are learning the same lessons that Stop Smoking Services learnt in the early days of their establishment in the UK over ten years ago (i.e. setting goal posts with users of services, dealing with drop out, what interventions are most effective). As Dr Chris Luke stated earlier in the day, when we are looking for solutions to drug use, let’s also look to history for our solutions and where there is evidence about what works in terms of treatment or behaviour change, let’s use it.

The day ends with a presentation from Karen Hughes of the Centre of Public Health in Liverpool, where they have developed a very useful free online assessment tool for cities and towns to use to help develop their night-time policies with all relevant stakeholders. NightSCOPE is a free resource which can be used for a city, town or other nightlife area. It involves the completion of an online questionnaire by representatives from a range of local agencies. Responses are brought together and analysed using a grading system to identify where structures are well developed and where they could be improved. Results are presented in report and a user manual provides advice on action that can be undertaken to strengthen practice.

To develop a NightSCOPE assessment for your town or city, click here.

Wednesday 14th December 2011

Today opened with a presentation on 'New Drugs, What's Coming Our Way?' by Jane Mounteney from the EMCDDA. Jane opened by describing the trends we have seen recently with some of the most widely used drugs. Notably, cocaine, which is used to a larger extent in a few European countries such as the UK, Ireland, Spain and Denmark, all saw declines of the use of the drug in 2010. Although Jane explains that cocaine is used "minimally" in other European Countries, she does emphasise that it is still the EU's most common illicit stimulant and there are still in the region of 1000 cocaine related deaths reported each year.

Cannabis, of course, is still the most used illicit drug across Europe, with the highest prevalence rates being seen in the UK, France, Italy, Spain and the Czech Republic. The strongest downward trend has been seen in the UK, which has dipped below the EU average rates for the first time. Encouragingly, it seems that the greatest decrease has been seen in the 16-24 age group. Whilst there are wide variations in cannabis use across Europe, one gender pattern remains noticeable, there are almost 3 times as many men than women, using cannabis on a daily basis.

So, in terms of new drugs, what can expect to see in 2012 and beyond? Well, according to today's presentation, the EMCDDA say to look out for:

• More interplay between the illicit and licit markets

• More derivatives of known drugs (like synthetic cocaine and cannabinoids)

• Potential interest in opiods and sedatives?

• Influx of cheaper drugs (perhaps as a result of recession)

• Potentially less recreational use (as a result of recession - some disagreement by delegates on this point)

• Less interventions to tackle drug use as recession hits public sector and healthcare budgets

This is followed by a session by Dr David Caldicott, Nevill Hall Hospital, Abergavenny, UK, who sets out what he has seen in the emergency room as a consequence of new patterns of drug use. Some of his main points are that:

1. People are presenting to emergency departments with a set of symptoms rather than the name of a drug

2. Problem that many drugs cause similar symptoms but different dosages of the same drug cause different symptoms

3. Dizzying array of products, or as David put it, "there are too many for us to keep up with at the minute"

4. Increased cases of haemorrhagic cystitis as a result of ketamine use and also from drugs which are being sold as 'bladder friendly' ketamine but which have the same effects

5. Coronary effects from cannabinoids from people who had no other health problem

In Wales, as part of David's work, they have established the Welsh Emergency Department Investigation of Novel Substances Group. The group have set to work getting a picture of what drug use is occuring in their local area. They have been working with people who present to the emergency department and ask them to share the product with them for testing, so that they can better identify the products and consequently how to deal with the people who present with the symptoms of their use.

Notably, they are also working on a project with ESBRITES.EU to help develop brief interventions for drug users in the emergency department environment.

David ends by saying that whilst 'new drugs' may not be as common as drugs such as cocaine or cannabis, the danger lies in the mutation rate and market of these new drugs and likens their development to a vacuum flask where evolution is occuring. Remember MPTP which caused Parkinsons? David says these are the sorts of things we need to keep a look out for and this comment really brings me back to one of the comments on the first day of the conference, where one speaker said we really don't know what we don't know about new drugs.

The afternoon session offers an interesting debate, akin to the chicken and the egg, on how preferences in music influence drug taking behaviours and whether drug taking begins as a result of integration or experimentation in the music scene or vice versa. The research, carried out by Tina Van Havere, from the University of Ghent, concluded that respondents who liked dance music were 2.47 times more likely to use illegal drugs, than those who didn't. Interestingly, she found the reverse for people who liked rock music, who were less likely to consume cocaine, amphetamines or ecstasy but this effect did not extend to alcohol or cannabis. So which is first, the music or the drugs? Well as Tina says, you need to include the effect of the identity development of the young people involved and how this gets linked to music and drugs.

The afternoon ends with a focus on the psychological abnormalities associated with MDMA use by Claus Vogele from the University of Luxembourg. He found that compared to other drug users in his study, those using MDMA were less psychologically well than those using other drugs in his study. The MDMA users scored higher on the severity index of depression scores but Claus went to great lengths to emphasise that these were not just scores on a questionnaire, the people studied were found to have actual psychological problems which required treatment. Claus' study, although small-scale, did bring up a very interesting methodological debate: in a world of increasing poly drug use, how can you tell that the use of one particular drug had that effect? In Claus' study, he analysed ecstasy users (who also used other drugs) against non-ecstasy users who did use other drugs. He found it necessary to compare with other drug users, rather than non-drug users. This problem will become one of the future, particularly, when looking at the longitudnal effects of drug use.

More information on Club Health, can be found here.